Atopic keratoconjunctivitis

Dermot was a fifteen-year-old schoolboy with several years of itchy, watering eyes. He also had a history of rhinitis and asthma. His eyes remained itchy in spite of anti-allergy eye drops and antihistamine tablets. His only relief came about by vigorously rubbing the eyes. His action was quite classical: he would press his curled index finger over his closed eye, and rub in a circular motion. And I mean rub! The eye surgeon diagnosed atopic keratoconjunctivitis with corneal deformity. His cornea had lost its nice smooth dome-shaped appearance, and looked more like the oval end of a rugby ball! We call this conical deformity 'keratoconus'. Dermot now needed a corneal graft (and here's one more good reason to sign your donor card!); without a healthy cornea from a donor eye, he would go blind. But how would a graft survive all this rubbing? The eye surgeon referred him to the Allergy Clinic for help with the allergic aspects of his disease. From the history, we suspected that certain airborne allergens were making him worse: house dust, animal danders, feathers and grass pollen all made his eye intensely itchy. He also noticed that perfumes, and the like, could aggravate his symptoms. Having confirmed his allergies by skin tests, we started him on a course of desensitisation. He has had four injections over the past eight months and his symptom are much better controlled. Specifically, the itch and the rubbing have ceased, and the surgeon is now ready to proceed with the graft.



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