Vernal keratoconjunctivitis ophthalmology

ophthalmology

1. VERNAL KERATOCONJUNCTIVITIS VIGNESH A

2. VERNAL KERATOCONJUNCTIVITIS (VKC ) SPRING CATARRH recurrent, bilateral, interstitial, self-limiting, periodic seasonal incidence . Etiology hypersensitivity reaction to some exogenous allergen(grass pollens. IgE mediated atopic mechanisms Raised IgE + eosinophilia personal or family h/o other atopic diseases ( hay fever , asthma, or eczema)

3. Predisposing factors: 4-20 years, common in males More in summer  ' Warm weather conjunctivitis ’ Prevalent in tropics, non-existent in cold climate

4. pathology Conjunctival epithelial hyperplasia Marked infiltration in adenoid cell layer Proliferation of fibrous layer Conjunctival vascular proliferation vasodilation & permeability Formation of multiple papilllae in upper tarsal conjunctiva

5. SYMPTOMS Marked burning and itching, more in warm climate Mild photophobia, lacrimation “ Ropy(stingy) Discharge” Heaviness of eyelids

6. signs Palpabrel form: Upper tarsal conjunctiva Presence of hard, flat topped, papillae arranged in 'cobble-stone' or 'pavement stone', fashion Giant papillae in severe cases White ropy conjunctival discharge COBBLE STONE APPEARANCE

7. Bulbar form : Dusky red triangular congestion of bulbar conjunctiva in palpebral area Gelatinous thickened accumulation of tissue around the limbus Presence of discrete whitish raised dots along the limbus ( Tranta's spots )

8. Mixed: Combined features of both forms

9. Corneal involvement in VKC Punctate epithelial keratitis : Involves upper cornea, mostly in palpebral form Lesions always stain with rose bengal

10. Ulcerative vernal keratitis : ( shield ulceration) Shallow transverse ulcer in upper part of cornea due to epithelial macroerosions

11. Vernal corneal plaques: Due to coating of areas of epithelial macroerosions with coating of altered exudates

12. Subepithelial scarring : In a form of a ring scar Pseudogerontoxon   resembles arcus senilis ( gerontoxon ) IN limbal vernal or atopic keratoconjunctivitis . only clinical evidence of previous allergic eye disease. 

13. Clinical course: self-limiting Usually goes off spontaneously in 5-10 years Differential diagnosis : Trachoma with predominantly papillary hypertrophy

14. treatment Local therapy Topical steroids: Flouromethalone , dexamethasone, loteprednol Use should be minimal and for short-duration Frequent instillation (4 hourly for 2 days)  maintenance therapy for 3-4 times a day* 2 weeks . Mast cell stabilizers :Sodium cromoglycate , azelastine , ketotifen Topical antihistaminic eye drops Acetyl cysteine (0.5%) eye drops mucolytic property Topical cyclosporine 1% eye drops

15. Systemic therapy Oral histaminics Oral steroids in severe cases for short duration Treatment of large papillae : Supratarsal injection of long acting steroid Cryo application Surgical excision for extra-ordinary large papillae

16. General measures : Dark goggles Cold compress & ice packs Change of environment (working environment also) Desensitization Not much awarding results Treatment of vernal keratopathy : PEK : steroid instillation should be increased Large vernal plaque: surgical lamellar keratectomy Severe shield ulcer: debridement, superficial keratectomy, amniotic membrane transplantation

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