Jones Sophie M, Weinstein Joel M, Cumberland Phillippa, Klein N, Nischal Ken K
Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.
Ophthalmology. 2007 Dec;114(12):2271-80. doi: 10.1016/j.ophtha.2007.01.021.
To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children.
Noncomparative, interventional, retrospective case series.
Twenty-seven children with BKC.
Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy.
Corneal and eyelid status, visual acuity (VA), and refractive error at final examination.
Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom onset and treatment resulted, on average, in a reduction of 0.06 logMAR units of VA (95% confidence interval, 0.00-0.12; P = 0.054).
These findings suggest that visual loss may be significant in BKC and that delayed treatment may result in decreased final BCVA. Adequate management needs both topical and systemic treatment. Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics.
描述儿童慢性睑缘角膜结膜炎（BKC）的病因、治疗及对角膜和视功能的影响。
非对照、干预性、回顾性病例系列研究。
27例BKC患儿。
记录患儿就诊时的年龄、最佳矫正视力（BCVA）、屈光不正情况以及任何角膜或眼睑的病理特征。治疗包括改良眼睑卫生护理、局部使用抗生素和类固醇。全身治疗包括口服抗生素，从2003年起，使用亚麻籽油替代长期抗生素。弱视治疗包括屈光矫正、遮盖或阿托品治疗。
最终检查时的角膜和眼睑状况、视力（VA）及屈光不正情况。
就诊时平均年龄为6.9岁（范围7个月至15.9岁），平均随访时间为2.3年（范围5个月至6.1年）。所有患者就诊时均有不适、结膜充血及睑缘炎后部体征。14例患者（52%）有畏光症状，6例（22%）有眼睑前部炎症。3例患者（11%）确诊为酒渣鼻。44只眼（81%）出现角膜受累，18例患者（67%）有睑板腺囊肿复发史。患眼单眼BCVA中位数在就诊时为0.28最小分辨角对数（logMAR）单位（四分位间距[IqR]，0.02 - 0.40），末次随访时为0.02 logMAR单位（IqR，0.00 - 0.18）。70%的患眼最佳矫正视力提高，30%保持不变。15例患者（48%）存在并接受了叠加性弱视治疗。最终检查时未达到0.2 logMAR单位或更好视力的8例患者（20%）就诊时均为双眼角膜受累。1例儿童口服抗生素出现全身副作用。局部治疗无儿童出现明显副作用。12例患者（44%）在逐渐减量治疗方案中使用了亚麻籽油。症状出现与治疗之间平均间隔2年导致VA平均降低0.06 logMAR单位（95%置信区间，0.00 - 0.12；P = 0.054）。
这些发现表明BKC可能导致明显视力丧失，延迟治疗可能导致最终BCVA下降。充分的治疗需要局部和全身治疗。亚麻籽油可能是一种有效的抗炎营养疗法，可替代长期抗生素。
