Case Report of Restoration of the Corneal Epithelium in a Patient with Atopic Keratoconjunctivitis Resulting in Amelioration of Ocular Allergic Inflammation

Abstract

ABSTRACT: Background: Atopic and vernal keratoconjunctivitis are severe types of ocular allergic disease characterized not only by conjunctival inflammation but also by corneal involvement. In vitro studies have suggested that breakdown of corneal epithelial barrier function and subsequent activation of stromal fibroblasts may amplify ocular allergic inflammation.Case Summary: A 27-year-old man with atopic dermatitis developed atopic keratoconjunctivitis including corneal ulcer with plaque deposition in his right eye. Conjunctival inflammation in the right eye was resistant to topical steroid therapy. Surgical removal of corneal plaque and administration of autologous fibronectin eye-drops resulted not only in resurfacing of the corneal epithelium but also in amelioration of conjunctival inflammation. Discussion: This case suggests that loss of corneal epithelial integrity likely exacerbates conjunctival allergic inflammation and that restoration or maintenance of the barrier function of the corneal epithelium may be one of the important targets for the treatment of severe ocular allergic diseases. KEY WORDS: allergic inflammation, atopic keratoconjunctivitis, conjunctiva, corneal ulcer, epithelium