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Vernal Keratoconjunctivitis


Also called spring catarrh or warm weather conjunctivitis

  1. Type :       
    1. Palpebral                        
    2. Limbal VKC               
    3. Mixed
  2. C/F: Intense ocular itching, Lacrimation, Photophobia, Foreign body sensation, Burning thick mucus discharge, Coagulates to membrane on exposure to sunlight. (ROPY DISCHARGE- MAXWELL LYON SIGN) *
  3. Palpebral VKC
    1. Papillary hypertrophy most marked on superior tarsus*
    2. Papillae- become larger – cobble – stone appearance*
  4. Limbal VKC
    1. Limbal papillae with smooth, round, surface.
    2. At the apices of papillae- “Trantas spots” composed predominantly of eosinophils. Also called “Horner – Trantas spots*”
  5. Corneal changes in VKC:
    1. Gerontoxon – “ cupids bow”( gelatinous droplets on limbus)
    2. Shield ulcer* on cornea due to mechanical rubbing of cornea by papillae
    3. Secondary keratoconus
  6. Treatment
  • medical
  1. Steroids-Fluorometholone and Clobetasone topical . supratarsal injection of triamcinolone in refractory cases
  2. DOC-Antihistaminics with Dual action (Antihistaminics+Mast) cell stabilizers-Sodium Cromoglycate, Ketotifen, Olopatadine and Epinestine.
  3. Refractony VKC-Cyclosporine (Topical), Tacrolimus
  4. acetyl cysteine 0.5%
  • surgical
    1. excision of papillae
    2. amniotic membarane transplantation
    3. photo-therapeutic keratectomy

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