Pharmacotherapeutic management of atopic keratoconjunctivitis

ABSTRACT

Introduction

Atopic keratoconjunctivitis (AKC) is a form of allergic eye disease that can have sight threating implications. Prevalence is underestimated due to scarce published data and treatment is expanding as a result of limitations of current strategies. This article aims to provide an up-to-date overview of AKC and summarize current and upcoming management.

Areas covered

The authors provide history, immunopathogenesis, and summary of the clinical manifestations of AKC as well as presenting a review of the evidence in relation to treatment options including mast cell stabilizers, antihistamines, corticosteroids, and immunomodulatory drugs based on clinical trials. Future trends, drug targets, and novel delivery drug systems are also highlighted in this review.

Expert opinion

Previously established treatment strategies of AKC had relied on corticosteroids, but the side effects of long-term therapy resulted in the expansion into the use of immunomodulatory drugs such as tacrolimus and ciclosporin. However, these too provide limited success due to the suboptimal structural properties of the current molecules. The ideal molecule should generate maximum permeability across the multi-layered structure of the cornea, be able to be formulated into eye drops for ease of application with minimal dosing and for maximal clinical effect.

KEYWORDS:

• Allergic eye disease
• allergy
• antihistamine
• atopic keratoconjunctivitis
• ciclosporin
• corticosteroid
• mast cell stabilizer
• tacrolimus

Article highlights

• Atopic keratoconjunctivitis (AKC) is the most severe manifestation of allergic eye disease.

• It is a combination of Type I and Type IV hypersensitivity reaction.

• It is a bilateral condition and is always associated with systemic atopic conditions including but not exclusively atopic dermatitis.

• Sight threatening implications of AKC include corneal ulceration pannus formation, corneal neovascularisation, and visual loss.

• AKC is largely a clinical diagnosis and the goals of treatment are aimed at symptom relief, reducing exacerbations and maintaining remission.

• There is a general stepwise algorithm that utilizes both topical and systemic treatment including mast cell stabilizers, antihistamines, steroid, and steroid-sparing agents.

• Current treatments are limited due to efficacy and side effects, future trends are focussing on alternate targets such as signaling molecules and novel drug delivery systems.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.