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Disease

• 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

Symptoms

• Redness, itching, tearing

Findings

• 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)

Treatment

• 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

• Allergic Conjunctivitis
• Atopic Keratoconjunctivitis

Sources

• 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)