🌿 Vernal Keratoconjunctivitis (VKC) – Summary Notes

Overview & Epidemiology

• Uncommon but serious allergic eye condition.
• Affects children and young adults:
  • Onset: 5–15 years
  • Duration: 5–10 years
• Sex predilection:
  • More common in males before puberty
  • No gender bias after puberty
• Ethnic & Geographic trends:
  • Decreasing among Caucasians
  • Increasing among South Asians
  • Tarsal/palpebral form → more common in pale-skinned Caucasians
  • Limbal form → more common in darker-skinned individuals
  • Often presents as a mixed form
  • More common in warm climates
  • Typically seasonal: Spring/Summer
• Atopic association:
  • 80% of patients have a history of atopy
    
  • Immune mechanism:
    • Type I hypersensitivity
    • Cell-mediated immunity (Th2 dominant)
    • Th2 cytokines inhibit matrix metalloproteinases (MMPs), leading to collagen build-up in conjunctiva

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👁️ Clinical Features

• Typical presentation:
  • Young male, spring season, history of atopy
  • Symptoms: Intense itching, thick ropy mucus discharge
• Tarsal Signs:
  Flat-topped giant papillae (“cobblestone appearance”) on upper tarsal conjunctiva

• Limbal Signs:
  • Limbal papillae
  • Trantas dots: white dots at limbus (aggregates of eosinophils)
• Corneal Involvement (Keratitis):
  • Superior punctate epithelial erosions
  • Vernal shield ulcer with adherent mucus plaque
    • Can lead to subepithelial scarring
  • Pseudogerontoxon: lipid deposition near limbus

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🧬 Overview & Epidemiology

• Uncommon but serious allergic eye condition.
• Affects children and young adults:
  • Onset: 5–15 years
  • Duration: 5–10 years
• Sex predilection:
  • More common in males before puberty
  • No gender bias after puberty
• Ethnic & Geographic trends:
  • Decreasing among Caucasians
  • Increasing among South Asians
  • Tarsal/palpebral form → more common in pale-skinned Caucasians
  • Limbal form → more common in darker-skinned individuals
  • Often presents as a mixed form
  • More common in warm climates
  • Typically seasonal: Spring/Summer
• Atopic association:
  • 80% of patients have a history of atopy
    
  • Immune mechanism:
    • Type I hypersensitivity
    • Cell-mediated immunity (Th2 dominant)
    • Th2 cytokines inhibit matrix metalloproteinases (MMPs), leading to collagen build-up in conjunctiva

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👁️ Clinical Features

💊 Treatment

🔸 Topical Treatment

• Mast Cell Stabilizers:
  • Sodium cromoglicate 2%, 4×/day
• Topical Steroids:
  • For acute exacerbations:
    • Dexamethasone 0.1% PF, hourly
  • Taper to maintenance:
    • Fluorometholone 0.1%, 1–2×/day
  • Use lowest effective dose to reduce side effects
• Topical Ciclosporin (steroid-sparing):
  • 0.1% ciclosporin drops, 3–4×/day (unlicensed)
  • 0.2% ciclosporin ointment, 3–4×/day (off-label; veterinary-licensed)
  • Can be used long-term to reduce steroid dependence
• Injectable Steroids –

Agent:Triamcinolone acetonide 40 mg/mL
Dose: 0.5–1 mL via posterior sub-Tenon’s injection

• Sunconjunctival
• Subtenons
• Subtarsal
• Mucolytics (for thick mucus plaques):
  • Acetylcysteine 5%, 4×/day
  • Acetylcysteine 10% PF, 4×/day (hospital special preparation)

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🔸 Systemic Treatment

• Consider systemic immunosuppression in severe/refractory cases
  • Collaborate with a dermatologist or clinical immunologist
• If immunosuppressants used → Herpes prophylaxis required:
  • Aciclovir 200 mg 5×/day or 400 mg 2×/day

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🔸 Surgical Management

• For persistent plaques or shield ulcers:
  • Debridement
  • Superficial lamellar keratectomy

Also refer, https://eyewiki.org/Vernal_Keratoconjunctivitis