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