Severe Blepharokeratoconjunctivitis in Children—The Toronto Experience
Bibliographic record
Abstract
PURPOSE: To report on the clinical characteristics and treatment outcomes of a large cohort of pediatric patients who presented with severe blepharokeratoconjunctivitis (BKC). DESIGN: Retrospective consecutive cohort study. SUBJECTS: Patients aged under 18 years with BKC presented to the Cornea Service at the Hospital for Sick Children, Toronto, Canada, between 2006 and 2021. METHODS: Children with severe BKC, defined as BKC with inflammation, new vessel formation, scarring, thinning, and lipid deposits affecting the peripheral and/or central cornea, and a follow-up of at least 6 months were included. Basic demographics, best corrected visual acuity (BCVA), refractive error, disease laterality, type and duration of antibiotic therapy, flare-up rate, and extent of corneal involvement were analyzed. MAIN OUTCOME MEASURES: BCVA, refraction, extent of corneal involvement, procedures, flare-up of BKC, and time to flare-up rate after cessation of systemic antibiotics treatment. RESULTS: Out of 2542 patients with blepharitis, 197 patients (315 eyes) were identified with severe BKC. The mean age at the first presentation was 7.6 years, with a 2:1 female predominance. At the presentation, 65% had a history of chalazion, and 28% had BCVA worse than 0.3 logMAR, which improved to 17% at final follow-up (P = .007). The most striking corneal pathologies affecting the peripheral and central cornea were scarring (83%) and new vessel formation (49%). One hundred forty-two patients (72%) required systemic antibiotics (azithromycin, clarithromycin, erythromycin, or doxycycline), of whom 23% experienced flare-ups requiring an escalation in treatment with topical steroids and/or systemic antibiotics, and 75% of these occurred within the first year of treatment cessation. Ninety-one percent of patients achieved complete response, defined as no disease activity and no use of topical steroids or systemic antibiotic treatment. Fifteen patients required surgical intervention. CONCLUSIONS: BKC is a serious disease in children, potentially causing irreversible ocular morbidity and vision loss. Central scarring and astigmatism can affect vision in a significant proportion of children. Therefore, early identification and treatment are necessary to reduce disease morbidity. Close follow-up is crucial as one in four patients may experience a flare-up, especially within the first year of treatment cessation. Most patients with severe BKC require both topical steroids and systemic antibiotics to control disease activity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".