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Pediatric Blepharokeratoconjunctivitis (PBKC)
Definition
- from PBKC Study group, “Pediatric Blepharokeratoconjunctivis is an underdiagnosed, sight-threatening, chronic, and recurrent inflammatory ocular surface disease affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement ranging from superficial punctate keratitis (SPK) to corneal infiltrates with vascularization and scarring”
- Results in corneal leukoma, irregular astigmatism, corneal perforation and permanent vision loss.
- a.k.a. Staphylococcal blepharokeratoconjunctivitis, Ocular rosacea, Meibomitis- related keratoconjunctivitis, phlyctenular keratoconjunctivitis.
Risk Factors
- Poor hygiene
- History of Atopy
- Infestation with Demodex mites
- High levels of C.acnes bacteria in meibum cultures
Causes
- Presumed immunologic response to ocular surface antigens from bacteria (staphylococcus, cutibacterium, mycobacteria) or other agents or organisms (demodex)
Treatment
Bacteria
-
- PO 250-500 mg thrice weekly for 4-8 weeks (5-10 mg/kg)
- Topical: Azasite 1% ophthalmic solution most useful in maintenance of remission
- Erythromycin
- PO 250-500 mg QD or BID x 4-8 weeks
- Topical: 0.5% ointment, most helpful for maintaining remission
- Doxycycline in children over 8 with their adult teeth.
- Low dose: 40 mg QD or 20 mg BID x 4-8 weeks
- Regular dose: 100 mg QD x 4-8 weeks
Demodex
- Tea Tree Oil 50% eyelid scrubs daily
- Xdemvy drops (lotilaner ophthalmic solution 0.25%) BID x 6 weeks
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