This document summarizes vernal keratoconjunctivitis (VKC), a type of allergic conjunctivitis that occurs more commonly in hot weather. It affects the conjunctiva and cornea and is characterized by papillae on the tarsal conjunctiva. Symptoms include itching, tearing, and discharge. Treatment involves topical steroids, mast cell stabilizers, and antihistamines. For severe cases, oral steroids or surgery may be needed. VKC typically resolves spontaneously after several years but can cause corneal scarring if not properly treated.

1. BY: YOHANANTH SIVANANTHAN
ROLL NO:132
NEPALGUNJ MEDICAL COLLEGE
NEPAL
AUG 10 BATCH
OPTHALMOLOGY SEMINAR SERIES

2.  It is a recurrent, bilateral, interstitial, self
limiting allergic inflammation of the
conjunctiva may have a periodic seasonal
incidence.
 It is a type of allergic conjunctivitis.
 Occuring with the onset of hotweather,
during summer rather than spring.
 Sporadic and non contagious in nature.
 Recently it also called as warm weather
conjunctivitis.

3.  Sporadically occur in wide geographical
incidence.
 More common in indian subcontinent and africa
like tropical countries than europe.
 Coloured races are more prone to form limbal
form of disease.
 Essentially disease of youth occuring more
frequently in between ages of 5-10 years.
 Sex incidence very high pecentages are seen in
males
 Family history of allergy found in 40-60
percentages.

4.  Three theories are found currently
 Due to the action of physical factors like
 Heat
 Humidity
 Light
 Due to the endocrine glands and vagotonic states
 Manifestation of an allegic condition.
 Pollens
 Toxins
 Dusts
 Animal debris,hair
 Inhalants
 Injestants
 Mostly pathogenesis IgE mediated allegic reaction

6.  Conjunctval epithelium
 Undergoes hyperplasia
 Sends downwards projections into the sub epithelial
tissue
 Adenoid layer
 Marked cellular infiltrations
 Eosinophils, plasmacells, lymphocytes,and histiocytes
 Fibrous layer
 Shows proliferation
 Later on undergoes hyaline changes
 Conjunctival vessels
 Proliferation
 Increased permeability and vasodilation.
 All these lead to formation of multiple papillae in the
upper tarsal conjunctiva…

7.  Marked burning and foreignbody sensation.
 Itching sensation.
 Mild photophobia.
 Lacrimation+watering
 Stringy( thick ropy white) discharge and
heaviness of lids.
in the cooler months the conditions subsides
and symptoms persits and is symptomsless
although the lesions persists,but recur with
the return of the heat.

8.  Signs may be described under 3 clinical forms
of disease
 Palperbral form
 Bulbar form
 Mixed form

9.  Usually upper tarsal conjunctiva of
both eyes involved.
 Easily recognised
 On everting upper lid the palperbral
conjunctiva is seen to be
hypertropied and mapped out into
polygonal raised are like
cobblestones or pavement stones
fashion.
 In severe cases papillae may
hypertropy-produce giant
papillae,cauliflower like
excresenses.
 The colour is bluish white,like
milk,and this apppearancce may
also be seen over the lower
palperbral conjunctiva.
 The flat topped nodules are hard
consist cheifly of dense fibrous
tissue,but the epithelium over them
thickned giving rise to milky hue.
 Histologically they are
hypertrophied papillae not follicles

11.  Eosinophillic leukocytes are present in them
in great numbers and found in the secretion
 Infiltrationof
lymphocytes,plasmacells,macrophages,basop
hills.
 Palperbral form cannot be mistaked if typical
but may resemble trachoma.

12.  Recognised by an
opacification of the limbus
with nodules or a wall of
gelatinous thickening at
the limbus
 Dusky red triangular
conjestion of bulbar
conjunctiva in palperbral
area.
 White dots consisting the
esonophills and epithelial
debris known as horner-
trantas dots if seen at
limbus are a very
characteristic feature.

15.  It shows combined features of both
palperbral and bulbar form

16.  Mainly due to corneal involvement otherwise
prognosis is good
Vernal keratopathy
 Due to corneal involvement in vernal kerato
conjunctivitis
 May be primary or secondary due to
extension of limbal lesions.
 Includes 5 types of lesions

17.  PUNCTATE EPITHELIAL KERATITIS
 INVOLVE UPPER CORNEA
 MOSTLY WITH PALPERBRAL FORM
 STAIN WITH ROSEBENGAL INVARIABLY WITH FLOURESCEIN
 ULCERATIVE VERNAL KERATITIS
 SHALLOW TRANSVERSE ULCER IN UPPER CORNEA
 VERNAL CORNEAL PLAQUES
 DUE TO COATING OF BARE AREAS OF EPITHELIAL MACRO
EROSIONS WITH A LAYER OF ALTERED EXUDATES
 SUBEPITHELIAL SCARRING
 IN A FORM OF RING SCAR
 PSEUDOGERONTOXON.
 CHARACTERISED BY CUPID BOW OUTLINE.

19.  SELF LIMITING
 USUALLY BURNS OUT SPONTANEOUSLY AFTER
5 TO 10 YEARS.

20.  TRACHOMA
 Mainly trachoma with
predominant papillary
hypertrophy from
palperbralform of spring
catarrah
 It can be differentiated as
follows
 Papillae are large and
usually cobblestone
appearance in spring
catarrah.
 Ph of tears alkaline in spring
catarrah while in trachoma
acidic.
 Discharge ropy in spring
catarrah
 Conjunctival cytology and
labtest in difficult cases.

21.  Local therapy
 Topical steroids.
 Used for all type of spring
catarrah
 Beware of steroid induced
glucoma in prolonged use
 Measure IOP during
treatment
 Frequent instillation 4
houly for 2days, then 3-
4times a day for 2 weeks
 Fluorometholone
medrysone.
 Betamethosone.
 Dextramethosone
 Medrysone and
flurometholone are most
safest.

22.  Local theraphy
 Mast cell stabilizers.
 Sodium chromoglycate 2%
drops 4-5 times a day
 Topical
antihistaminics.
 Acetyl cysteine 0.5%
 Mucolytic properties
 In early plaque
formation
 Topical cyclosporine
1%
 In un responsible cases
 Steroid resistant cases.

23.  Systemic therapy
 Oral antihistamininics
 Anti allergic
 Relive from itching
 Oral steroids
 Short duration recommended for advanced,very severe
non responsive cases.

24.  Treatment for large papillae.
 Giant papillae can be tackled by
 Supratarsal injection of long acting steroids.
 Cryo application
 Sugical excision recommended for extra ordinary large papillae
 General measures
 Dark goggles for photophobia
 Coldcompression for soothing effect
 Change of place to hot to cold area if possible
 Desensitization
 Treatment for vernal keratopathy
 Punctate epithilial type-no extra treatment instillation of steroid must be increased.
 Large vernal plaque-surgery(superficial keratectomy)
 Severe shied ulcer-resistant to medical theraphy
 Sugery is preffered in debridement,superficial keratectomy,eximer laser,therapeutic keratectomy.
 Prophylaxis
beta radiation,disodium chromoglycate 2% 3 to 4 times.