DR.Maria Kanwal
PG Trainee R1
VKC
Case#1
•A 7 years old Haleema presented with C/O
Itching, foreign body sensation and mucoid
discharge since 1 year.
Case#2
•A 6 yearsold boy Bilal came with C/O
watering Burning and Foreign body
sensation from 1 year on and off..
Case#3
• A 7 years old Boy Umair came in opd with C/O
watering,photophobia and discharge from 6
months on and off.
INTRODUCTION :
• Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, allergic
inflammatory disorder, occurs on seasonal basis involving primarily
upper tarsal conjunctiva.
• Affects: Male
• 5 years age
• Peak incidence: spring, Summer
Classification
THREE clinical forms
• 1.Palpebral type
• 2.Limbal type
• 3.Mixed type
SYMPTOMS
• Increased blinking is common
• MARKED BURNING AND ITCHING, MORE IN WARM CLIMATE
• PHOTOPHOBIA,
• LACRIMATION
• Mucoid DISCHARGE
Signs
• Conjuctival Hyperemia
• Velvety papillary hypertrophy
• Macropapillae
• Giant Papillae(Cobblestone)
• Horner-trantas dots
• Shield Ulcer
• Pseudogerontoxon
Shield ulcer
• Rare
• Develop in palpebral and mixed
• Painless
• Vision threatening
• Drug resistant
SN
• Age
• Predominance
• Duration
• Conjuctival
involvement
• Cornea
• Corneal
vascularization
VKC
AKC
• Yonger
• Male
• Limited
• Upper tarsus
• Older
• No predilection
• Chronic
• Lower tarsus
• Shield ulcer
• Rare
• Epithelial defects
• Common
Treatment
• NON PHARMACOLOGICAL INTERVENTION
•
•
•
•
•
Avoidance of allergens
Cold compression
Lubrication
Bandage contact lens to prevent epithelial defects
Lid hygiene
• Pharmacological
Local
1. MAST CELL STABILISERS
• Sodium cromoglicate,nedocromil
• Until then topical antihistaminics and steroids can be used
2. TOPICA antihistamine
• Emadastine 1 drop qid
• Epinastine
3. Antihistamine+decongestant
•
•
Antazoline
Xylometazoline
4. NSAIDS
• ketorolac
• Diclofenac
 Topical steroids
Prednisolone 0.5%
hourly to BID
Loteprednol 0.2 to 0.5% QID
Flouromethalone0.1%
BID TO QID
Steroid Ointment >Hydrocortisone
Immune modulators>Cyclosporin 2 to 6 times
daily.
Steroid Injection can be given in severe palpebral
disease
Oral
• Oral Antihistamines
• Antibiotics
• Immunosuppressive agents
Surgical
• Superficial Keratectomy
• Surface Maintainance/Restoration
• Gluing