VKC Flashcards
What is allergic conjunctivitis ?
It is the inflammation of the conjunctiva due to allergic or hypersensitivity reactions which can be immediate (humoral) or delayed (cell mediated)
What is VKC?
Recurrent , bilateral , interstitial, self limiting allergic inflammation of the conjunctiva having a periodic seasonal incidence
Other names of VKC
Spring catarrh
Warm weather conjunctivitis
Etiopathogenesis of VKC
Primary event - Th2 lymphocyte alteration
Secondary event - exaggerated IgE response to common allergens
What does the pathological changes in VKC leads to ?
It leads to the formation of multiple papillae in the upper tarsal conjunctiva
Symptoms of VKC
Marked BURNING or ITCHING sensation which is accentuated in warm humid climate ; itching is more in palpebral form of disease
Watering , STRINGY / ROPY discharge , mild photophobia , heaviness of lids
Clinical forms of VKC
Palpebral VKC
Bulbar VKC
Mixed VKC
Signs of palpebral VKC
Upper tarsal conjunctiva of both the eyes are involved
Characterised by the formation of papillae - hard , reddish flat topped raised areas that are arranged in COBBLE STONE or PAVEMENT STONE fashion along with conjunctival hyperaemia
In severe cases - papillae will hypertrophy forming cauliflower like excrescence called GIANT PAPILLAE
discharge - white ropy discharge
How to differentiate between palpebral form of VKC and active trachoma with predominant papillary hyperplasia?
Papillae in palpebral form of VKC - arranged in cobblestone / pavement stone fashion unlike trachoma
PH of tears - alkaline in VKC and acidic in trachoma
Apart from papillae , follicles and pannus are found in trachoma and not in VKC
Discharge - ropy in VKC
If the cases are clinically indistinguishable then , lab tests are done to differentiate between these two
Signs of bulbar VKC
Dusky red triangular congestion
Limbal papillae occur as gelatinous , thick , confluence accumulation of tissue around the limbus
HORNER TRANTA’S spots - discrete white raised dots along the limbus
Signs of mixed VKC
Has signs of both palpebral and bulbar VKC
What is vernal keratopathy ?
Vernal keratopathy is the corneal involvement in VKC ; more common in palpebral form
The lesions are
🌔superior punctate epithelial keratitis
🌔epithelial macroerosions
🌔vernal corneal plaques
🌔ulcerative vernal keratitis (shield ulceration)
🌔subepithelial scarring
🌔pesudogerontoxon
DD of VKC
Atopic keratoconjunctivitis
Active trachoma with predominant papillary hypertrophy
Treatment of VKC
Topical anti allergic and anti inflammatory - mainstay of treatment
Topical steroids
Mast cell stabilisers
Topical immunomodulators
Topical lubricating and mucolytic agents
Systemic therapy - for severe cases
Treating large papillae
Conservative treatment
Treating vernal keratopathy
When is topical immunomodulator given in VKC ?
It is given when steroid are ineffective , inadequate or poorly tolerated
These include tacrolimus and cyclosporine
