VKC by HARSHIT VERMA.pptx conjunctivitis

Vernal kerato conjunctivitis

1. VERNAL KERATOCONJUNCTIVITIS (VKC ) OR SPRING CATARRH PRESENTATION BY: HARSHIT VERMA Roll No 56 MBBS 2021-2022 DEPARTMENT OF OPTHALMOLOGY SANTOSH MEDICAL COLLEGE

2. VERNAL KERATOCONJUNCTIVITIS (VKC) OR SPRING CATARRH It is a recurrent, bilateral, interstitial, self-limiting, allergic inflammation of the conjunctiva having a periodic seasonal incidence.

3. Pathology 1. Conjunctival epithelium undergoes hyperplasia and sends downward projections into the subepithelial tissue . 2. Adenoid layer shows marked cellular infiltration by eosinophils, plasma cells, lymphocytes and histiocytes. 3 . Fibrous layer shows proliferation which later on undergoes hyaline changes. 4 . Conjunctival vessels also show proliferation, increased permeability and vasodilation. All these pathological changes lead to formation of multiple papillae in the upper tarsal conjunctiva.

4. Clinical Picture Symptoms. Spring catarrh is characterised by marked burning and itching sensation which is usually intolerable when patient comes in a warm humid atmosphere. Itching is more marked with palpebral form of disease. Other associated symptoms include: mild photophobia, lacrimation, stringy (ropy) discharge and heaviness of lids.

5. Signs of vernal keratoconjunctivitis can be described in following three clinical forms: 1. Palpebral form . Usually upper tarsal conjunctiva of both eyes is involved. The typical lesion is characterized by the presence of hard, flat topped, papillae arranged in a 'cobble-stone’ or 'pavement stone', fashion . In severe cases, papillae may hypertrophy to produce cauliflower like excrescences of 'giant papillae'. Conjunctival changes are associated with white ropy discharge. may hypertrophy to produce cauliflower like excrescences of 'giant papillae'. Conjunctival changes are associated with white ropy discharge .

6. 2. Bulbar form. It is characterized by: ( i ) dusky red triangular congestion of bulbar conjunctiva in palpebral area; (ii) gelatinous thickened accumulation of tissue around the limbus; and (iii) presence of discrete whitish raised dots along the limbus ( Tranta's spots) (Fig. 4.21). 3. Mixed form. It shows combined features of both palpebral and bulbar forms (Fig. 4.22)

7. Treatment A. Local therapy 1 . Topical steroids. These are effective in all forms of spring catarrh. However, their use should be minimised , as they frequently cause steroid induced glaucoma. Therefore, monitoring of intraocular pressure is very important during steroid therapy. Frequent instillation (4 hourly) to start with (2 days) should be followed by maintenance therapy for 3-4 times a day for 2 weeks. Commonly used steroid solutions are of fluorometholone medrysone , betamethasone or dexamethasone. Medrysone and fluorometholone are safest of all these. 2 . Mast cell stabilizers such as sodium cromoglycate (2%) drops 4-5 times a day are quite effective in controlling VKC, especially atopic cases. It is mast cell stabilizer. Azelastine eye drops are also effective in controlling VKC. 3 . Topical antihistaminics are also effective. 4 . Acetyl cysteine (0.5%) used topically has mucolytic properties and is useful in the treatment of early plaque formation. 5 . Topical cyclosporine (1%) drops have been recently reported to be effective in severe unresponsive cases.

8. B. Systemic therapy A. Oral antihistaminic may provide some relief from itching in severe cases. B . Oral steroids for a short duration have been recommended for advanced, very severe, nonresponsive cases. C. Treatment of large papillae. Very large (giant) papillae can be tackled either by : Supratarsal injection of long acting steroid or Cryo application Surgical excision is recommended for extraordinarily large papillae. D . General measures include : Dark goggles to prevent photophobia Cold compresses and ice packs have soothing effects. Change of place from hot to cold area is recommended for recalcitrant cases. E. Desensitization has also been tried without much rewarding results. F. Treatment of vernal keratopathy Punctate epithelial keratitis requires no extra treatment except that instillation of steroids should be increased. A large vernal plaque requires surgical excision by superficial keratectomy. Severe shield ulcer resistant to medical therapy may need surgical treatment in the form of debridement, superficial keratectomy, excimer laser therapeutic keratectomy as well as amniotic membrane transplantation to enhance reepithelialization .