Cornea and External Diseases

Vernal Keratoconjunctivitis

Bilateral vernal keratoconjunctivitis demonstrating "cobblestones" giant papillae on the upper tarsus. This patient has a healed shield ulcer in the superior of his right cornea.
  • A bilateral, recurrent conjunctivitis, occurs predominantly in males aged 5 - 20 with peak incidence between 11 and 13 years
  • Usually a personal or family history of atopy
  • Symptoms are commonly exacerbated in the spring/ summer, but in tropical climates the disease may persist year-long

Clinical Findings

  • Symptoms: itching, photophobia, blurred vision, thick "ropy" discharge and blepharospasm
  • Signs:
    • Palpebral VKC
      • Bulbar conjunctival hyperemia and chemosis
      • Characteristic polygonal, flat-topped, pale pink/ grayish "cobblestones" papillae are located predominantly on the upper tarsal conjunctiva
  • Limbal VKC may develop alone or in association with palpebral VKC
    • Appears as thickening and opacification of the limbus
    • Limbal nodules may develop and become confluent
    • Horner-Trantas' dots may be seen as small white elevated lesions that represent macroaggregates of desquamated epithelial cells and eosinophils
  • Corneal changes that may occur include:
    • Punctate epithelial erosion
    • Superficial pannus
    • Shield ulcer; noninfectious, oval-shaped, circumscribed epithelial ulcer with underlying stromal opacification in the superior or central cornea. After the ulcer heals, an anterior stromal opacity persists.

Management

  • Topical antihistamine may have some role in the treatment of mild cases
  • Topical mast-cell stabilizer such as cromolyn sodium or lodoxamide is indicated for moderate to severe cases and should be started at least one month prior to seasonal onset of symptoms
  • Topical corticosteroids may be required in a severely inflamed eye or when there is a shield ulcer
  • Moving to a cooler climate reduces the likelihood of disease recurrence