Clinical features and diagnosis of adult atopic keratoconjunctivitis and the effect of treatment with sodium cromoglycate.

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Abstract
Seventeen cases of atopic keratoconjunctivitis in adults are described. In 8 cases, the clinical appearances were nonspecific and sufficiently different from vernal keratoconjunctivitis to make diagnosis difficult. These atypical cases often showed a fine papillary conjunctival reaction on the upper tarsus, subconjunctival scarring and in 1 case severe symblepharon. Corneal features included corneal microcysts, peripheral vascularization and various patterns of punctate epithelial keratitis. It was important to establish the atopic status of the patient. A personal or family history of other atopic disease was elicited in every case, and the diagnosis was confirmed by the detection of raised serum IgE level. Uncontrolled clinical assessment suggested that 10 of 15 patients experienced improvement in symptoms with the use of 2% sodium cromoglycate eyedrops 4 times a day. A subsequent double-masked cross-over trial comparing the same treatment with a matched placebo preparation indicated that 6 of 9 patients preferred sodium cromoglycate while one preferred the placebo. Two patients noted no difference. Cases showing nonspecific or atypical clinical features responded to treatment just as frequently as did cases of typical vernal keratoconjunctivitis.