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Vernal Keratoconjunctivitis (VKC)

Vernal Keratoconjunctivitis (VKC) is an infrequent, but periodically occurring condition that affects individuals at a very young age, and those who primarily live in hot-dry climates. Since, onset of the eye-allergy disorder is generally during the spring season, it is called Vernal Keratoconjunctivitis.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Spring Catarrh
  • Warm Weather Conjunctivitis
  • VKC

What is Vernal Keratoconjunctivitis? (Definition/Background Information)

  • Vernal Keratoconjunctivitis (VKC) is an infrequent, but periodically occurring condition that affects individuals at a very young age, and those who primarily live in hot-dry climates. Since, onset of the eye-allergy disorder is generally during the spring season, it is called Vernal Keratoconjunctivitis
  • VKC affects individuals with a family history of allergic disorders, and those who (may) themselves suffer from eczema, atopic rhinitis, or other environmental allergies
  • Conjunctivitis is inflammation of conjunctiva of the eye which is the membrane covering the white region of the eye
  • In Conjunctivitis the white part of the eye turns red or pink, and hence it is known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision. VKC is not infectious
  • VKC always involves the cornea and conjunctiva, of both the eyes. The condition is seen to subside in children automatically, by or after puberty

Who gets Vernal Keratoconjunctivitis? (Age and Sex Distribution)

  • Young children, adolescents, and teens (age between 4-20 years), commonly suffer from Vernal Keratoconjunctivitis. Among these, children below the age of 10, are affected the most
  • Boys tend to be affected more than girls (about 2-4 times more)
  • Dark-skinned individuals (particularly Africans & Indians) are more susceptible to a certain form of the disorder
  • The incidence of the disorder is high in certain hot dry, hot wet geographical regions, such as the Middle East Asia, Africa, and Mediterranean areas

What are the Risk Factors for Vernal Keratoconjunctivitis? (Predisposing Factors)

The potential risk factors for Vernal Keratoconjunctivitis are:

  • An individual with a family history of allergies (like when parents are allergic to such allergens), is more prone to the condition
  • The presence of other allergy-related diseases or disorders (like allergic rhinitis, asthma, eczema) may trigger the condition. There is a high, 90% probability of being affected by VKC, in such cases
  • Warm dry, warm wet regions; spring-summer months
  • Environmental or occupational exposure to seasonal allergy causing substances

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Vernal Keratoconjunctivitis? (Etiology)

  • Vernal Keratoconjunctivitis is caused by seasonal exposure to external agents or particles that cause an allergic inflammatory response. An individual has to be allergic to that substance (these could either be single or multiple allergens)
  • When the allergen comes into contact with the conjunctiva and mucus membranes lining the eyes, the body releases histamine (an organic chemical) triggering the allergy symptoms. This is caused due to an extremely sensitive body immune system
  • The hypersensitive reaction of the body is thought to occur due to a morphological (anatomical) susceptibility to allergic conditions such as rhinitis, eczema, and asthma
  • VKC has not been understood properly. It is believed that the sex hormones (estrogen & progesterone), the central nervous system, and other body factors may also play significant roles
  • Environmental factors and allergic substances like pollen, dust, dander, smoke, chemicals, and other pollutants
  • Sometimes, certain non-specific elements like wind, heat, sun, may aggravate the allergic response

What are the Signs and Symptoms of Vernal Keratoconjunctivitis?

Signs and symptoms of Vernal Keratoconjunctivitis (which is present seasonally) include:

  • Itching and redness of the eye(s)
  • Eye pain and inflammation; with gritty feeling of sand-like particles inside the eye
  • Eyelids may show the presence of small nodules (papillae); eyelids may droop, twitch
  • Continuous discharge of watery fluid from the eyes
  • Blurred vision, light sensitivity
  • About 25% of the individuals may experience symptoms throughout the year; in 60%, the symptoms are noticed during winter months too
  • The seasonal variation of the disorder may change or decrease after 3 years, and VKC may gradually become a long-standing illness

How is Vernal Keratoconjunctivitis Diagnosed?

Vernal Keratoconjunctivitis is diagnosed as follows

  • The ophthalmologist or physician performs a detailed eye examination; including a slit lamp or ophthalmoscope exam
  • Evaluation of the patient’s medical history; specifically the incidence of any other allergies, asthma, rhinitis, etc. The chronic/repetitive nature and seasonal variation of the condition, is noted
  • Blood analysis; to measure serum IgE level, eosinophil count
  • Examination of conjunctival scrapings; culture to rule out infectious cause
  • Differential diagnosis of other types of conjunctivitis should be considered, in order to eliminate other eye conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Vernal Keratoconjunctivitis?

Serious complications may arise if Vernal Keratoconjunctivitis is not treated. It is also dependent upon the presence of other secondary conditions (if any). The complications could include:

  • Corneal damage, scar, and perforation
  • Damage to the eye, loss of vision (with late or no treatment)
  • Bacterial or viral (herpes) infections
  • Cataract, glaucoma; these may also be the side effects of various treatment medications
  • Prolonged discomfort, mental and emotional stress

How is Vernal Keratoconjunctivitis Treated?

Vernal Keratoconjunctivitis needs to be treated effectively to control its potentially blinding effect. The substance(s) responsible for an allergic trigger has to be identified and controlled, the symptoms treated, and the body immune response system moderated. Some general management measures include:

  • Addressing the chronic (long-term) nature of VKC; this includes using medications such as oral antihistamines and mast cell stabilizers (a non-steroid drug). These medications also prevent worsening of the condition
  • Other drugs to provide relief from symptoms are immunosuppressants, corticosteroids (prescribed in severe symptom cases only), cyclosporine, oral aspirin, and decongestants
  • Lubricating or anti-inflammatory eye-drops, and topical ointments are usually not very effective
  • Avoidance of outdoor allergens and control of indoor allergy-inducing irritants should be considered. It is important that the specific allergen(s) be identified
  • Application of cold compress can help reduce discomfort; and so can staying in air-cooled indoor spaces
  • Immunotherapy (allergy shots) is used to desensitize the body and prevent it from overreacting to such external triggers. This method is usually considered, in case of a severe allergic attack that does not respond well to treatment, or when other medical disorders are also present
  • Suitable corrective surgery may be used to manage cataract, corneal injury, and eye inflammation
  • Avoid the use of contact lens during this period; wear eye glasses instead

How can Vernal Keratoconjunctivitis be Prevented?

  • Vernal Keratoconjunctivitis is a spontaneous body (eye) response to the presence of an allergen; it cannot be prevented, but only managed
  • Be aware of the allergy activating factor(s) and avoid such locations or situations, which provoke the body immune system to respond in such a manner
  • In order to preserve the eye condition, always maintain hygiene and wash hands regularly. Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also avoid touching or rubbing the eyes (this may be difficult when the individuals are very young children)
  • Stop or restrain yourself from smoking tobacco, or drinking alcohol
  • Keep clean, air-conditioning filters, either at home or at offices, in order to prevent airborne pollen from reaching or circulating indoors; particularly during the allergy periods
  • Regular medical screenings at periodic intervals with physical examinations are mandatory for those diagnosed with this disorder
  • In case of a severe incidence of the condition; relocation to colder climates is beneficial, but it may not always be practicable

What is the Prognosis of Vernal Keratoconjunctivitis (Outcomes/Resolutions)

  • Vernal Keratoconjunctivitis, without proper diagnosis and quick treatment could potentially cause eye damage and loss of vision, due to corneal complications
  • Accurate diagnosis with management of VKC, can help avoid worsening of the condition and save the eyes from damage, and possible blindness
  • Mild cases of VKC are known to resolve spontaneously. Young children usually outgrow the condition, after the onset of puberty

Additional and Relevant Useful Information for Vernal Keratoconjunctivitis:

  • Many alternatives medicine therapies, natural therapy, or home remedies are available to ease the discomfort of Allergic Conjunctivitis. However, such treatment methods are not a proven science and should not be substituted for a qualified healthcare provider’s medical advice
  • Vernal Keratoconjunctivitis is also called as Warm Weather Conjunctivitis

What are some Useful Resources for Additional Information?

Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
Email: cdcinfo@cdc.gov
Website: http://www.cdc.gov

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002005/ (accessed on 02/24/13)

http://www.mayoclinic.com/health/pink-eye/DS00258/DSECTION=causes (accessed on 02/24/13)

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002026/ (accessed on 02/24/13)

http://www.nature.com/eye/journal/v18/n4/full/6700675a.html (accessed on 02/24/13)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705659/ (accessed on 02/24/13)

Helpful Peer-Reviewed Medical Articles:

Bonini, S., Bonini, S., Lambiase, A., Marchi, S., Pasqualetti, P., Zuccaro, O., ... & Bucci, M. G. (2000). Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term followup. Ophthalmology, 107(6), 1157-1163.

Pucci, N., Novembre, E., Cianferoni, A., Lombardi, E., Bernardini, R., Caputo, R., ... & Vierucci, A. (2002). Efficacy and safety of cyclosporine eyedrops in vernal keratoconjunctivitis. Annals of Allergy, Asthma & Immunology, 89(3), 298-303.

Bonini, S., Coassin, M., Aronni, S., & Lambiase, A. (2004). Vernal keratoconjunctivitis. Eye, 18(4), 345.

Uchio, E., Ono, S. Y., Ikezawa, Z., & Ohno, S. (2000). Tear levels of interferon-gamma, interleukin (IL)-2, IL-4 and IL-5 in patients with vernal keratoconjunctivitis, atopic keratoconjunctivitis and allergic conjunctivitis. Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology, 30(1), 103-109.

Leonardi, A. (2002). Vernal keratoconjunctivitis: pathogenesis and treatment. Progress in retinal and eye research, 21(3), 319-339.

Gupta, V., & Sahu, P. K. (2001). Topical cyclosporin A in the management of vernal keratoconjunctivitis. Eye, 15(Pt 1), 39-41.

Kumar, S. (2009). Vernal keratoconjunctivitis: a major review. Acta ophthalmologica, 87(2), 133-147.

Sridhar, M. S., Sangwan, V. S., Bansal, A. K., & Rao, G. N. (2001). Amniotic membrane transplantation in the management of shield ulcers of vernal keratoconjunctivitis. Ophthalmology, 108(7), 1218-1222.

Leonardi, A., Busca, F., Motterle, L., Cavarzeran, F., Fregona, I. A., Plebani, M., & Secchi, A. G. (2006). Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological study. Acta Ophthalmologica Scandinavica84(3), 406-410.