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-
- Patient may have family history of atopic disease- hay fever,asthama,allergic rhinitis, atopic dermatitis. Their eosinophil count may be high in blood.
- Age- specially 4-20 years. Boys > girls
- Season- Summer is the main season “ warm weather conjunctivitis” . Spring Catarrah is known to be a misnomer.
- More prevalent in tropical areas than tundra region.
- Marked burning and itching sensation in eyes – intolerable and aggravated by warm and humid condition.
- Mild Photophobia
- Ropy discharge ( string like)
- Heaviness of lids.
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)
- Dusky red triangular congestion of the bulbar conjunctiva in palpebral area.
- Gelatinous accumulation aroung the limbus ( junction of cornea and conjunctiva)
- 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.
- Dark goggles
- Cold compression
- Extreme cases shifting to a colder region may be necessary
- Topical Steroids – Q4hrly for 2 days then Q6-8hrly for 2 weeks
- Mast Cell stabilizer- Sodium cromoglycate 2 % drops 4-5 times a day, Azelasine drops.
- Topical Antihistaminics
- Acetyl Cysteine 0.5% used a muclytic .
- Topical Cyclosporine 1% in severe and unresponsive cases.
- Oral antihistaminics
- Oral steroids
Treatment of large papillae-
- Supratarsal injection of long acting steroid
- Surgical excision.
Reference: Ophthalmology- A K Khurana, Web