Pediatric blepharokeratoconjunctivitis: review of epidemiology, pathophysiology, and current treatments.

Abstract

Purpose of review: This review aims to provide a comprehensive overview of the epidemiology and clinical features of pediatric blepharokeratoconjunctivitis (BKC), with a focus on elucidating the underlying pathophysiology and evaluating new therapeutic strategies.

Recent findings: Ongoing research continues to refine the management of pediatric BKC. Recent evidence suggests that disease remission can be achieved in approximately 95% of cases through an integrated approach involving topical or systemic antibiotics, corticosteroids, topical immunosuppressants, and lid hygiene. Notably, a significant advancement in the treatment of Demodex blepharitis is the FDA approval of 0.25% lotilaner ophthalmic solution, which has demonstrated safety and efficacy with twice-daily application over six weeks.

Summary: Pediatric blepharokeratoconjunctivitis is a chronic inflammatory condition affecting the eyelids, conjunctiva, and cornea. It is underdiagnosed and associated with significant vision-threatening complications. While there is no established consensus on the most effective therapeutic strategy, management currently includes lid hygiene, topical/systemic antibiotics, corticosteroids, immunosuppressants, lubricants, and dietary supplements. Challenges arise from its chronicity, recurrence, and lack of standardized treatment protocols. This underscores the importance of early diagnosis, education, and continued research on treatment methods to prevent severe outcomes.