Vernal keratoconjunctivitis

A chronic allergic eye disease

Vernal Keratoconjunctivitis

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.

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.

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.

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.

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.

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.

Related pages

• Allergic conjunctivitis
• Keratitis
• Conjunctivitis
• Corneal ulcer