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Conference Roundup
Dry Eye/OSD

Understanding disease evolution key to vernal keratoconjunctivitis management

Posted on May 17, 2022

The key to successfully managing vernal keratoconjunctivitis (VKC) is making the patients and caregivers aware of the long duration of disease, as well as its chronic evolution and possible complications, said Simon Fung, MD, MA, FRCOphth, during a presentation at the American Association for Pediatric Ophthalmology and Strabismus Annual Meeting.

During the symposium, “Rising to the Challenge of Vernal Keratoconjunctivitis: Practitioner and Caregiver Perspectives,” Dr Fung, Erin Stahl, MD, and colleagues provided an overview of this sight-threatening, allergic ocular disease, as well as challenges clinicians face when treating it.

VKC, a severe form of allergic conjunctivitis that can be seasonal or perennial, can lead to sight-threatening permanent injury due to chronic inflammation of the ocular surface.

Childhood VKC is typically diagnosed before the age of 10 and has an average duration of 4-8 years before subsiding shortly before or after puberty. Boys are 4 times more likely to have VKC than girls.

VKC is characterized by acute or sub-acute phases of inflammation of the ocular surface, with 2 types of physiologic manifestations: palpebral or limbal.  Palpebral VKC is characterized by cobblestone papillae on the superior tarsal conjunctiva whereas limbal VKS is marked by broad thickened, circumferential gelatinous opacification of the lumbus.

Although rare—accounting for approximately 0.10% to 0.50% of all cases of ocular disease—VKC can dramatically affect the quality of life of the children who have it and their families, despite the treatments that are currently available.

Symptoms include tearing, hyperemia, mucus/serous discharge, intense itching, photophobia, foreign body sensation, and pain. Keratitis is a common complication of VKC, with up to 50% of cases developing it. Shield ulcers, plaque formation, permanent reduction of visual acuity, chronic epithelial abnormalities, and amblyopia can also occur in individuals with VKC.

In addition to the physical complications, there are a number of management challenges when treating patients with VKC.

There is currently no gold standard treatment for VKC, and well-defined management guidelines are lacking. Treatments that are available only provide symptom relief and are only effective in mild/moderate cases. In addition, steroids, often used as treatment, are associated with adverse events such as glaucoma and cataracts.

Dr Fung said that the goal of therapy for these patients should be to improve quality of life and prevent long-term complications, which requires educating all parties about the duration of the disease and its chronic evolution.

Visits should be made before times of the year that may trigger symptoms, typically in the Spring and clinicians should aim to prevent and control inflammation while limiting the continuous use of corticosteroids.

Reference
Rising to the Challenge of Vernal Keratoconjunctivitis: Practitioner and Caregiver Perspectives. Presented at: AAPOS 2022 Annual Meeting.

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