Atopic Keratoconjunctivitis (AKC)

What Is Atopic Keratoconjunctivitis?

Atopic keratoconjunctivitis (AKC) is the result of a condition called "atopy". Atopy is a genetic condition where your immune system produces higher than normal antibodies in response to a given allergen.  Although AKC is a perennial (year round) disease, your symptoms may worsen in the winter. Unlike atopic dermatitis, which is generally seen early in childhood, atopic keratoconjunctivitis appears during late adolescence and early adulthood. Men are more commonly affected than women.

With AKC, the conjunctiva lining the eyelids is usually red and swollen. The lower eyelid generally is affected more than the upper eyelid. This is a differentiating symptom from vernal keratoconjunctivitis where the upper eyelid is most often affected. If left untreated, AKC can progress to ulceration, scarring, cataract, keratoconus, and corneal vascularization.


  • Sensitivity to light
  • Itching
  • Burning
  • Tearing
  • Red and hardened eyelids

The symptoms described above may not necessarily mean that you have atopic keratoconjunctivitis. However, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam.


AKC is a genetic condition.

Risk Factors

  • A family history of multiple allergies
  • Atopic dermatitis
  • Eczema
  • Asthma

Tests and Diagnosis

AKC usually is diagnosed by clinical exam and a medical and family history, although a conjunctival biopsy may be helpful in distinguishing AKC from other conditions.

Treatment and Drugs

Combinations of oral and topical antihistamines and mast cell stabilizers usually are effective in controlling symptoms. In more severe cases, there is potential for damage to the eye caused by scratching and rubbing. A ophthalmologist may advise you to wear cotton gloves at night to prevent unintentional damage to the ocular surface. Cold compresses and saline irrigation to lower the elevated tear pH also may be helpful. Only in severe cases should topical steroid therapy be considered. Other steroid-sparing agents may be helpful, including cyclosporine or tacrolimus. Systemic treatment of the conditions that accompany AKC may be very helpful. 

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Reviewed by Jill E. Bixler, M.D.