Vernal keratoconjunctivitis


Vernal keratoconjunctivitis

Description, Causes and Risk Factors:

ICD-10-DC: H16.2 (keratoconjunctivitis, NOS).

Vernal keratoconjunctivitis (VKC) is a recurrent ocular inflammatory disease that has a seasonal incidence. VKC is a rare condition in most countries, accounting for roughly 0.1 to 0.5% of ocular diseases. It tends to occur more in dry, warm climates. VKC is a disease that affects children and young adults. It is primarily found in men between the ages of 3 and 20 years. Some people experience symptoms year round, however the peak season for VKC is between April and August.

VKC is not associated with a positive skin test or RAST in 42-47% of patients, confirming that it is not solely an IgE-mediated disease. On the basis of challenge studies as well as immunohistochemical and mediator studies, a Th2-driven mechanism with the involvement of mast cells, eosinophils, and lymphocytes has been suggested. Th2 lymphocytes are responsible for both hyperproduction of IgE (interleukin-4, IL-4) and for differentiation and activation of mast cells (interleukin-3, IL-3) and eosinophils (interleukin-5, IL-5). Other studies have demonstrated the involvement of neural factors such as substance P and NGF (nerve growth factor) in the pathogenesis of VKC, and the overexpression of estrogen and progesterone receptors in the conjunctiva of VKC patients has introduced the possible involvement of sex hormones. Thus, the pathogenesis of VKC is probably multifactorial, with the interaction of the immune, nervous, and endocrine systems.

To prevent the recurrence of the disease timely diagnosis, prompt therapeutic medication, avoidance of allergic environment and allergens is a mandatory.

Symptoms:

VKC is characterized by hard, elevated, cobblestone like bumps on the upper eyelid. There may also be swellings and thickening of the conjunctiva.

Other symptoms include:

    Ocular itching.

  • Redness and burning of the eye.

  • Epiphora (an overflow of tears/watering).

  • Mucoid discharge.

  • Sensitivity to light.

  • Impairment in vision.

Diagnosis:

VKC is diagnosed according to the Clinical findings. Impression cytology, which is an easy, simple, and noninvasive method, can be applied on the cytologic investigation of ocular surface changes. The alterations in theconjunctival epithelium during the course of VKC were examined by Conjunctival impression cytology. Aragonausing impression cytology demonstrated that allcytologic parameters were significantly modified in patients with VKC; the earliest alterations were found in thedistribution of goblet cells, in the intercellular junctions, inthe chromatin morphology, and in the degree of keratinization. The inflammatory cells included predominantlypolymorphonuclear leukocytes with a few eosinophils andmast cells. In impression cytology examination, there was a significant increase in inflammation,presence of a honeycomb pattern, plasma cells, and mucous strands in the upper tarsal conjunctiva of the specimens.

Treatment:

A category of therapeutic known as mast cell stabilizers are specifically approved for treatment of VKC, and have been shown to be effective. They are effective in reducing itching, hyperemia and mucous discharge. In severe cases, they may be used concurrently with mild corticosteroids. Often patients with severe VKC have asthmatic manifestations and their eyes may improve while on steroids or theophylline for the asthma. The use of topical antihistamines may also help alleviate the ocular itching associated with this condition.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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