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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- predisposition to produce IgE in response to common allergens
- 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
- Erythromycin
- Topical: 0.5% ointment, most helpful for maintaining remission
Demodex
- Tea Tree Oil 50% eyelid scrubs daily
- Xdemvy drops (lotilaner ophthalmic solution 0.25%) BID x 6 weeks
- Send to BlinkRx Phone: 1-833-919-4942 Fax: 1-866-585-4631 12639 W Explorer Dr, Suite 100 Boise, ID 83713 NPI #: 1891461885
Meibomian Gland Dysfunction
- Flaxseed oil- 1 Tsp/day = about 1800 ALA, or 2 capsule about 720 ALA/capsule
- Azithromycin (preferred over erythromycin—better bioavailability, longer half-life, higher tissue concentration)
- 5 mg/kg daily for 2 months
- Pulsed/cyclic 5-7 day course, one week on 3 week off
- Monitor for GI upset and QT prolongation.
- Topical: Azasite 1% ophthalmic solution most useful in maintenance of remission
- Doxycycline only 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