A group of researchers used the Delphi consensus method to develop a pragmatic treatment algorithm to assist in the management of blepharokeratoconjunctivitis in children, based on published evidence and clinical experience.
Four senior clinicians experienced in the management of pediatric external eye disease took part in a four-round survey based on electronically delivered questionnaires. Disease severity, treatment choices, and indications and dosages of treatment modalities were investigated.
The consensus approach showed that all four specialists target treatment to specific signs in the three tissues affected by blepharokeratoconjunctivitis, namely the eyelids, the conjunctiva and the cornea.
There was substantial agreement on the use of topical steroids, topical antibiotics and cyclosporine as a steroid-sparing alternative. Systemic antibiotics were the common first-line choice in active blepharitis, recurrent chalazia and active keratitis. All responders agreed that systemic immunosuppression should be limited to extreme cases. Conversely, there was lack of agreement on the use of alternative treatment options with a weak evidence base. These included diet, eyelid hygiene and the use of lubricants. Concern was often expressed in relation to compliance, with both systemic and topical treatments.
The authors said that involving only four experts, all practicing at the same institution, was a limitation to their work and that a broader basis for the consensus is needed. They pointed out, however, that their institution is “one of the largest children’s eye care facilities in the world and a tertiary referral center, with several hundred children with blepharokeratoconjunctivitis attending ... every year.” They felt therefore “ideally placed to begin the consensus process locally.” – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.