Friday, May 4, 2012


Vernal keratoconjunctivitis is a bilateral, recurrent disorder in which IgE and cell mediated immune mechanisms plays important roles. It primarily affects boys and usually presents in the first decade of life . 95% of cases remit by the late teens and the remainder develops atopic keratoconjunctivitis.


Classification :
               > Palpebral disease primarily involves the upper tarsal conjunctiva.
               > Limbal disease typically affects black and Asian people
               > Mixed has features of both palpebral and limbal disease

Diagnosis :
             > Symptoms consist of intense itching, which may be associated with lacrimation, photophobia, a foreign body sensation, burning and thick mucoid discharge.
            > Palpebral disease
                    - Diffuse papillary hypertrophy on the superior tarsus
                    - Macro papillae (>1mm) (cobblestones)
                    - Giant papillae
            > Limbal Disease
                    - Gelatinous papillae on the limbal conjunctiva that may be associated with discrete white spots at their apices (Trantas dots)
                    - in tropical regions limbal disease may be very severe
           > Keratopathy
                    - punctate epithelial erosion
                    - epithelial macro erosion
                    - shield ulcer and plaques
                    - pseudogenerontoxon
                    - peripheral superficial vascularization
                    - herpes simplex keratitis
Treatment :
            Topical :
                        > Mast cell stabilizers
                        > Antihistamines
                        > Steroids
                        > Acetyl cysteine
                        > Ciclosporin
                        > Supratarsal steroid injection
            Systemic :
                       > Immunosupressive agent
                       > Oral antihistamines
            Surgery :
                       > Superficial keratectomy
                       > Amniotic membrane overlay graft

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