Presentation
In patients with vernal conjunctivitis, acute hydrops may be the presenting sign of keratoconus in preadolescence. [ncbi.nlm.nih.gov]
An otherwise healthy 6-year-old boy presented to the emergency department with a 2-year history of what his mother referred to as “eye problems.” She reported noticing “whitish specks” surrounding both irises, which had been increasing in size. [nejm.org]
Topical antihistamines, both over the counter and prescription options, are commonly used for non-severe acute and chronic allergic conjunctivitis, according to the presentation. [healio.com]
Clinical Presentation Demographics VKC is a disease showing great racial and geographical variation. [aao.org]
Entire Body System
- Inflammation
[…] in the bulbar form by gelatinous nodules adjacent to the corneoscleral limbus. vernal conjunctivitis [vur′nəl] Etymology: L, vernare, springlike, conjunctivus, connecting; Gk, itis, inflammation a chronic, bilateral inflammation of the conjunctiva, thought [medical-dictionary.thefreedictionary.com]
[…] role in the mechanism of inflammation of the disease, thus raising hopes for future addition to therapy. [ncbi.nlm.nih.gov]
Chronic disease periodicity is defined as inflammation free intervals of less than one month during which patient is off medications. [doi.org]
Considering taking medication to treat inflammation of cornea and conjunctiva occurring in spring? Below is a list of common medications used to treat or reduce the symptoms of inflammation of cornea and conjunctiva occurring in spring. [webmd.com]
- Asymptomatic
Fourteen asymptomatic patients with vernal conjunctivitis and 10 healthy volunteers were challenged in one eye with 10 microliters of increasing doses (0.01, 0.05, 0.5, and 1 mg/ml in phosphate-buffered saline) of histamine diphosphate. [ncbi.nlm.nih.gov]
Their action is purely asymptomatic. See BAÑO OCULAR POEN®. ALOSOL®. Anti-allergic and antihistaminic agents: they act by inhibiting the degranulation of mastocites and blocking histamine-receptors. [poen.com.ar]
Penetration of the globe which does not involve the corneal areas can be relatively asymptomatic. Identifying different types of conjunctivitis[2] Conjunctivitis of different aetiologies can appear to present in a similar fashion. [patient.info]
- Severe Pain
Keratitis: this may be associated with conjunctivitis but can occur alone, often secondary to infection (be suspicious of this in contact lens wearers) - look for unilaterality, severe pain and photophobia. [patient.info]
Take note of symptoms, such as pain or itching, to further help distinguish etiology. [reviewofoptometry.com]
The patient should also be asked about the occurrence of pain. Duration, laterality, and the presence and severity of pain are the cornerstones of diagnosis. [aerzteblatt.de]
- Pallor
Dilated Fundal Exam (DFE): No pallor or edema of disc, OU. Normal macula vessels and periphery, OU. Course: The patient's course and presentation is classic for vernal keratoconjunctivitis. [webeye.ophth.uiowa.edu]
- Malaise
It presents with generalised malaise and a unilateral conjunctivitis. It responds to treatment of the underlying cause. [patient.info]
Respiratoric
- Rhinitis
Allergic rhinoconjunctivitis (both seasonal allergic rhinitis -SAR- and perennial allergic rhinitis -PAR-) and/or urticaria. [sigma.larvol.com]
A percentage of patients with vernal conjunctivitis have a close relative with an allergic condition like asthma, atopic dermatisis, allergic rhinitis or even allergic conjunctivitis. [barraquer.com]
In contrast, the control groups (eight atopic individuals, four with seasonal rhinitis, and 12 with allergic conjunctivitis) had low amounts of specific IgG antibodies to these two pollen antigens in their tears. [ncbi.nlm.nih.gov]
Predisposing factors and Risk factors- Patient may have family history of atopic disease- hay fever,asthama,allergic rhinitis, atopic dermatitis. Their eosinophil count may be high in blood. Age- specially 4-20 years. [medchrome.com]
Medications: His allergic rhinitis is treated with beclomethasone dipropionate nasal spray (Vanceril) and combined oral therapy of chlorpheniramine and pseudoephedrine (Kronofed, antihistamine and decongestant). [webeye.ophth.uiowa.edu]
- Sneezing
[…] keratoconjunctivitis: eyelid tightening, loss of eyelashes, cataracts Giant papillary conjunctivitis : eyelid inflammation and ptosis Clinical features History of allergy, asthma, or eczema Itching (pruritus), chemosis, tearing and redness with or without sneezing [pathologyoutlines.com]
It's quite common that a patient with vernal conjunctivitis is also affected by rhinitis, sneezing and a red congested nose in the spring. Causes and risk factors The cause is allergenic pollen to which the patient has hypersensitivity. [barraquer.com]
The specialist will write the medical history of the patient, detailing: • • Family or personal allergy background Description of the symptoms: eye pruritus, tearing, photophobia, edema, foreign body sensation, association of symptoms of other organs (sneezes [poen.com.ar]
People with allergic conjunctivitis are likely to have a history of other allergic symptoms including sneezing, itchy nose, and runny nose. [visionaware.org]
- Rhinorrhea
Oral antihistamines (eg, fexofenadine, cetirizine, or hydroxyzine ) can be helpful, especially when patients experience other allergic symptoms (eg, rhinorrhea). [msdmanuals.com]
- Nasal Congestion
Reduced allergen-induced nasal congestion and leukotriene synthesis with an orally active 5-lipoxygenase inhibitor. N Engl J Med 1990; 323: 1745–1748. 35 Marom Z, Shelhamer JH, Kaliner M. [nature.com]
- Dyspnea
[…] personal allergy background Description of the symptoms: eye pruritus, tearing, photophobia, edema, foreign body sensation, association of symptoms of other organs (sneezes, nasal itchiness, nasal obstruction, skin or nasal itching or lesions, cough, dyspnea [poen.com.ar]
Skin
- Pruritus
The patient complains of photophobia and pruritus of the eyes. The outcome of vernal conjunctivitis is favorable. Treatment consists of antiallergic and hormonal preparations and symptomatic therapy. [encyclopedia2.thefreedictionary.com]
[…] thinning, infection, keratoconus, and vision loss Atopic keratoconjunctivitis: eyelid tightening, loss of eyelashes, cataracts Giant papillary conjunctivitis : eyelid inflammation and ptosis Clinical features History of allergy, asthma, or eczema Itching (pruritus [pathologyoutlines.com]
Similarly, cold compresses can be extremely useful to avoid the customary irrational rubbing response to chronic or paroxysmal pruritus. [emedicine.medscape.com]
Wheal and pruritus scores, quality of life, patient discomfort, somnolence, and safety were assessed. [yumpu.com]
Differential Diagnosis: • Eczematous Dermatitis • Seborrheic blepharitis The specialist will write the medical history of the patient, detailing: • • Family or personal allergy background Description of the symptoms: eye pruritus, tearing, photophobia [poen.com.ar]
Eyes
- Photophobia
Associated symptoms include mild photophobia in case of corneal involvement, lacrimation, stringy discharge and heaviness of eyelids. [en.wikipedia.org]
[…] ver·nal con·junc·ti·vi·tis a chronic, bilateral conjunctival inflammation with photophobia and intense itching that recurs seasonally during warm weather; characterized in the palpebral form by cobblestone papillae in the upper palpebral conjunctiva and [medical-dictionary.thefreedictionary.com]
Both eyes are generally involved, and patients often report ocular burning or itching, tearing, and photophobia. Diagnosis is typically based on the clinical findings of giant cobblestone papillae on the tarsal conjunctiva or at the limbus. [nejm.org]
Topical steroids are widely used in controlling the severe distressing symptoms as intense itching, photophobia and lacrimation. [jpma.org.pk]
- Lacrimation
Topical steroids are widely used in controlling the severe distressing symptoms as intense itching, photophobia and lacrimation. [jpma.org.pk]
In contrast, the tear concentration of lactoferrin (another important tear protein produced by the lacrimal glands) was reduced both in VC and GPC patients. [ncbi.nlm.nih.gov]
Mild Photophobia Ropy discharge ( string like) Lacrimation Heaviness of lids. Signs- Palpebral form- Cobblestone or pavement stone arrangement of inflamed papillae on the Upper Tarsal conjunctiva. [medchrome.com]
Results: Dramatic relief of symptoms (burning, itching, lacrimation and photophobia, ropy discharge) was seen in all patients in first few days after the supratarsal injection. [scopemed.org]
(Lacrimal Apparatus Diseases) Arcus Senilis Arcus, Corneal (Arcus Senilis) Asthenopia Astigmatism Astrocytoma, Malignant, Optic Nerve (Optic Nerve Glioma) Atrophies, Gyrate (Gyrate Atrophy) Atrophies, Hereditary Optic (Optic Atrophies, Hereditary) Atrophy [provisu.ch]
- Chemosis
Prostaglandin D2 is a secondary mast cell mediator that causes redness, chemosis, mucous discharge, and eosinophil chemotaxis in the eye. It may play an important role in allergic ocular disease. [ncbi.nlm.nih.gov]
[…] infection, keratoconus, and vision loss Atopic keratoconjunctivitis: eyelid tightening, loss of eyelashes, cataracts Giant papillary conjunctivitis : eyelid inflammation and ptosis Clinical features History of allergy, asthma, or eczema Itching (pruritus), chemosis [pathologyoutlines.com]
Chemosis and a characteristic dermatoblepharitis with hyperemia, edema and lichenification of the medial upper first and then lower eyelid, are common. [msdmanuals.com]
Watering Mucoid stringy discharge Blurred vision Photophobia Difficulty opening eyes on waking NB: the symptoms are often asymmetrical in the two eyes Signs Stringy white mucous exudate Palpebral, limbal and corneal manifestations: Palpebral hyperaemia and chemosis [college-optometrists.org]
- Visual Impairment
Int Symp Blindness and Visual Impairment, Los Angeles. 172. Hyvarinen L. Assessment of vision of multihandicapped children (1988) Int Symp Blindness and Visual Impairment, Los Angeles, abstract. 173. Hyvarinen L. [medicpdf.com]
In some cases, permanent changes to the ocular surface may occur and be accompanied by permanent visual impairment. [nature.com]
impairment among students in southwestern Nigeria. 61 Ajaiyeoba AI...Oluleye TS 17585376 2007 35 Prevalence of refractive error and other eye diseases in schoolchildren in the Greater Accra region of Ghana. 61 Ntim-Amponsah CT...Ofosu-Amaah S 17913172 [malacards.org]
Discussion VKC is a chronic, seasonally exacerbated allergic inflammation of the ocular surface involving the tarsal and/or the bulbar conjunctiva. [5] VKC is not a blinding disease but visual impairment is common if the cornea is involved. [tjmrjournal.org]
- Visual Impairment
Int Symp Blindness and Visual Impairment, Los Angeles. 172. Hyvarinen L. Assessment of vision of multihandicapped children (1988) Int Symp Blindness and Visual Impairment, Los Angeles, abstract. 173. Hyvarinen L. [medicpdf.com]
In some cases, permanent changes to the ocular surface may occur and be accompanied by permanent visual impairment. [nature.com]
impairment among students in southwestern Nigeria. 61 Ajaiyeoba AI...Oluleye TS 17585376 2007 35 Prevalence of refractive error and other eye diseases in schoolchildren in the Greater Accra region of Ghana. 61 Ntim-Amponsah CT...Ofosu-Amaah S 17913172 [malacards.org]
Discussion VKC is a chronic, seasonally exacerbated allergic inflammation of the ocular surface involving the tarsal and/or the bulbar conjunctiva. [5] VKC is not a blinding disease but visual impairment is common if the cornea is involved. [tjmrjournal.org]
Neurologic
- Irritability
The first think to do is to avoid rubbing your eyes because this causes further irritation. Most cases can be treated at home. [healthline.com]
One type of noninfectious conjunctivitis is “irritant conjunctivitis.” It is caused by irritants to the eye, such as pollution particles in the air, chlorine in swimming pools, or an acid or base accidentally dropped or rubbed onto the eye. [tedmontgomery.com]
The reduction in symptom severity was significantly greater in the levocabastine group than in the control group for photophobia (p < 0.003) after 1 week, and for photophobia (p < 0.008), irritation (p = 0.05) and itchy eyes (p = 0.05) at the end of the [ncbi.nlm.nih.gov]
Chronic and severe anterior blepharitis: the reduction in the tear film associated with blepharitis can cause chronic irritation and scarring. Drugs: may cause mild-to-severe irritation. [patient.info]
It is more common in young people and may result from sensitivity to external irritants. It usually responds to treatment with antiallergy or anti-inflammatory medication. Read More [britannica.com]
- Burning Sensation
Treatment involves antihistamine eyedrops to reduce the burning sensation and allergic reaction. [barraquer.com]
Symptoms: • Mild itchiness • Tearing • Burning sensation • Pressure sensation in the posterior part of the eye. [poen.com.ar]
Symptoms of this condition include: irritated, painful, itchy eyes a burning sensation in the eyes excessive tearing swollen eyes (especially the area around the edge of the cornea where the cornea meets the sclera, or white of the eye ) pink or red eyes [healthline.com]
CYCLOSPORINE 2% QID Severe to intractable VKC MOAImmunosuppressive,T CELL inhibition reduce collagen producn and coz apoptosis of fibroblasts S/E burning sensation Subjective and objectve improvement occurs in 3 days and complete improvement [slideshare.net]
For the purpose of this study, six symptoms (ocular itching, red eye, burning sensation, photophobia, tearing, and ocular foreign body sensation) were evaluated and also eight clinical signs (conjunctival hyperemia, ocular surface condition, conjunctival [omicsonline.org]
- Seizure
Other signs are frontal bossing, persistent frontal lobe reflexes, strabismus and seizures. It has been described in three generations of one family. Transmission is X-linked, and the gene is located on chromosomal region Xq27.3-qter. [rarediseases.info.nih.gov]
[…] characterised by early-onset parkinsonism (postural changes, tremor, rigidity), defects of the basal ganglia, megalencephaly, mental retardation and other variably present signs such as frontal bossing, persistent frontal lobe reflexes, strabismus and seizures [medical-dictionary.thefreedictionary.com]
- Stroke
Wang TJ, Keller JJ, Sheu JJ, Lin HC: A 3-year follow-up study on the risk of stroke among patients with conjunctival haemorrhage. Acta Ophthalmol 2013; 91: 226–30 CrossRef MEDLINE e15. [aerzteblatt.de]
Susceptibility gene for human stroke; methods of treatment US6479493B1 ( en ) 2001-08-23 2002-11-12 Cell Pathways, Inc. Methods for treatment of type I diabetes US20030073711A1 ( en ) * 2001-08-23 2003-04-17 Whitehead Clark M. [google.com.do]
Workup
Seasonal allergic conjunctivitis (SAC) is a self-limiting condition that usually exhibits small tarsal papillae.3 Atopic keratoconjunctivitis has prolonged symptoms and can have sight-threatening consequences.3 Your workup should begin with a thorough [reviewofoptometry.com]
[…] blepharoconjunctivitis; SPK, superficial punctate keratitis; NA, not affected. 2 Methods A systematic review of the literature was performed in PubMed and ScienceDirect databases, using the following key words: Allergic Conjunctivitis or Ocular Allergy [AND] Diagnosis workup [onlinelibrary.wiley.com]
Treatment
Treatment of vernal keratopathy- Punctuate epithelial keratitis require no extra treatment except that instillation of steroids should be increased. Large vernal plaque requires surgical excision. [en.wikipedia.org]
The mean level of PGE2 in the patients before treatment was found to be slightly lower than that in the control group, and it dropped even lower during treatment. [ncbi.nlm.nih.gov]
[…] that it be used as a second line treatment and is not recommended before 2 years of age. [doi.org]
Prognosis
Prognosis- Disease is usually self-limiting and resolves in 5-10 years but may result in complications like Keartoconus. [medchrome.com]
Prognosis Since allergic conjunctivitis generally clears up readily, the prognosis is favorable. Complications are very rare, with corneal ulcers or keratoconus occurring rarely. [slideshare.net]
Outlook (Prognosis) The condition continues over time (is chronic). It gets worse during certain seasons of the year, most often in the spring and summer. Treatment may provide relief. [m.ufhealth.org]
The prognosis for VKC patients is generally good and the disease is generally self-limiting with appropriate treatment. [dovepress.com]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Hereditary and environmental factors may contribute to the etiology of keratoconus and corneal hydrops. [ncbi.nlm.nih.gov]
The virus etiology of the nonbacterial conjunctivitis of the newborn known as inclusion blennorrhea (Lindner1) was confirmed in a former report ;2 in this paper evidence was presented to indicate that the basophilic cytoplasmic inclusion bodies (Stargardt3 [jamanetwork.com]
Etiology Seasonal allergic conjunctivitis (hay fever conjunctivitis) is caused by airborne mold spores, or pollen of trees, grasses, or weeds. [msdmanuals.com]
Etiology VKC is thought to be an allergic disorder in which IgE mediated mechanism play a role. [slideshare.net]
Epidemiology
The purpose of this review is to give an update on its epidemiology, immunopathogenesis and management. [ncbi.nlm.nih.gov]
Epidemiology Occurs annually in spring or early summer Affects adolescents Affects Males more often than females III. Pathophysiology Allergic Conjunctiva response to light or heat IV. [fpnotebook.com]
Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological study. Acta Ophthalmol Scand 2006;84(3):406–10. Lambiase A, Minchiotti S, Leonardi A, Secchi AG, Rolando M, Calabria G, et al. [jamc.ayubmed.edu.pk]
Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological study. Acta Ophthalmol Scand. 2006; 84:406–410. Trocmé SD, Hallberg CK, Gill KS, Gleich GJ, Tyring SK, Brysk MM. [aao.org]
Pathophysiology
However, its aetiology and pathophysiology remain unclear. The clinical course of this disease is usually benign and self-limiting, but a minority of patients will face very debilitating and sight threatening complications. [ncbi.nlm.nih.gov]
Pathophysiology Allergic Conjunctiva response to light or heat IV. Symptoms Bilateral eye involvement Watery Eye Discharge Photophobia Severe eye itching V. [fpnotebook.com]
Although a large body of information exists on the pathophysiology of ACDs, this has not yet lead to the development of clear recommendations and guidelines for the diagnosis of ACDs or development… Publisher Full Text In vitro safety of ketotifen as [unboundmedicine.com]
Sites Unilateral or bilateral; affects palpebral and bulbar conjunctiva Pathophysiology Ocular surface inflammation (usually mast cell driven) is associated with type 1 hypersensitivity reactions ( eMedicine: Allergic Conjunctivitis [Accessed 24 April [pathologyoutlines.com]
Prevention
Prevention Using air conditioning or moving to a cooler climate may help prevent the problem from getting worse in the future. Images References Barney NP, Cook EB, Stahl JL. Allergic and immunologic diseases of the eye. [m.ufhealth.org]
Prevention Using air conditioning or moving to a cooler climate may help prevent the problem from getting worse in the future. References Barney NP, Cook EB, Stahl JL. Allergic and immunologic diseases of the eye. [pennstatehershey.adam.com]
We believe that administering prophylactic treatment would be helpful in VC patients who are to have intraocular surgery to prevent postoperative endophthalmitis. [ncbi.nlm.nih.gov]
More information Vernal Keratoconjunctivitis (VKC) Prevention The general principle for preventing all allergies is to avoid the triggers. [healthengine.com.au]