Vernal Keratoconjunctivitis

Aswathi Selvam S
Introduction

Vernal Kerato Conjunctivtis

Spring Cornea Conjunctival

inflammation

● It is a recurrent, bilateral,self limiting allergic inflammation

of the conjunctiva having a periodic seasonal incidence.
Clinical Scenario
A 5 year old boy presented to the
ophthalmologist for the first time with chief
complaint of red and itchy eyes of
approximately 3 weeks duration.The patient
had watery eyes and stringy, white ,thick
discharge. The patient's mother reported that
the itching had been intermittent over the
last 12 months.
Predisposing factors

● Age - 4 to 20 years
● Sex-common in boys than girls
● Season-common in summer
● Climate- tropical zones
● Other atopic manifestations-asthma
Pathology
● IgE mediated type 1 hypersensitivity with Th2 lymphocytes alteration

Epithelium: undergoes
hyperplasia

Adenoid layer: infiltration of mast

cells,eosinophils,lymphocytes

Fibrous layer: shows proliferation

Blood vessels: show

proliferation, vasodilation
Symptoms

● Marked burning and itching sensation-

intolerable in a humid warm atmosphere
● Mild photo phobia
● Ropy (stringy) discharge
● Heaviness of lids
Signs
1. Palpebral form:
● Cobblestone or pavement stone
pattern-papillae are hard,flat topped
● Conjunctival hyperemia
● Severe cases- papillary hypertrophy
seen as cauliflower like giant
papillae
2. Bulbar Limbal VKC
● Red triangular congestion
● Gelatinous limbal membrane
● Horner-Tranta’s spots: whitish
raised dots along limbus
Vernal keratopathy

● Vernal corneal plaques

● Shield ulcer- shallow transverse ulcer
in upper part of cornea
● Pseudogerontoxon: gray-white lipid
deposition in peripheral cornea
resembling arcus senilis
Cobble stone papillae Ropy discharge

Horner-Tranta’s spot Shield ulcer

Differential diagnosis of spring catarrh
Allergic Keratoconjunctivitis (AKC)

VKC AKC
Age ● Atopic keratoconjunctivitis(AKC)
Younger Older
Duration Limited Chronic
Time of year Summer Perennial
Cornea Shield ulcer Persistent epithelial
defects
 Treatment
Topical anti-allergic drugs:
1. Antihistamines -Olopatidine
2. Mast cell stabilizers-Sodium cromoglycate
3. Steroids- Loteprednol, Fluorometholone
Topical lubricants:
● Artificial tears- Carboxymethyl cellulose
Supportive measures:
● Cold compress, ice packs