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{{More citations needed|date=December 2014}}
{{SI}}  
{{Infobox medical condition (new)
{{Infobox medical condition
| name            = Vernal keratoconjunctivitis
| name            = Vernal keratoconjunctivitis
| synonyms        =  '''Spring catarrh'''
| image          = [[File:Vernal.jpg|alt=Vernal keratoconjunctivitis|upright=1.2]]
| image          = Vernal.jpg
| caption        = Eye with vernal keratoconjunctivitis
| alt             =  
| field          = [[Ophthalmology]]
| caption        = Some of the cornea and conjunctiva findings in vernal conjunctivitis
| synonyms        = Spring catarrh, warm weather conjunctivitis
| pronounce      =  
| symptoms        = [[Itching]], [[redness]], [[tearing]], [[photophobia]], [[discharge]]
| field          = Ophthalmology
| complications  = [[Corneal ulcer]], [[vision loss]]
| symptoms        =  
| onset          = Typically in [[childhood]]
| complications  =  
| duration        = [[Chronic condition|Chronic]], often resolves after [[puberty]]
| onset          =  
| causes          = [[Allergy|Allergic reaction]]
| duration        =  
| risks          = [[Atopy]], [[family history]]
| types          =
| diagnosis      = [[Clinical diagnosis]], [[slit lamp examination]]
| causes          =  
| differential    = [[Atopic keratoconjunctivitis]], [[giant papillary conjunctivitis]], [[allergic conjunctivitis]]
| risks          =  
| treatment      = [[Antihistamines]], [[mast cell stabilizers]], [[topical corticosteroids]]
| diagnosis      =  
| frequency      = More common in [[tropical]] and [[subtropical]] regions
| differential    =  
| prevention      =
| treatment      =  
| medication      =
| prognosis      =
| frequency      =  
| deaths          =
}}
}}
 
{{Short description|A chronic allergic eye disease}}
'''Vernal keratoconjunctivitis''' ('''VKC''') is a recurrent, bilateral, and self-limiting inflammation of [[conjunctiva]], having a periodic seasonal incidence.
'''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 keratopathy==
==Signs and Symptoms==
Corneal involvement in VKC may be primary or secondary due to extension of limbal lesions. Vernal keratopathy includes 5 types of lesions.
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===
#Punctuate epithelial keratitis.
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.
#Ulcerative vernal keratitis (shield ulceration).
===Corneal Involvement===
#Vernal corneal plaques.
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.
#Subepithelial scarring.
==Pathophysiology==
#Pseudogerontoxon.
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.
 
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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==
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.
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==
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.
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==
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.
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.
 
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==
==See also==
*[[Conjunctivitis]]
* [[Allergic conjunctivitis]]
*[[Allergic conjunctivitis]]
* [[Keratitis]]
 
* [[Conjunctivitis]]
== External links ==
* [[Corneal ulcer]]
{{Medical resources
[[Category:Eye diseases]]
|  DiseasesDB      =
[[Category:Allergology]]
|  ICD10          = H16.2
|  ICD9            = <!-- {{ICD9|xxx}} -->
|  ICDO            =
|  OMIM            =
|  MedlinePlus    =
|  MeSH            =
|  GeneReviewsNBK  =
|  GeneReviewsName =
|  Orphanet        = 70476
}}
 
[[Category:Diseases of the eye and adnexa]]
[[Category:Disorders of conjunctiva]]
[[Category:Rare diseases]]

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Vernal keratoconjunctivitis
Vernal keratoconjunctivitis
Synonyms Spring catarrh, warm weather conjunctivitis
Pronounce N/A
Specialty N/A
Symptoms Itching, redness, tearing, photophobia, discharge
Complications Corneal ulcer, vision loss
Onset Typically in childhood
Duration Chronic, often resolves after puberty
Types N/A
Causes Allergic reaction
Risks Atopy, family history
Diagnosis Clinical diagnosis, slit lamp examination
Differential diagnosis Atopic keratoconjunctivitis, giant papillary conjunctivitis, allergic conjunctivitis
Prevention N/A
Treatment Antihistamines, mast cell stabilizers, topical corticosteroids
Medication N/A
Prognosis N/A
Frequency More common in tropical and subtropical regions
Deaths N/A


A chronic allergic eye disease


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[edit]

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[edit]

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[edit]

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[edit]

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[edit]

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[edit]

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[edit]

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[edit]