Vernal Conjunctivitis
🌸 Vernal Conjunctivitis (Vernal Keratoconjunctivitis – VKC)
🔍 Definition
Vernal Conjunctivitis is a chronic, bilateral, allergic inflammation of the conjunctiva, often involving the cornea. It’s seasonal, with symptoms worsening in spring and summer, hence the name "vernal."
🌍 Epidemiology
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🧒 Affects boys > girls, aged 5–15 years
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More common in hot, dry climates (Africa, Middle East, India)
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Often associated with personal or family history of atopy (asthma, eczema, allergic rhinitis)
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Usually resolves by puberty
🧠 Pathophysiology
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IgE- and T-cell-mediated hypersensitivity
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Chronic inflammation leads to conjunctival thickening, goblet cell changes, and sometimes corneal involvement
👁️ Types of VKC
| Type | Location Affected | Features |
|---|---|---|
| Palpebral | Upper tarsal conjunctiva | Cobblestone papillae, giant papillae |
| Limbal | Around cornea (limbus) | Horner-Trantas dots, gelatinous limbal swelling |
| Mixed | Both areas involved | Most common |
👀 Symptoms
| Symptom | Notes |
|---|---|
| Severe itching | Most prominent symptom |
| Photophobia | Especially with corneal involvement |
| Tearing (epiphora) | Due to irritation |
| Stringy or ropy mucus | Thick discharge, very characteristic |
| Foreign body sensation | From papillae or corneal involvement |
| Burning | Mild to moderate |
🔍 Signs
| Sign | Description |
|---|---|
| Giant papillae | "Cobblestone" appearance on upper lid |
| Limbal gelatinous thickening | Especially superiorly |
| Horner-Trantas dots | White dots of eosinophils at limbus |
| Shield ulcers | Oval/hexagonal corneal ulcers (non-infectious, from rubbing or toxin effect) |
| Ptosis (mechanical) | Due to large papillae on upper eyelid |
🔬 Diagnosis
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Clinical — based on characteristic symptoms and signs
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Usually no lab tests needed
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Consider swabs if secondary infection is suspected
💊 Treatment
🔹 General Measures
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Avoid allergens (dust, pollen, smoke)
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Cold compresses
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Sunglasses (reduce UV exposure and allergen contact)
🔹 Medications
| Type | Examples | Notes |
|---|---|---|
| Lubricating drops | Artificial tears | Flush allergens, soothe eyes |
| Dual-action drops | Olopatadine, Ketotifen | Antihistamine + mast cell stabilizer |
| Topical antihistamines | Emedastine | Relieve itching |
| Mast cell stabilizers | Sodium cromoglycate, Nedocromil | Preventive use, slow onset |
| Topical steroids | Loteprednol, fluorometholone | For severe inflammation; short-term only |
| Topical cyclosporine A | 0.05–0.1% drops | For steroid-sparing in chronic cases |
| Antibiotics | If shield ulcer is infected | Based on culture or empirically |
⚠️ Long-term steroids should be avoided due to risk of glaucoma, cataracts, and secondary infection.
⚠️ Complications
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Shield ulcers → corneal scarring → ↓ vision
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Secondary bacterial infection
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Keratoconus (from chronic eye rubbing)
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Ptosis (from mechanical pressure of papillae)
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Permanent vision loss (rare)
📋 Summary Table
| Feature | Vernal Conjunctivitis |
|---|---|
| Age group | Children, especially boys (5–15 yrs) |
| Climate | Warm, dry |
| Symptoms | Itching, photophobia, stringy mucus |
| Signs | Cobblestone papillae, Horner-Trantas dots |
| Corneal involvement | Shield ulcer, punctate keratitis |
| Main treatment | Mast cell stabilizers, antihistamines, ± steroids |
| Long-term control | Topical cyclosporine for chronic cases |
🧠 Mnemonic – “VKC = VIGOR”
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V – Vernal
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I – Itching (severe!)
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G – Giant papillae
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O – Opacity (shield ulcers)
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R – Ropy discharge
Would you like:
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A visual comparison of VKC vs allergic conjunctivitis?
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A shield ulcer diagram?
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Or a flashcard-style summary?
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