Vernal keratoconjunctivitis - Revision history

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			{{SI}}
			{{Infobox medical condition
			\| name = Vernal keratoconjunctivitis
			\| image = [[File:Vernal.jpg\|alt=Vernal keratoconjunctivitis\|upright=1.2]]
			\| caption = Eye with vernal keratoconjunctivitis
			\| field = [[Ophthalmology]]
			\| synonyms = Spring catarrh, warm weather conjunctivitis
			\| symptoms = [[Itching]], [[redness]], [[tearing]], [[photophobia]], [[discharge]]
			\| complications = [[Corneal ulcer]], [[vision loss]]
			\| onset = Typically in [[childhood]]
			\| duration = [[Chronic condition\|Chronic]], often resolves after [[puberty]]
			\| causes = [[Allergy\|Allergic reaction]]
			\| risks = [[Atopy]], [[family history]]
			\| diagnosis = [[Clinical diagnosis]], [[slit lamp examination]]
			\| differential = [[Atopic keratoconjunctivitis]], [[giant papillary conjunctivitis]], [[allergic conjunctivitis]]
			\| treatment = [[Antihistamines]], [[mast cell stabilizers]], [[topical corticosteroids]]
			\| frequency = More common in [[tropical]] and [[subtropical]] regions
			}}
	{{Short description\|A chronic allergic eye disease}}		{{Short description\|A chronic allergic eye disease}}
	~~{{Use dmy dates\|date=October 2023}}~~

	~~==Vernal Keratoconjunctivitis==~~
	~~[[File:Vernal.jpg\|thumb\|right\|A patient with vernal keratoconjunctivitis showing characteristic symptoms.]]~~
	'''Vernal keratoconjunctivitis''' (VKC) is a chronic, bilateral inflammation of the conjunctiva and cornea. It is a form of [[allergic conjunctivitis]] that primarily affects children and young adults, particularly males, and is more prevalent in warm, dry climates.		'''Vernal keratoconjunctivitis''' (VKC) is a chronic, bilateral inflammation of the conjunctiva and cornea. It is a form of [[allergic conjunctivitis]] that primarily affects children and young adults, particularly males, and is more prevalent in warm, dry climates.

	==Signs and Symptoms==		==Signs and Symptoms==
	VKC is characterized by intense [[itching]], [[photophobia]], [[tearing]], and a thick, ropy [[discharge]]. Patients often experience a burning sensation and a feeling of a foreign body in the eye. The condition is typically seasonal, with exacerbations in the spring and summer months.		VKC is characterized by intense [[itching]], [[photophobia]], [[tearing]], and a thick, ropy [[discharge]]. Patients often experience a burning sensation and a feeling of a foreign body in the eye. The condition is typically seasonal, with exacerbations in the spring and summer months.

	===Conjunctival Changes===		===Conjunctival Changes===
	The conjunctiva may exhibit [[papillae]] on the upper tarsal conjunctiva, which can become large and cobblestone-like. Limbal papillae may also be present, often associated with [[Horner-Trantas dots]], which are collections of degenerated epithelial cells and eosinophils.		The conjunctiva may exhibit [[papillae]] on the upper tarsal conjunctiva, which can become large and cobblestone-like. Limbal papillae may also be present, often associated with [[Horner-Trantas dots]], which are collections of degenerated epithelial cells and eosinophils.

	===Corneal Involvement===		===Corneal Involvement===
	Corneal involvement can lead to [[keratitis]], with the potential for [[corneal ulceration]] and [[pannus]] formation. In severe cases, [[shield ulcers]] may develop, which can significantly impact vision.		Corneal involvement can lead to [[keratitis]], with the potential for [[corneal ulceration]] and [[pannus]] formation. In severe cases, [[shield ulcers]] may develop, which can significantly impact vision.

	==Pathophysiology==		==Pathophysiology==
	VKC is an [[IgE]]-mediated hypersensitivity reaction. The condition involves a complex interplay of [[mast cells]], [[eosinophils]], and [[T-lymphocytes]]. The release of inflammatory mediators such as [[histamine]] and [[cytokines]] contributes to the symptoms and tissue changes observed in VKC.		VKC is an [[IgE]]-mediated hypersensitivity reaction. The condition involves a complex interplay of [[mast cells]], [[eosinophils]], and [[T-lymphocytes]]. The release of inflammatory mediators such as [[histamine]] and [[cytokines]] contributes to the symptoms and tissue changes observed in VKC.

	==Diagnosis==		==Diagnosis==
	Diagnosis is primarily clinical, based on the characteristic signs and symptoms. A detailed patient history and examination of the conjunctiva and cornea are essential. In some cases, conjunctival scrapings may be performed to identify eosinophils.		Diagnosis is primarily clinical, based on the characteristic signs and symptoms. A detailed patient history and examination of the conjunctiva and cornea are essential. In some cases, conjunctival scrapings may be performed to identify eosinophils.

	==Management==		==Management==
	Management of VKC involves avoiding known allergens and using pharmacological treatments to control symptoms. [[Topical antihistamines]], [[mast cell stabilizers]], and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) are commonly used. In more severe cases, [[topical corticosteroids]] or [[immunomodulatory agents]] such as [[cyclosporine]] may be necessary.		Management of VKC involves avoiding known allergens and using pharmacological treatments to control symptoms. [[Topical antihistamines]], [[mast cell stabilizers]], and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) are commonly used. In more severe cases, [[topical corticosteroids]] or [[immunomodulatory agents]] such as [[cyclosporine]] may be necessary.

	==Prognosis==		==Prognosis==
	The prognosis for VKC is generally good, with most patients experiencing a reduction in symptoms as they age. However, ongoing management is often required to prevent complications and maintain quality of life.		The prognosis for VKC is generally good, with most patients experiencing a reduction in symptoms as they age. However, ongoing management is often required to prevent complications and maintain quality of life.
			==See also==
	==~~Related pages~~==
	* [[Allergic conjunctivitis]]		* [[Allergic conjunctivitis]]
	* [[Keratitis]]		* [[Keratitis]]
	* [[Conjunctivitis]]		* [[Conjunctivitis]]
	* [[Corneal ulcer]]		* [[Corneal ulcer]]

	[[Category:Eye diseases]]		[[Category:Eye diseases]]
	[[Category:Allergology]]		[[Category:Allergology]]

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	{{Use dmy dates\|date=October 2023}}		{{Use dmy dates\|date=October 2023}}

	'''Vernal keratoconjunctivitis''' (VKC) is a chronic, bilateral inflammation of the conjunctiva and cornea. It is a ~~recurrent condition~~ that ~~typically~~ affects children and young adults, particularly males, and is more prevalent in warm, dry climates.		==Vernal Keratoconjunctivitis==
			[[File:Vernal.jpg\|thumb\|right\|A patient with vernal keratoconjunctivitis showing characteristic symptoms.]]
			'''Vernal keratoconjunctivitis''' (VKC) is a chronic, bilateral inflammation of the conjunctiva and cornea. It is a form of [[allergic conjunctivitis]] that primarily affects children and young adults, particularly males, and is more prevalent in warm, dry climates.

			==Signs and Symptoms==
			VKC is characterized by intense [[itching]], [[photophobia]], [[tearing]], and a thick, ropy [[discharge]]. Patients often experience a burning sensation and a feeling of a foreign body in the eye. The condition is typically seasonal, with exacerbations in the spring and summer months.

			===Conjunctival Changes===
			The conjunctiva may exhibit [[papillae]] on the upper tarsal conjunctiva, which can become large and cobblestone-like. Limbal papillae may also be present, often associated with [[Horner-Trantas dots]], which are collections of degenerated epithelial cells and eosinophils.

	==~~Signs and symptoms~~==		===Corneal Involvement===
	~~Vernal keratoconjunctivitis is characterized by intense itching, photophobia, tearing~~, and ~~a thick~~, ~~ropy discharge. Patients often experience a burning sensation and a feeling of grittiness in the eyes. The condition is seasonal~~, ~~with symptoms worsening in the spring and summer months~~.		Corneal involvement can lead to [[keratitis]], with the potential for [[corneal ulceration]] and [[pannus]] formation. In severe cases, [[shield ulcers]] may develop, which can significantly impact vision.

	==Pathophysiology==		==Pathophysiology==
	VKC is an ~~allergic~~ condition ~~mediated by~~ [[~~immunoglobulin E~~]] ~~(IgE)~~ and ~~involves a hypersensitivity reaction~~. The ~~conjunctiva becomes inflamed due to the~~ release of inflammatory mediators ~~from mast cells. This leads~~ to the ~~characteristic~~ symptoms ~~of itching~~ and ~~redness~~.		VKC is an [[IgE]]-mediated hypersensitivity reaction. The condition involves a complex interplay of [[mast cells]], [[eosinophils]], and [[T-lymphocytes]]. The release of inflammatory mediators such as [[histamine]] and [[cytokines]] contributes to the symptoms and tissue changes observed in VKC.

	==Diagnosis==		==Diagnosis==
	Diagnosis ~~of VKC~~ is primarily clinical, based on the patient's history and ~~symptoms. Slit-lamp~~ examination ~~may reveal giant papillae on~~ the ~~upper tarsal~~ conjunctiva and ~~limbal infiltrates~~. ~~Corneal involvement can lead~~ to ~~the formation of shield ulcers~~.		Diagnosis is primarily clinical, based on the characteristic signs and symptoms. A detailed patient history and examination of the conjunctiva and cornea are essential. In some cases, conjunctival scrapings may be performed to identify eosinophils.

	==~~Treatment~~==		==Management==
	Management of VKC involves avoiding allergens and using ~~medications~~ to control symptoms. Topical antihistamines ~~and~~ mast cell stabilizers are commonly ~~prescribed~~. In severe cases, topical corticosteroids ~~may be necessary, but their use is limited due to potential side effects. Immunomodulatory~~ agents such as cyclosporine ~~can also~~ be ~~effective~~.		Management of VKC involves avoiding known allergens and using pharmacological treatments to control symptoms. [[Topical antihistamines]], [[mast cell stabilizers]], and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs) are commonly used. In more severe cases, [[topical corticosteroids]] or [[immunomodulatory agents]] such as [[cyclosporine]] may be necessary.

	==Prognosis==		==Prognosis==
	The prognosis for VKC is generally good, with most patients experiencing a reduction in symptoms as they age. However, ~~chronic inflammation can lead~~ to complications ~~such as corneal scarring and vision loss if not properly managed.~~		The prognosis for VKC is generally good, with most patients experiencing a reduction in symptoms as they age. However, ongoing management is often required to prevent complications and maintain quality of life.

	~~==Epidemiology==~~
	~~VKC is more common in males and typically presents in children and young adults. It is more prevalent in regions with warm, dry climates, such as the Mediterranean, Africa,~~ and ~~the Middle East~~.

	==Related pages==		==Related pages==
	* [[Allergic conjunctivitis]]		* [[Allergic conjunctivitis]]
	* [[~~Atopic keratoconjunctivitis~~]]		* [[Keratitis]]
	* [[~~Giant papillary conjunctivitis~~]]		* [[Conjunctivitis]]
			* [[Corneal ulcer]]
	~~==References==~~
	~~{{Reflist}}~~

	[[Category:Eye diseases]]		[[Category:Eye diseases]]
	[[Category:Allergology]]		[[Category:Allergology]]
	~~[[Category:Conjunctivitis]]~~

	~~[[File:Vernal.jpg\|thumb\|right\|A patient with vernal keratoconjunctivitis showing characteristic symptoms.]]~~

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2025-02-09T15:45:41Z

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Deepika vegiraju at 02:22, 24 July 2020

2020-07-24T02:22:20Z

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{{More citations needed|date=December 2014}}
{{Infobox medical condition (new)
| name = Vernal keratoconjunctivitis
| synonyms = '''Spring catarrh'''
| image = Vernal.jpg
| alt =
| caption = Some of the cornea and conjunctiva findings in vernal conjunctivitis
| pronounce =
| field = Ophthalmology
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}

'''Vernal keratoconjunctivitis''' ('''VKC''') is a recurrent, bilateral, and self-limiting inflammation of [[conjunctiva]], having a periodic seasonal incidence.
==Vernal keratopathy==
Corneal involvement in VKC may be primary or secondary due to extension of limbal lesions. Vernal keratopathy includes 5 types of lesions.

#Punctuate epithelial keratitis.
#Ulcerative vernal keratitis (shield ulceration).
#Vernal corneal plaques.
#Subepithelial scarring.
#Pseudogerontoxon.

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==Sign and symptoms==
*Symptoms- VKC is characterised by marked burning and itchy sensations which may be intolerable and accentuates when patient comes in a warm humid atmosphere. Associated symptoms include mild [[photophobia]] in case of corneal involvement, [[lacrimation]], stringy discharge and heaviness of eyelids.
*Signs of VKC can be described in three clinical forms (Cameron Classification):
#Palpebral form- Usually upper tarsal conjunctiva of both the eyes is involved. Typical lesion is characterized by the presence of hard, flat-topped papillae arranged in cobblestone or pavement stone fashion. In severe cases papillae undergo hypertrophy to produce cauliflower-like excrescences of 'giant papillae'.
#Bulbar form- It is characterised by dusky red triangular congestion of bulbar conjunctiva in palpebral area, gelatinous thickened accumulation of tissue around limbus and presence of discrete whitish raised dots along the [[Corneal limbus|limbus]] (Tranta's spots).
#Mixed form- Shows the features of both palpebral and bulbar types.

==Cause==
VKC is thought to be an allergic disorder in which IgE mediated mechanism play a role. Such patients often give family history of other atopic diseases such as [[hay fever]], [[asthma]] or [[eczema]], and their peripheral blood shows [[eosinophilia]] and increased serum [[IgE]] levels.

==Risk factors==
*Age and sex – 4–20 years; more common in boys than girls.
*Season – More common in summer. Hence, the name Spring catarrh is a misnomer. Recently it is being labelled as Warm weather conjunctivitis.
*Climate – More prevalent in the tropics. VKC cases are mostly seen in hot months of summer, therefore, more suitable term for this condition is "summer catarrh" Ref.

==Pathology==
* Conjunctival [[epithelium]] undergoes [[hyperplasia]] and sends downward projection into sub-epithelial tissue.
* Adenoid layer shows marked cellular infiltration by [[eosinophils]], [[lymphocytes]], [[plasma cells]] and [[histiocytes]].
* Fibrous layer show proliferation which later undergoes hyaline changes.
*Conjunctival vessels also show proliferation, increased permeability and vasodilation.

==Diagnosis==
Diagnosis of VKC is based upon typical clinical features, thus many mild or atypical cases may escape diagnosis. Lack of standardised diagnostic criteria regarding the severity of VKC renders this disease more difficult to diagnose and manage.

Despite facts suggesting immune responses in the pathogenesis of VKC, no clinical or laboratory test has evolved to support the diagnosis in atypical cases or predict the course of disease.

History of atopy in patient or the family, elevated serum level of total and specific IgE, higher number of eosinophils and mast cells, increased level of mediators and favourable response to anti-allergic therapy is observed in VKC.

Prevalence of IgE sensitisation is found to be significantly lesser in bulbar as compared to palpebral and mixed type of VKC.

=== Classification ===
Based on severity, authors have classified VKC into clinical grades:

Grade 0 - Absence of symptoms

Grade 1 MILD - Symptoms but no corneal involvement

Grade 2 MODERATE - Symptoms with photophobia but no corneal involvement

Grade 3 SEVERE - Symptoms, photophobia, mild to moderate SPK's OR with Diffuse SPK or corneal ulcer

==Treatment==
*Local therapy- Topical steroids are effective. Commonly used solutions are of [[fluorometholone]], [[medrysone]], [[betamethasone]] or [[dexamethasone]]. Mast cell stabilizers such as [[sodium cromoglycate]] (2%) drops 4–5 times a day are quite effective in controlling VKC, especially atopic ones. Azelastine eyedrops are also effective. Topical antihistamines can be used. Acetyl cysteine (0.5%) used topically has mucolytic properties and is useful in the treatment of early plaque formation. Topical [[Cyclosporine]] is reserved for unresponsive cases.
*Systemic therapy- Oral antihistamines and oral steroids for severe cases.
*Treatment of large papillae- Cryo application, surgical excision or supratarsal application of long-acting steroids.
*General measures include use of dark goggles to prevent photophobia, cold compresses and ice pack for soothing effects, change of place from hot to cold areas.
*Desensitization has also been tried without much rewarding results.
*Treatment of vernal keratopathy- Punctuate epithelial keratitis require no extra treatment except that instillation of steroids should be increased. Large vernal plaque requires surgical excision. Ulcerative vernal keratitis require surgical treatment in the form of debridement, superficial keratectomy, excimer laser therapeutic keratectomy, as well as amniotic membrane transplantation to enhance re-epithelialisation.
*Recently treatment with [[tacrolimus]] ointment (0.1%) used topically twice daily is showing encouraging results.

==See also==
*[[Conjunctivitis]]
*[[Allergic conjunctivitis]]

== External links ==
{{Medical resources
| DiseasesDB =
| ICD10 = H16.2
| ICD9 = 
| ICDO =
| OMIM =
| MedlinePlus =
| MeSH =
| GeneReviewsNBK =
| GeneReviewsName =
| Orphanet = 70476
}}

[[Category:Diseases of the eye and adnexa]]
[[Category:Disorders of conjunctiva]]
[[Category:Rare diseases]]