Vernal conjunctivitis

This is a recurrent allergic condition with a seasonal incidence that usually begins in the prepubertal years and lasts for 5-10 years. It is bilateral and is more common in boys than girls. It is often associated with asthma and eczema.

There is marked giant papillary proliferation of the upper tarsus which creates a distinctive cobblestone appearance. Fine papillae may be observable in the lower tarsus. The conjunctiva has a milky appearance. The eyes are usually chronically inflamed with a stingy mucous discharge. In a few cases, the lesions may spread onto the cornea.

A grading system has been developed to indicate the severity of this disease, ranging from 0 (absence of symptoms and no therapy) to 4 (severe disease involving the cornea and needing pulsed high-dose topical steroid) (2)

Treatment is usually with topical sodium cromoglycate drops . This condition requires long-term treatment; short courses of medication are unhelpful.

Refer suspected vernal conjunctivitis to ophthalmologists. The management is specialised and serious corneal complications can occur. Topical steroids may need to be added to conventional anti-inflammatory treatment and, on occasion, specialist systemic therapy with steroids ± ciclosporin. (2)

References

1. What sets vernal keratoconjunctivits apart form other allergic conditions, and how to create targeted treatments for it. Review of Ophthalmology, 2012
2. Sacchetti M, Lambiase A, Mantelli F, et al. Tailored approach to the treatment of vernal keratoconjunctivitis. Ophthalmology. 2010 Jul;117(7):1294-9.