Vernal Keratoconjunctivitis – VKC or Spring Catarrah

It is (RIBSA) Recurrent Interstitial Bilateral Self-limiting Allergic inflammation of the Conjunctiva having a Seasonal incidence. It is an hypersensitivity reaction to exogenous allergen specially grass pollen.  IgE mediated reaction has a crucial role here.

Predisposing factors and Risk factors-

  1. Patient may have family history of atopic disease- hay fever,asthama,allergic rhinitis, atopic dermatitis. Their eosinophil count may be high in blood.
  2. Age- specially 4-20 years. Boys > girls
  3. Season-  Summer is the main season “ warm weather conjunctivitis” . Spring Catarrah is known to be a misnomer.
  4. More prevalent in tropical areas than tundra region.

Symptoms-

  • Marked burning and itching sensation in eyes – intolerable and aggravated by warm and humid condition.
  • Mild Photophobia
  • Ropy discharge ( string like)
  • Lacrimation
  • Heaviness of lids.

Signs-

Palpebral form- Cobblestone or pavement stone arrangement of inflamed papillae on the Upper Tarsal conjunctiva. Cauliflower like giant papillae can be seen in extreme cases. White ropy discharge.

Bulbar form- Characterized by (DGTal Mnemonic Dusky red triangle, Gelatinous accumulation, Tranta’s Spot)

  1. Dusky red triangular congestion of the bulbar conjunctiva in palpebral area.
  2. Gelatinous accumulation aroung the limbus ( junction of cornea and conjunctiva)
  3. Tranta’s spot- discrete white dots along the limbus.

Mixed form. Features of both.

Vernal Keratopathy- Corneal lesions

PUS PV- Punctate Epithelial Keratitis, Ulcerative vernal Keratitis, Subepithelial scarring,Pseudogerontoxon, Vernal cornela plaques.

Prognosis- Disease is usually self-limiting and resolves in 5-10 years but may result in complications like Keartoconus.

 

Treatment-

General Measures-

  • Dark goggles
  • Cold compression
  • Extreme cases shifting to a colder region may be necessary

Local-

  1. Topical Steroids – Q4hrly for 2 days then Q6-8hrly for 2 weeks
  2. Mast Cell stabilizer- Sodium cromoglycate 2 % drops 4-5 times a day, Azelasine drops.
  3. Topical Antihistaminics
  4. Acetyl Cysteine 0.5% used a muclytic .
  5. Topical Cyclosporine 1% in severe and unresponsive cases.

Systemic therapy-

  • Oral antihistaminics
  • Oral steroids

Treatment of large papillae-

  • Supratarsal injection of long acting steroid
  • Cryo-application
  • Surgical excision.

Reference: Ophthalmology- A K Khurana, Web

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