CORNEAL EPITHELIUM REMODELLING AFTER EYE RUBBING DISCONTINUATION IN PEDIATRIC ALLERGIC PATIENTS

To evaluate the effect of eye rubbing discontinuation on the epithelial thickness profile by spectral-domain AS-OCT (anterior segment optical coherence tomography) in allergic children with no tomographic sign of corneal ectasia.

ULSAS | Hospital Garcia de Orta

Right-handed boys (average age 11.2 years, 8-12 years) with history of eye rubbing and relatively normal Pentacam (Oculus; Wetzlar, Germany) exams were recruited for the study. Patients were evaluated using AS-OCT (Zeiss Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA) at the baseline and after 8 weeks of treatment. Treatment included education to avoid eye rubbing and preservative free 0.25mg/mL topical ketotifen. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared with paired non-parametric Wilcoxon (signed-ranked) test.  A p-value lower than 0.05 was considered for statistical significance.

Twenty-five boys completed the protocol. No eyes had tomographic criteria for keratoconus (Belin-Ambrosio Deviation Value < 1.22). Minimum epithelial location moved from the inferotemporal to superotemporal octant after treatment. The differences between minimum and maximum epithelial thickness (-2.8µm vs. -5.2 µm; p<0.01) and between nasal and temporal octants (N-T) (3.1µm vs. 1.4µm; p<0.01) were higher at the baseline. The difference between inferior and superior (I-S) octants (1.1µm vs. 2.7µm; p<0.01) was lower at the baseline.

AS-OCT analyses reveal epithelial remodeling after allergy treatment and eye rubbing discontinuation, with marked inferotemporal thickening. The importance of educating against eye rubbing and treating allergy should consider its importance on corneal epithelial remodeling. Further studies should include patients with corneal ectatic conditions and to explore other clinical measurements such as biomechanical assessment.