A 55-year-old male patient presents with decreased vision bilaterally. He also complains of itchy eyes and mucoid discharge. Past relevant medical history include a history of waxing and waning eczema over the past ten years. He denies any ocular pain, photophobia, or fever/chills. Surgical history was unremarkable. Visual acuity was 20/70 OD and 20/60 OS. His right and left eyes are shown below (A and B, respectively).
Which of the following is the most likely diagnosis?
A. Atopic Keratoconjunctivitis
B. Vernal keratoconjunctivitis
C. Seasonal allergic conjunctivitis
D. Giant papillary conjunctivitis
Correct Answer: A
Answer: This patient’s presentation of decreased vision, itching, mucoid discharge, and findings of chronic conjunctivitis, with a history of long-term eczema, are consistent with a diagnosis of atopic keratoconjunctivitis. Atopic keratoconjunctivitis is a chronic allergic conjunctivitis that occurs in patients with history of atopic dermatitis that usually appears between late puberty and the fifth decade of life. Atopic keratoconjunctivitis typically affects both eyes, with symptoms that waxes and wanes with no predilection to a particular season. The lack of seasonal correlation differentiates it from vernal keratoconjunctivitis (option B), which is typical in the spring-summer months, has an earlier age of onset (early teens) and the episodes are self-limiting and do not compromise vision. Seasonal allergic conjunctivitis (option C) is the most prevalent form of allergic conjunctivitis that is associated with watery rather than mucoid discharge, and is typically due to outdoor allergens like grass and pollens that is worse during spring through fall. Giant papillary conjunctivitis (option D) is an inflammatory disorder caused by chronic mechanical conjunctival stimulation seen in patients who are contact lens wearers or have exposed sutures in their ocular surface. It is not non-allergic in nature and typically resolves by avoiding the precipitating cause.
Source: Eyewiki, Iowa Eyerounds
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