Dr. Orwa Nasser MD MPH - Vernal Keratoconjunctivitis

Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammatory condition affecting the conjunctiva and sometimes the cornea. It most commonly affects children and young adults and tends to flare seasonally, especially in warmer months. VKC is more severe than typical seasonal allergic conjunctivitis and may significantly affect comfort and vision if not properly managed.

Symptoms:

·    Intense itching.

·    Redness.

·    Excessive tearing.

·    Light sensitivity (photophobia).

·    Thick mucus discharge.

·    Blurred vision in severe cases.

·    Giant papillae under the upper eyelid.

Causes:

·    VKC results from an exaggerated allergic immune response to environmental allergens such as pollen and dust.

·    Seasonal and environmental factors.

·    Symptoms typically worsen during high-allergen seasons such as spring and summer.

·    Atopy and immune hypersensitivity.

·    Many patients have a personal or family history of asthma, eczema, or allergic rhinitis.

Diagnosis and Tests: Diagnosis is based on clinical examination, symptom history, and identification of papillary changes and corneal involvement.

Management and Treatment:

·    Conservative measures: Cool compresses and lubricating eye drops may relieve irritation.

·    Medications: Treatment may include antihistamine or mast cell stabilizer eye drops, dual-acting agents, topical corticosteroids for flares, and immunomodulatory medications in selected cases.

·    Corneal involvement: If the cornea is affected, additional protective and anti-inflammatory treatment may be necessary.

Prognosis: Many children experience improvement after puberty, though some individuals may have persistent symptoms.

Prevention: Reducing allergen exposure and proactive seasonal management may help reduce flare severity.

When Should I See My Healthcare Provider? Seek evaluation if symptoms persist, worsen, or affect vision.

When Should I Go to the Emergency Room? Urgent care is needed for sudden vision loss, severe pain, or suspected corneal ulcer.

What Questions Should I Ask My Healthcare Provider?

·    How severe is my inflammation?

·    Which treatments are safest long term?

·    How can I prevent seasonal flare-ups?

·    How do we monitor for corneal complications?

Key Takeaways:

·    VKC is a chronic allergic inflammatory eye disease.

·    It primarily affects children and young adults.

·    Symptoms include intense itching and redness.

·    Proper treatment prevents corneal complications.