Editor’s Note
Blepharokeratoconjunctivitis (BKC) refers to a series of conjunctival and corneal lesions secondary to blepharitis. Studies show that 50.7% of blepharitis patients have associated conjunctival lesions, and most present with chronic lesions of the conjunctiva and cornea. Recurrent episodes of BKC can lead to irreversible visual impairment, and in severe cases, corneal thinning or perforation may occur. Currently, there are no unified diagnostic standards or treatment guidelines for BKC. To enhance the understanding of BKC among ophthalmologists and standardize the diagnosis and treatment of this condition, a handbook titled “Diagnosis and Treatment of BKC,” co-edited by Academician Xie Lixin, Professor Hong Jing, and Professor Sun Xuguang, will soon be available to ophthalmologists. The International Ophthalmology Bulletin is honored to invite Professors Hong Jing and Sun Xuguang for an interview to provide a detailed introduction to the handbook and share their experiences in the diagnosis and treatment of BKC. We believe that the “Diagnosis and Treatment of BKC” handbook will provide valuable guidance for clinical ophthalmologists.
Professor Hong Jing
1Background of the Writing of the Handbook
Blepharokeratoconjunctivitis (BKC) is a common clinical condition, but due to a lack of understanding of BKC in the past, misdiagnosis is quite common in clinical practice. In recent years, the concept of BKC has been proposed and gradually recognized, but there are still no unified standards and guidelines for the diagnosis and treatment of BKC. Professor Hong Jing mentioned that because of this reason, she and Professor Sun Xuguang wrote the “Diagnosis and Treatment of BKC” handbook, which was reviewed by Academician Xie Lixin who also wrote the preface. This handbook succinctly summarizes the etiology, pathogenesis, clinical manifestations, treatment, and prevention of BKC based on relevant domestic and international literature, aiming to help clinicians in grassroots hospitals better understand BKC, thus reducing misdiagnosis in clinical practice.
2Graded Treatment of BKC
Professor Hong Jing discussed that BKC can be classified based on the time of onset into early acute phase, mid-progressive phase, and late scar phase; and based on the depth and extent of the lesions, it can be divided into mild, moderate, and severe. This staging and grading is very important for clinicians in grassroots hospitals. Corresponding treatment plans should be given based on the etiology, staging, and grading: mild cases focus on physical therapy and health care, moderate cases require the addition of antibacterial and anti-inflammatory medications, and severe cases may require systemic medication. The handbook provides clear staging and grading along with corresponding treatment strategies, which is very instructive for clinicians.
3Treatment of Moderate to Severe BKC
Professor Hong Jing introduced that the onset of BKC is influenced by multiple factors: firstly, lesions of the eyelid margin cause mechanical damage, and secondly, blepharitis often combines with bacterial and microbial infections. Both of these factors can lead to local inflammatory changes, resulting in the release of inflammatory mediators around the ocular surface, ultimately leading to corneal lesions. Tobramycin-dexamethasone (Dexa-Tobramycin®) contains both antibiotic and anti-inflammatory steroid components, effectively targeting the causes and mechanisms of BKC. For the treatment of BKC, especially in moderate to severe cases, the use of tobramycin-dexamethasone eye drops and ointment (Dexa-Tobramycin®) is particularly recommended. For eyelid margin lesions, eye drops cannot act effectively on the local area for a long time, while the ointment can both remain at the lesion site for an extended period and release slowly. Therefore, for moderate to severe blepharitis, it is recommended to apply tobramycin-dexamethasone ointment (Dexa-Tobramycin®) to the eyelid margin twice daily for two weeks. For moderate to severe BKC, tobramycin-dexamethasone eye drops can also be added twice daily for two weeks, and after two weeks, the eyelid performance and changes in BKC should be assessed, along with monitoring intraocular pressure. If symptoms improve, it is recommended to switch to a weaker steroid.
Additionally, a multicenter clinical observation by Professor Hong Jing and others on blepharitis and BKC showed that the efficacy of tobramycin-dexamethasone in treating BKC is very good, capable of controlling inflammatory responses in a short time and significantly alleviating ocular symptoms. This provides important information and evidence for clinicians, recommending the use of tobramycin-dexamethasone in the early treatment of moderate to severe blepharitis and BKC patients.
Professor Sun Xuguang
1Correct Understanding of BKC
As the chief editor of the “Diagnosis and Treatment of BKC”, Professor Sun Xuguang mentioned that the concept of BKC has been recognized by many doctors through academic exchanges in recent years. Clinically, BKC is a very important but often overlooked disease in the diagnosis of corneal diseases. In the past, we have paid great attention to the causes of infectious and immune corneal diseases, but the conjunctival lesions caused by blepharitis are often neglected. Some doctors treat it as viral keratitis, leading to delays in treatment. Therefore, understanding this disease and its etiology is very helpful for timely and accurate diagnosis and treatment of corneal lesions, reducing corneal blindness.
2BKC Etiology and Pathogenesis
The main cause of BKC is blepharitis. Blepharitis is an inflammation of the eyelid margin, which can be classified into infectious and non-infectious based on its etiology. Among the infectious causes, bacteria and Demodex mites are the most concerning. Among the non-infectious causes, MGD (Meibomian Gland Dysfunction) is the most significant. Based on these two main causes, blepharitis can be divided into infectious and non-infectious blepharitis, both of which can lead to conjunctival lesions. Bacteria, as the primary cause of infectious blepharitis, need to be considered first in clinical practice. Bacteria have two roles: they can directly invade and damage tissues, and they can also break down lipids and produce toxic metabolic products, leading to the production of inflammatory factors. Therefore, treatment requires not only antibacterial therapy but also anti-inflammatory therapy.
3BKC Diagnostic Criteria
Professor Sun mentioned that the “Diagnosis and Treatment of BKC” handbook and the already published “Blepharitis and Meibomian Gland Dysfunction” both mention the diagnostic criteria for BKC. The primary condition for diagnosing BKC is a clear diagnosis of blepharitis. The diagnostic criteria for BKC include the presence of blepharitis and typical conjunctival lesions, including recurrent papillary conjunctivitis or keratoconjunctivitis, bilateral follicular conjunctivitis, peripheral corneal infiltration or epithelial lesions, and superficial neovascularization. After the corneal or conjunctival lesions appear, combined with the diagnosis of blepharitis, BKC can be diagnosed. Additionally, Professor Sun shared the clinical characteristics of BKC: first, BKC usually occurs bilaterally; second, corneal lesions often begin from the peripheral lower cornea; third, corneal lesions are often accompanied by superficial neovascularization of the cornea.
4BKC Treatment Principles
Professor Sun emphasized that an important principle in the treatment of BKC is that both blepharitis and conjunctival lesions must be treated simultaneously, not just one of them. Second, the treatment duration for blepharitis must be sufficient, lasting 2 to 3 months or more. If the treatment method is correct, the conjunctival lesions of BKC patients usually recover within one month, but the blepharitis requires more than 2 to 3 months to recover; if the treatment duration is insufficient and the inflammation of the eyelid margin is not controlled, it will lead to prolonged and recurrent lesions. Professor Sun shared that in the drug treatment of BKC, both anti-inflammatory and antibacterial aspects are included. Tobramycin-dexamethasone contains an antibiotic and a steroid, providing strong anti-inflammatory and bactericidal effects, quickly controlling inflammation and reducing bacterial load. In the treatment of BKC, tobramycin-dexamethasone (Dexa-Tobramycin®) ointment is mainly used for moderate to severe blepharitis treatment. The use of tobramycin-dexamethasone (Dexa-Tobramycin®) ointment during the first and second weeks of treatment for moderate to severe blepharitis shows very significant effects. For moderate to severe BKC, tobramycin-dexamethasone (Dexa-Tobramycin®) eye drops can be used early, and the ointment can be applied at night.
(Source: The International Ophthalmology Bulletin Editorial Department)
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