Conference Roundup
Cornea and External Disease

Controlling vernal keratoconjunctivitis before it’s severe is key for children

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Vernal keratoconjunctivitis (VKS) is a relatively rare disease that is often challenging to manage. During a presentation at AAO 2021, Dr Euna Koo discussed VKS and the impact it has on patients, highlighting the need to control the disease before it becomes severe and vision-threatening.

VKC is a severe form of allergic conjunctivitis that typically presents in children between the ages of 4-7 years.

“Given the critical vision development that children are going through in these years, diseases that seriously alter the ocular service or VA in any way can be vision threatening,” said Dr Koo.

There are 2 main types of VKC: palpebral (tarsal) and limbal (bulbar). Palpebral, which accounts for 48% of cases, is marked by cobblestone papillae on the superior tarsal conjunctiva whereas limbal, accounting for 44% of cases, is marked by a broad, thickened, circumferential gelatinous opacification of the lumbus. Only 8% of cases present with a mix of palpebral and limbal.

On initial presentation, the clinical findings of VKS may be mild, but as the ocular service is more disturbed as the disease progresses, symptoms may intensify.

In the first few hours, symptoms can include pruritus, erythema, chemosis, and edma. Within days to months of presentation, there can be a reappearance of initial symptoms as well as disruption to the ocular service. After months or years, disruption to the ocular surface can occur with continued inflammation and ocular surface changes which may have visual consequences.

Corneal complications can cause a permanent decrease or loss of vision in children suffering from VKC. Corneal scarring occurs in approximately 20% of patients with VKC and leads to mild, moderate, and severe visual impairment in approximately 60%, 36%, and 5% of patients, respectively.

Dr Koo noted that although keratoconus is less common, occurring in approximately 6% of patients with VKC, it leads to more severe visual impairment at a frequency of about 30%.

Dr Koo ended the presentation by saying that VKS has the potential to impact many aspects of children’s lives and a multidisciplinary approach is needed to manage this disease.

This Industry Showcase was presented by Santen, Inc.

Koo E, et al. Lifting the Lid on VKC – Understanding Diagnosis and Treatment. Presented at: 2021.