Vernal Keratoconjunctivitis

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  • IgE- and cell-mediated immune reaction
  • Bilateral allergic (kerato)conjunctivitis
  • Often affects boys in the first decade of life
  • 90% have other atopic conditions such as asthma and eczema
  • Symptoms most severe in spring and summer


  • Redness, itching, tearing


  • Conjunctival hyperemia
  • Subtarsal (giant) papillae , sometimes mucus deposits between giant papillae
  • Limbal Horner-Trantas dots (elevated gelatinous papillae with white spots)
  • Corneal shield ulcer (white sterile infiltrate with epithelial defect)


  • General measures:
    • Avoidance of the allergen
    • Cold compresses
    • Lid hygiene, especially in associated Staphylococcal blepharitis
  • Topical medication:
    • Mast cell stabilizers, e.g., Cromoglicic acid: Allergo Comod 2% gtt 4x/day
    • H1 receptor antagonists, e.g., Emadine SE gtt 4x/day
    • Combination preparations, e.g., Zaditen gtt SDU 2x/day or Opatanol gtt 2x/day
    • Steroid-containing drops; e.g., Dexafree or FML gtt 3-4x/day, up to every 2 hours in exceptional cases and during acute flare-ups for a few days
    • +/- immunomodulators: Cyclosporine 0.05% 2x/day if no response to steroids
    • +/- tacrolimus ointment (Protopic) 0.03% 1-2x/day long-term (CAUTION: off-label)
  • Consider systemic antihistamines

Differential Diagnoses


  • EyeWiki Vernal Keratoconjunctivitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)