Blepharokeratoconjunctivitis (BKC) is common in children, but testing for it isn’t so easy. In the past, making the diagnosis has been purely based on clinical appearance. Doctors have looked for a vague combination of lid margin irregularities and telangiesctasia, meibomian gland dysfunction, frequent chalazia, conjunctival hyperemia, inflammation and corneal scarring. Along with a lack of precise diagnostic techniques, treatment is often poorly targeted. London-based researchers are now saying that they may have cracked the case on this confounding conjunctival condition.

The team wanted to explore the potential of an automated conjunctival hyperemia quantification system that uses Oculus Keratograph 5M (Oculus) images (with and without the instillation of topical fluorescein), keratograph meibography of the upper and lower lids and anterior segment optical coherence tomography (AS-OCT) imaging in conjunction with questionnaires specifically designed for children in an effort to standardize this ambiguous malady’s diagnosis.

The team looked at 63 children, 31 with BKC and 32 without ocular surface inflammation. The children indicated discomfort during imaging on a five-point Smiley Face Likert scale. The subjects also completed a nine-item Children’s Health Utility 9D questionnaire. The median Likert scale value was 0, or “comfortable,” in healthy subjects and 1, or “a little bit uncomfortable,” in those with BKC. The researchers say that this shows that keratograph imaging is well-tolerated by children, even those with mild to moderated BKC. Furthermore, the automated system was able to distinguish between subjects with BKC and those without ocular surface inflammation. This research could potentially open the door to an objective standard in diagnosing BKC quickly and without much patient discomfort.

Al-Hayouti H, Daniel M, Hingorani M, et al. Automated ocular surface image analysis and health-related quality of life utility tool to measure blepharokeratoconjunctivitis activity in children. Cornea. June 2019. [Epub ahead of print].