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'''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 recurrent condition that typically affects children and young adults, particularly males, and is more prevalent in warm, dry climates.
==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.
==Signs and symptoms==
#Ulcerative vernal keratitis (shield ulceration).
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.
#Vernal corneal plaques.
#Subepithelial scarring.
#Pseudogerontoxon.
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==Pathophysiology==
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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.
*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 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.
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.
==Treatment==
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.
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.
==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.
Prevalence of IgE sensitisation is found to be significantly lesser in bulbar as compared to palpebral and mixed type of VKC.
==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.
=== Classification ===
==Related pages==
Based on severity, authors have classified VKC into clinical grades:
* [[Allergic conjunctivitis]]
* [[Atopic keratoconjunctivitis]]
Grade 0 - Absence of symptoms
* [[Giant papillary conjunctivitis]]
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==
==References==
*[[Conjunctivitis]]
{{Reflist}}
*[[Allergic conjunctivitis]]
== External links ==
[[Category:Eye diseases]]
{{Medical resources
[[Category:Allergology]]
| DiseasesDB =
[[Category:Conjunctivitis]]
| ICD10 = H16.2
| ICD9 = <!-- {{ICD9|xxx}} -->
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| Orphanet = 70476
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[[Category:Diseases of the eye and adnexa]]
[[File:Vernal.jpg|thumb|right|A patient with vernal keratoconjunctivitis showing characteristic symptoms.]]
[[Category:Disorders of conjunctiva]]
[[Category:Rare diseases]]
Revision as of 15:45, 9 February 2025
A chronic allergic eye disease
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 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.
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.
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.
Treatment
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.
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.
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.
