🌿 Vernal Keratoconjunctivitis (VKC) – Summary Notes

• 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
    

🧬 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
      

👁️ 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)
    

🔸 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
    

🔸 Surgical Management

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

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