Managing blepharokeratoconjunctivitis in children: a review

Abstract

Blepharokeratoconjunctivitis (BKC) in children has been under-recognized for a variety of reasons until now, as traditionally it has been considered an ‘adults’disease’ till date. It is however, an important cause of preventable and treatable visual morbidity in children. The exact etiology and pathogenesis of this condition is still unknown. We have performed a literature review using PubMed and the MeSH terms like blepharitis, blepharokeratoconjunctivitis, children, ocular rosacea and meibomian gland dysfunction. We have discussed all the major series on childhood BKC reported in the literature. The diagnosis and management of BKC in children is challenging. Detailed evaluation and a stepwise management protocol is essential to manage the disease at an earlier stage and to prevent the development of severe visual sequeale. Examination of affected children includes the assessment of visual acuity, refraction, thorough evaluation of the eyelids, the anterior tear meniscus, conjunctiva and cornea. Management comprises of conservative measures such as lid hygiene along with antibiotics and steroids depending upon the severity of the disease. Surgical treatment may be required in severe cases with corneal involvement. This review aims to discuss the clinical presentation of BKC in children, available treatment modalities and a preferred stepwise management algorithm.