Atopic Keratoconjunctivitis Symptoms

Atopic keratoconjunctivitis (AKC) is a severe form of eye allergy that can involve the cornea of the eye, as well as the eyelids and conjunctiva. AKC usually affects young adults starting in the late teens to early twenties and can persist for decades.

The majority of people with AKC also have atopic dermatitis, allergic rhinitis, and/or asthma. Severe AKC can lead to complications including cataracts, eye infections, and blindness.

Keraconjunctivitis epidermica

Marco Mayer / Wikimedia Commons


The symptoms of AKC are initially similar to those of allergic conjunctivitis but tend to be much more severe. Symptoms include:

  • Light sensitivity
  • Blurred vision
  • A thick, stringy discharge

AKC is frequently associated with involvement of atopic dermatitis on the eyelids and the skin around the eyes and face. The inner lining of the eyelids and conjunctiva can appear red and swollen and may develop papillae (thickened bumps). Papillae are most frequently found under the lower lid in AKC.

Symptoms of AKC are typically year-round but you may notice seasonal worsening. Triggers can include animal dander, dust mites, and mold spores.


People with AKC are also at increased risk for eye infections, including certain bacterial and herpes infections.

Because AKC can affect the cornea, cataracts, and scarring can develop—potentially causing vision loss or blindness.


You should see your primary physician if you develop eye problems. You may need to see an ophthalmologist or an optometrist during your diagnostic evaluation.

AKC is diagnosed in much the same way as allergic conjunctivitis, although the presence of more severe symptoms and the presence of atopic dermatitis on the face are suggestive of a more severe disease process.


Your treatment may be prescribed by your primary care physician or an eye specialist.

The initial treatment of AKC is similar to the treatment of atopic conjunctivitis; an eye drop with antihistamine and mast-cell stabilizing agent is prescribed. If this does not suffice, a topical corticosteroid for the eye may be prescribed by an ophthalmologist.

You should be monitored by an ophthalmologist or optometrist when you use steroid eye drops for any prolonged period of time, as these medications can also lead to severe side effects (such as glaucoma and cataracts).

Immunotherapy in the form of allergy shots can be very effective in the treatment of atopic conjunctivitis and some cases of AKC. Allergy shots are injections of the allergens that a person is allergic to. They work by changing the body's immune response so allergic symptoms won't develop. The end result is fewer allergy symptoms and a decreased need for allergy medications. The benefits of immunotherapy can last for many years even after the injections are completed, provided that the person receives a minimum of three to five years of injections.

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  • Bielory L. Allergic and Immunologic Disorders of the Eye. Part II: Ocular Allergy. J Allergy Clin Immunol. 2000; 106:1019-32.
  • Ono SJ, Abelson MB. Allergic conjunctivitis: Update on pathophysiology and prospects for future treatment. J Allergy Clin Immunol. 2005; 115:118-22.

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.