About Vernal Keratoconjunctivitis
The causes of VKC occur when certain inflammatory cells enter the conjunctiva of the eye. These inflammatory cells include eosinophils, activated CD4+ lymphocytes, and cytokines.
There are both non-modifiable and modifiable risk factors associated with VKC.
Non-modifiable risk factors for VKC cannot be changed or controlled. These include:
- Pre-existing allergies: People who already have allergies are more likely to develop VKC.
- Family history: Having a family history of allergic rhinitis, atopic dermatitis, or asthma increases the risk of developing VKC.
Modifiable risk factors for VKC can be influenced or changed. These include:
- Environmental allergens: Exposure to certain allergens in the environment can increase the likelihood of developing VKC. These allergens can include pet dander, molds, pollens, and tobacco smoke. It's important for people with VKC to try to avoid these allergens as much as possible.
- Eye rubbing: Rubbing or touching the eyes can worsen symptoms and increase inflammation in people with VKC. It's recommended to avoid touching or rubbing the eyes if you have VKC.
- Hot climates: Dry and hot climates can contribute to flare-ups of VKC. People with the condition can reduce symptoms by staying indoors on hot days or wearing sunglasses to protect their eyes.
It's important for individuals with VKC to be aware of these risk factors and take steps to minimize their exposure to triggers. Avoiding allergens, practicing good hand hygiene by washing hands frequently, and protecting the eyes from hot weather can help reduce symptoms and prevent complications.
Remember, if you suspect you have VKC or any other eye condition, it's always best to consult with an eye care professional for an accurate diagnosis and appropriate treatment.
The most common early symptoms of VKC include:
- Redness: The eyes may appear red and bloodshot.
- Intense itching: Individuals with VKC often experience severe itching in their eyes.
- Sensation of a foreign body in the eye: People with VKC may feel as though there is something in their eye, such as sand or an eyelash.
- Watery eyes: Excessive tearing is a common symptom of VKC.
- Thick, ropy mucus discharge: Upon waking, individuals with VKC may notice a thick, stringy mucus discharge from their eyes.
- Blurred vision: In some cases, VKC can cause temporary blurring of vision.
- Sensitivity to light (photophobia): People with VKC may find bright lights uncomfortable or painful to their eyes.
As VKC progresses or becomes more severe, additional symptoms may occur. These symptoms can vary depending on the individual and the specific stage of the disease. Some common symptoms that may occur with later stages or higher severity of VKC include:
- Eczema or asthma: Vernal keratoconjunctivitis is often accompanied by other allergic conditions such as eczema or asthma.
- Severe itchiness: The itching sensation in the eyes can become more intense as VKC progresses.
- Thick mucus and high tear production: Individuals with VKC may experience increased production of thick mucus and tears.
- Foreign body sensation: The feeling of having something in the eye may become more pronounced.
- Light sensitivity: Sensitivity to light can worsen as VKC progresses.
- Corneal scarring: If left untreated, VKC can lead to scarring on the cornea, which can affect vision.
It's important for individuals experiencing any symptoms of VKC to consult a doctor for diagnosis and treatment options. Treatment can help alleviate symptoms and prevent permanent eye damage.
To diagnose VKC several examinations, tests, and procedures are commonly performed. These include:
- Medical history: The doctor will ask about your symptoms and any previous diagnoses.
- Clinical examination: A corneal specialist ophthalmologist or an experienced research optometrist will perform a clinical examination. This involves using a slit-lamp biomicroscope to examine the eyes for signs of VKC. They will look for thinning of the cornea’s middle layer, Vogts striae (wrinkles in the cornea), or a Fleischer ring (a ring of iron deposits).
- Retinoscopy examination: This test is done after dilating the pupil with eyedrops to check for specific signs of VKC under a light. The doctor will look for specific signs such as the “oil droplet” sign, where light reflection on the eye looks uneven, and “scissoring” of the red reflex, when the red reflection in the eye appears irregular.
- Videokeratography evaluation: This test is performed using specialized equipment such as the Topographic Modeling System, Orbscan II, Oculus Pentacam, or Keratron. It creates a detailed map of the cornea's shape and curvature. In VKC, the videokeratography map usually shows an uneven bowtie shape with lines that don’t match up above and below the middle line of the eye. This pattern helps doctors see specific changes in the eye’s shape that are linked to VKC.
To determine the stage or severity of VKC, additional examinations, tests, and procedures may be performed:
- Grading: The severity of VKC can be graded using a system described by Bonini et al. This system categorizes VKC into different stages, such as mild intermittent, moderate intermittent, moderate persistent, severe persistent, and very severe disease.
- Symptoms assessment: A visual analog scale may be used to assess symptoms such as itching, photophobia (sensitivity to light), watering, and redness in the eyes.
- Biomicroscopy: This is a detailed examination of the structures of the eye using a slit-lamp biomicroscope. It can help identify specific signs associated with different stages of VKC.
- Staining: Fluorescein break-up time (BUT) test, corneal fluorescein staining, and conjunctival lissamine green staining may be performed to assess the health of the eye surface and detect any abnormalities.
- Corneal esthesiometry: This test measures corneal sensitivity to determine if there is any loss of sensation in the cornea.
- Schirmer test: This test measures tear production by placing small strips of filter paper inside the lower eyelid for a few minutes to see how much tears are produced.
- Meibomian glands inspection and expression: The meibomian glands are examined to assess their function and identify any abnormalities.
By performing these examinations, tests, and procedures, healthcare professionals can accurately diagnose VKC and determine its stage or severity.
The goals of treatment for VKC are to alleviate inflammation, reduce symptoms, and prevent permanent eye damage. There are several types of medications, therapies, and procedures that can be used to achieve these treatment goals. Let's take a closer look at each of them:
- Medications:
- Anti-allergic eye drops: These eye drops help to reduce inflammation and relieve symptoms such as itching, redness, and swelling. They work by blocking the release of histamine, which is a chemical that triggers allergic reactions.
- Steroid eye drops: In more severe cases of VKC, steroid eye drops may be prescribed to reduce inflammation. Steroids are powerful anti-inflammatory medications that help to alleviate symptoms and prevent complications.
- Mast cell stabilizers: These eye drops help to prevent the release of histamine and other inflammatory substances from mast cells. By stabilizing mast cells, they can help reduce itching and inflammation.
- In severe cases of VKC, topical medications that adjust the immune system response (called immunomodulators) like cyclosporin and tacrolimus have been found to be effective in alleviating signs and symptoms. These medications help adjust the immune response in the eye and reduce inflammation.
- Therapeutic procedures:
- Immunotherapy: In some cases, immunotherapy may be recommended for individuals with severe VKC who do not respond well to other treatments. Immunotherapy involves receiving regular injections of small amounts of allergens to make the immune system less sensitive and reduce allergic reactions.
- Self-care and health behavior changes:
- Avoiding allergens: Identifying and avoiding allergens that trigger VKC symptoms can help prevent flare-ups. Common allergens include pollen, dust mites, pet dander, and certain foods.
- Wearing sunglasses: Wearing sunglasses outdoors can provide protection against allergens in the environment and reduce exposure to UV rays, which can worsen VKC symptoms.
- Cold compresses: Applying cold compresses to the eyes can help soothe inflammation and provide temporary relief from symptoms.
- Eyelid hygiene: Keeping the eyelids clean can help prevent bacterial infections and reduce symptoms. This can be done by gently cleaning the eyelids with warm water and a mild cleanser.
It's important for individuals with VKC to work closely with their doctor to develop a personalized treatment plan that addresses their specific needs and goals. Prompt diagnosis and appropriate treatment can help manage symptoms effectively and minimize the risk of long-term complications.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.
Over time, VKC tends to have a chronic and recurrent disease course with short intervals between relapses. The disease severity can vary, and it can lead to various complications that may impact daily activities and schooling. Some of the complications commonly associated with VKC include:
- Visual impairment: The inflammation caused by VKC can affect vision and lead to visual impairment. This can impact daily activities and schooling, especially since most affected individuals are in the school-going age group.
- Corneal involvement: VKC can cause inflammation of the cornea, which is the clear front surface of the eye. This can result in various corneal complications, such as punctate epithelial erosions, corneal shield ulcers, or corneal scars.
- Limbal swelling: VKC can cause swelling of the limbal area, which is the border between the cornea and the white part of the eye. This may be accompanied by the formation of Trantas dots, which are small white or yellowish bumps on the limbus.
- Giant papillae: VKC can lead to the formation of giant papillae on the upper tarsal conjunctiva. These are large bumps or elevations that can be seen upon examination.
It's important to note that while treatments can help manage symptoms and reduce complications, there is currently no known cure for VKC. Regular follow-up with a doctor is crucial for monitoring disease progression and adjusting treatment as needed.