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-
- 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.
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)
- 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.
Treatment-
General Measures-
- Dark goggles
- Cold compression
- Extreme cases shifting to a colder region may be necessary
Local-
- 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.
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
2 Comments
I have 3 year old bouy with severe VKC. I realy need to hear from somone hwo have this disease or is taking care of child with this.
Please send me an e-mail kth@islandia.is
In my country doctors are not familiar to this desease.
best regards
Kristin Th
Hello Christine, if you are still not helped by someone please contact me in my Skype Chris.alex70
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