Konjungtivitis Vernal – Download as Powerpoint Presentation .ppt), PDF File . pdf), Text File .txt) or view presentation slides online. Vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), and giant papillary conjunctivitis (GPC) constitute the remaining subtypes. Management of Vernal Keratoconjunctivitis. Multiple pharmacologic agents may be used to provide varying degrees of relief. Mucolytic agents.
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Residents and Fellows contest rules International Ophthalmologists contest rules. Vernal keratoconjunctivitis VKC is an atopic condition of the external ocular surface. It characteristically affects young males in hot dry climates in a seasonal manner; however this is not always the rule. The first description of VKC is credited to Arlt who described 3 cases of peri-limbal swelling in young patients in .
In Trantas described the vetnal white dots that had been previously demonstrated by Horner. InGabrielides identified eosinophils in conjunctival secretions as well of the peripheral blood of VKC patients. InTrantas characterized the spectrum of corneal vdrnal seen in VKC . It is typically bilateral but may be asymmetric in nature. The main differential diagnosis to be considered is atopic keratoconjunctivitis AKC. AKC typically has an older age of onset in the 2nd to 5th decade, as opposed to onset prior to age 10 with VKC.
Additionally, AKC is typically more chronic in nature and more commonly results in scarring of the cornea and conjunctival cicatrization, whereas VKC is typically more self-limiting [4, 6].
Additional differential diagnoses to consider depending on history and physical would be seasonal allergic conjunctivitis and giant papillary conjunctivitis. VKC is a condition seen primarily in hot and dry climates most commonly in West Africa and the Mediterranean basin [1, 2]. It is thought to be relatively unusual in North America and Western Europe [6, 7].
The increased incidence in hot regions is speculated to be secondary to a higher level of pollution by pollens and various other allergens. Males are affected more than females, but this difference becomes smaller as age increases . It is difficult to obtain an accurate prevalence as many patients may not present to clinics as they may have a mild form of the disease and the condition is largely self-limiting. Depending on konjubgtivitis and climate, prevalence of VKC can vary widely.
Additionally, prevalence in endemic regions is much higher when looking at adolescents compared to the population as a whole . For instance, one European study demonstrated the prevalence was between 1. The majority of VKC occurs in patients between the ages of years old with an age of onset between years old; however there are reports of patients as young as 5-months-old [2, 11].
A konjungtivits or family history of atopy is seen in a large proportion of VKC patients . VKC was originally thought to be due to a solely IgE mediate reaction via mast cell release . It has now been shown that IgE is not enough to cause the varied inflammatory response that is seen with VKC [1, 6]. Activated eosinophils are thought to play a significant role and these can be shown consistently in conjunctival scrapings; however mononuclear cells and neutrophils are also seen [1, 6].
Thought has been given to a possible endocrine method as well as there is a decrease in symptoms and prevalence after puberty [1, 2]. A hereditary association has been suggested, but no direct genetic associations have been made. VKC is seen more often konjungtivltis patients who have atopic family konjungtivjtis, but no clear correlation with specific genetic loci has been elucidated .
Removal of any and all possible allergens as well as conservative management such as cool compresses and lid scrubs make up the first line of therapy . A topical antihistamine only may work in mild cases . Topical mast cell stabilizers cromolyn sodium, nedocromil sodium, and lodoxamide are typically used with topical antihistamines and konjungtjvitis been shown to be effective in moderate presentations of VKC .
Treatment of Vernal Conjunctivitis
Mast-cell stabilizers have a loading period to reach their full therapeutic effect . If seasonal recurrence is known, it is suggested that mast-cell stabilization therapy be initiated prior to the season in which symptoms are encountered and continued throughout the season .
Konjungtivutis agents with both H1-blocking mechanism and mast-cell stabilization have the benefits of working immediately and having long-term disease modifying effects.
Topical corticosteroids are typically the most effective. High pulse dose with quick tapering and use of low-absorptions corticosteroids fluoromethelone, loteprednol, remexolone, etc. Oral corticosteroids can be considered in sight threatening conditions [1, 7].
Injection of local corticosteroid into the upper tarsal papillae can sometimes offer short term relief as well [2, 7]. Long term immunomodulation with steroid sparing agents such as cyclosporine and verbal is often needed.
Topical cyclosporin-A in concentrations of 0. Additionally, adult patients with VKC may respond more favorably to topical cyclosporin therapy .
Vernal keratoconjunctivitis – Wikipedia
Oral anti-histamines are sometimes utilized, but there is no real evidence in their support. There is at least one report of the successful use of omalizumab, an anti-IgE monoclonal antibody, in a patient with VKC recalcitrant to other treatment modalities . Generally VKC is a rather benign and self-limiting disease that may resolve with age or spontaneously at puberty [1, 2, 7].
Nonetheless, the sometimes debilitating nature of this disease when it is active necessitates therapy to control symptoms.
Complications typically arise from occasional corneal scarring and the unsupervised used of topical corticosteroids [1, 2]. In some patients symptoms may persist vernall childhood, which in some cases may represent a conversion to an adult form of atopic keratoconjunctivitis . Mannis, and Edward J. Ital J Pediatr, Br J Ophthalmol, Badr, Corneal ectasia in vernal keratoconjunctivitis.
Am J Trop Med Hyg, Eur Rev Med Pharmacol Sci, Toker, Tear cytokine levels in vernal keratoconjunctivitis: Kosrirukvongs, Use of cyclosporine A and tacrolimus in treatment of vernal keratoconjunctivitis. Curr Allergy Asthma Rep, Am J Ophthalmol, Indian J Ophthalmol, Barot, RK et al.
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