VERNAL KERATOCONJUNCTIVITIS

VIGNESH A

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)

PREDISPOSING FACTORS:

• 4-20 YEARS, COMMON IN MALES

• MORE IN SUMMER 'WARM WEATHER CONJUNCTIVITIS’

• PREVALENT IN TROPICS, NON-EXISTENT IN COLD CLIMATE

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

SYMPTOMS

• MARKED BURNING AND ITCHING, MORE IN WARM CLIMATE

• MILD PHOTOPHOBIA, LACRIMATION

• “ROPY(STINGY) DISCHARGE”

• HEAVINESS OF EYELIDS

V K

CPALPEBRAL

BULBAR

MIXED

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

• 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)

• MIXED:

• COMBINED FEATURES OF BOTH FORMS

CORNEAL INVOLVEMENT IN VKC

• PUNCTATE EPITHELIAL KERATITIS:

• INVOLVES UPPER CORNEA, MOSTLY IN PALPEBRAL FORM

• LESIONS ALWAYS STAIN WITH ROSE BENGAL

• ULCERATIVE VERNAL KERATITIS:

• (SHIELD ULCERATION)

• SHALLOW TRANSVERSE ULCER IN UPPER PART OF CORNEA DUE TO EPITHELIAL

MACROEROSIONS

• VERNAL CORNEAL PLAQUES:

• DUE TO COATING OF AREAS OF EPITHELIAL MACROEROSIONS WITH COATING OF

ALTERED EXUDATES

• 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.

• CLINICAL COURSE:

• SELF-LIMITING

• USUALLY GOES OFF SPONTANEOUSLY IN 5-10 YEARS

• DIFFERENTIAL DIAGNOSIS:

• TRACHOMA WITH PREDOMINANTLY PAPILLARY HYPERTROPHY

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

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

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