Vernal keratoconjunctivitis

December 31, 2014

Synonyms

Overview

Vernal keratoconjunctivitis is a chronic, severe allergy that affects the surfaces of the eyes. It most commonly occurs in boys living in warm, dry climates. Attacks associated with VKC are common in the spring (hence the name "vernal" and summer but often reoccur in the winter. The condition usually subsides at the onset of puberty.

Symptoms

Redness
Sticky mucus discharge
Involuntary blinking or spasms of the eyelid (blepharospasm)
Developmental delay
Foreign body sensation
Eyelid sticking
Pruritus
Conjunctival inflammation
Red conjunctiva
Blurred vision
Light sensitive eyes

Causes

It is caused by a hypersensitivity (allergic reaction) to airborne-allergens. VKC is thought to be an allergic disorder in which IgE mediated mechanism play a role. Such patients often give family history of other atopic diseases such as hay fever, asthma or eczema, and their peripheral blood shows eosinophilia and increased serum IgE levels.

The most common causative organisms include: bacterial — Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis chlamydial — Chlamydia trachomatis (inclusion conjunctivitis) viral — adenovirus types 3, 7, and 8; herpes simplex virus , type 1.

Diagnosis

There are not any established diagnostic criteria or lab tests to diagnose vernal conjunctivitis. A doctor can usually diagnose vernal conjunctivitis by asking about your medical history and examining your eye.

Prognosis

Vernal keratoconjunctivitis generally resolves spontaneously after puberty without any further symptoms or visual complications. However, the development of corneal ulcers (in approximately 9.7% of affected individuals), cataract or glaucoma can potentially cause permanent vision loss. Beginning treatment immediately after receiving the diagnosis of VKC is very important because the longer an individual has complications from the disease, the greater the chances of developing cataracts or permanent blindness. It has been reported that the size of the papillae is directly related to the probability of persistence or worsening of symptoms (i.e. the larger the papillae, the worse the prognosis is). It has also been reported that the bulbar forms of VKC have a worse long-term prognosis than the tarsal forms.

Treatment

Management of vernal keratoconjunctivitis focuses on preventing allergic attacks as well as relieving the signs and symptoms of the condition. It is often recommended that affected individuals try to avoid the agent that causes the allergy (if possible); wear dark sunglasses in the daytime; avoid dust; and stay inside on hot afternoons. Eye drops that affect the amount of histamine released by immune system cells (called mast cell stabilizers) may be used at the beginning of the season or at the first sign of a "flare-up" to prevent severe symptoms; however, they are not considered effective at relieving symptoms. Topical eye drops are generally preferred as the first source of treatment. Cold compresses, artificial tears, ointments and/or topical antihistamines may help. Non-steroid anti-inflammatory drugs (NSAIDS) may relieve symptoms in moderate cases; topical steroids are typically only used for more severe cases because long-term use can cause glaucoma.

A few prescription drugs may also be available for the treatment of VKC; these include cromolyn sodium, lodoxamide tromethamine and Levocabastine. Oral administration of montelukast, a drug usually prescribed for asthma, has also been shown to be an effective treatment of VKC. For more information about these drugs and their availability, individuals should speak with their health care providers.