What Is the Treatment of Atopic Keratoconjunctivitis During Acute Exacerbations?

Atopic keratoconjunctivitis can produce acute exacerbations with severe symptoms and signs that require timely topical intervention. This protocol addresses the evidence-based approach for managing these flares.

Clinical Scenario

Acute exacerbation of atopic keratoconjunctivitis presenting with severe symptoms and signs necessitating active topical treatment to achieve symptom and sign control.

Treatment Approach

Management centres on topical anti-inflammatory therapy to control severe symptoms and signs during the acute phase. An additional topical agent may be incorporated into the regimen, with the potential to reduce corticosteroid reliance over time.

Full agent selection, sequencing, and any steroid-sparing strategy are detailed in the complete structured protocol below.

Clinical Goals

The primary target is a meaningful reduction in signs and symptoms within a defined treatment window, with the aim of achieving durable control.

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References

For acute exacerbations of vernal/atopic conjunctivitis, topical corticosteroids are usually necessary to control severe symptoms and signs.
Topical cyclosporine 2% has demonstrated a reduction in signs and symptoms compared with placebo after two weeks of use in patients with VKC.
Commercially available 0.05% topical cyclosporine has also been shown to be effective in more frequent dosing for the treatment of severe vernal/atopic conjunctivitis [I+, Good, Strong] and it has been shown to be effective in preventing seasonal recurrences.
Use of cyclosporine may allow for reduced use of topical steroids.

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