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. V K C
PALPEBRAL
BULBAR
MIXED

7. 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

8. • 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)

9. • MIXED:
• COMBINED FEATURES OF BOTH FORMS

10. CORNEAL INVOLVEMENT IN VKC
• PUNCTATE EPITHELIAL KERATITIS:
• INVOLVES UPPER CORNEA, MOSTLY IN PALPEBRAL FORM
• LESIONS ALWAYS STAIN WITH ROSE BENGAL

11. • ULCERATIVE VERNAL KERATITIS:
• (SHIELD ULCERATION)
• SHALLOW TRANSVERSE ULCER IN UPPER PART OF CORNEA DUE TO EPITHELIAL
MACROEROSIONS

12. • VERNAL CORNEAL PLAQUES:
• DUE TO COATING OF AREAS OF EPITHELIAL MACROEROSIONS WITH COATING OF
ALTERED EXUDATES

13. • 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.

14. • CLINICAL COURSE:
• SELF-LIMITING
• USUALLY GOES OFF SPONTANEOUSLY IN 5-10 YEARS
• DIFFERENTIAL DIAGNOSIS:
• TRACHOMA WITH PREDOMINANTLY PAPILLARY HYPERTROPHY

15. 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

16. 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

17. 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