Two Cases With Keratoconus Presenting Steepening According To The Exacerbation Of Severe Allergic Eye Diseases
Published 2025
- 43rd Congress of the ESCRS
Reference: PO149
| Type: Case Report
| DOI:
10.82333/329f-b475
Authors:
Naoko Kato* 1
, Seika Den 2
, Emiko Miki 1
, Teruki Fukumoto 1
, Ikuko Toda 1
1Minamiaoyama Eye Clinic,Tokyo,Japan, 2Minamiaoyama Eye Clinic,Tokyo,Japan;Ophthalmology,The Jikei University School of Medicine,Tokyo,Japan
Purpose
The association between keratoconus and allergic eye diseases seems to be controversial. However, vernal keratoconjunctivitis has been suspected to be associated with the severity of keratoconus. Both frequent eye rubbing due to itching and the increase secretion of inflammatory proteins, such chemokines or cytokines, and matrix metalloproteinases, are suspected as a causative factor of exacerbation of keratoconus. We report two cases of keratoconus showing an increase in the severity according to the exacerbation of severe allergic eye diseases and improving topographical parameters after intensive treatment for allergic conjunctivitis/blepharitis.
Setting
Minamiaoyama Eye Clinic, Tokyo, Japan.
Report of case
Case 1 was a 19-year-old boy with atopic dermatitis. Both of his eyes revealed keratoconus with severe atopic blepharitis and moderate keratoconjunctivitis. The corneal tomography revealed a keratoconus pattern in both eyes, and Ks was 74.3D, Kmax 105.5D, and thinnest corneal thickness (TCT) 343 µm, OD. We treated him with tacrolimus ointment and eye drops. Fifteen months later, his blepharitis and conjunctivitis improved, and no inflammation was observed. The Ks and Kmax reduced to 68.8D and 92D, respectively. Case 2 was a 23-year-old male with severe atopic dermatitis and keratoconus in both of his eyes. He had had corneal crosslinking twice on his right eye, the most recent of which was in May 2020. Just before the 2nd CXL, Ks was 52.4D and TCT was 457 µm, OD. His left eye revealed advanced keratoconus with Ks 68.1D and TCT 276 µm. In April 2022, his atopic blepharitis worsened. The Ks was 54.5D, and Kmax 64.3D, OD. We prescribed the ophthalmic ointment with Prednisolone Acetate and 0.1% fluorometholone eye drops. However, his blepharitis worsened, and he rubbed his eyes. An acute hydrops occurred on his left eye in February 2023. His conjunctivitis showed exacerbation, and we prescribed the topical tacrolimus eye drop. Starting October 2023, we prescribed Dupilumab. His right eye showed Ks 55.1D, Kmax 63.4D in November 2023, however, after that his blephaloconjunctivitis improved dramatically, and his Ks reduced to 53.0D, Kmax 60.3D in April 2024.
Conclusion/Take home message
The topographical parameters of keratoconus can show the progression associated with the exacerbation of allergic keratoconjunctivitis/blepharitis. These findings may be caused by the thickened eyelid and conjunctival tissues or increased inflammatory proteins from allergic conjunctivitis. Patients with keratoconus associated with active inflammatory allergic conjunctivitis should be treated intensively first, and the progression should be determined only after the inflammation subsides.