Etiology, Pathophysiology, and Management of Vernal Keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a chronic, allergic eye disease that primarily affects children and young adults. It is characterized by inflammation of the conjunctiva and cornea, leading to symptoms such as itching, tearing, photophobia, and mucus discharge.

Etiology and Risk Factors

VKC is an immune-mediated disorder often linked to environmental allergens such as pollen and dust mites. It is more prevalent in warm climates and regions with increased exposure to allergens. Key risk factors include:

Genetic predisposition
Atopy history (asthma, eczema, allergic rhinitis)
Seasonal variation (worse in spring and summer)
Hormonal influences (more common in males)

Pathophysiology

VKC is driven by an abnormal immune response involving eosinophilic infiltration, mast cell activation, and release of inflammatory mediators. The disease leads to chronic inflammation, which can cause limbal hypertrophy and severe corneal complications.

Ocular Manifestations

Symptoms and signs of VKC include:

Intense ocular itching
Stringy mucus discharge
Trantas dots (white limbal deposits)
Giant papillae on the upper tarsal conjunctiva
Superficial punctate keratitis

Differential Diagnosis

Conditions to consider when diagnosing VKC include:

Atopic keratoconjunctivitis
Giant papillary conjunctivitis
Infectious conjunctivitis
Keratitis due to ocular surface disease

Complications

Severe VKC can lead to corneal complications such as shield ulcers, vision impairment, and keratoconus. Persistent inflammation may result in permanent ocular damage.

Management

Effective management strategies involve:

Allergen avoidance and environmental control
Topical antihistamines and mast cell stabilizers
Corticosteroids for severe cases (short-term use)
Cyclosporine and tacrolimus for steroid-sparing treatment
Lubricating eye drops and cold compresses

Conclusion

Vernal keratoconjunctivitis is a chronic allergic condition that requires long-term management. Early diagnosis and appropriate treatment are crucial to prevent vision-threatening complications.