Treatment for chronic severe bilateral blepharokeratoconjunctivitis
Reviewed by Fiona Rowe

This study evaluated the efficacy and safety of oral azithromycin treatment combined with topical antibiotics and anti-inflammatory agents in paediatric patients with chronic severe bilateral blepharokeratoconjunctivitis (BKC). The authors recruited 29 consecutive patients (58 eyes) with mean age at diagnosis of 6.51 ±3.08 years (range 2–14). There were 10 males and 19 females. Treatment dose was 5mg/kg daily, up to 10 weeks duration. Mean time of treatment was 5.87 ±1.92 weeks (range 4–10) and mean follow-up was 6.20 ±1.72 months (range 4–10). This treatment was tolerated well by patients and there were no significant side-effects. The most common clinical symptoms were redness, discharge and photophobia. All had active phlyctenular keratitis in at least one eye and diffuse posterior blepharitis in both eyes. Most signs and symptoms improved with treatment. There was no active disease in any eye at three-months follow-up and no recurrence during follow-up. Azithromycin is a dual-acting antibiotic agent with high intracellular penetration capability and long half-life. These results show this treatment to be effective and safe for management of paediatric chronic severe bilateral BKC. The authors acknowledge the lack of a control group and propose larger prospective studies.

Long-term, low-dose oral azithromycin treatment for chronic severe bilateral blepharokeratoconjunctivitis in pediatric patients.
Sari ES, Ozmen AT, Yildiz M.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2024;61(5):358–64.