Diagnostic criteria of chronic conjunctivitis: atopic keratoconjunctivitis and vernal keratoconjunctivitis

Abstract

Purpose of reviewChronic ocular allergies, vernal (VKC) and atopic keratoconjunctivitis (AKC) are relatively rare conditions that require definite diagnostic criteria to the most appropriate therapeutical approach. Recent findingsThe diagnosis of both VKC and AKC is generally based on clinical history, signs and symptoms, and the results of allergic tests, which allow to identify the different diseases phenotypes. However, other subtypes of the two diseases and/or overlaps may occur making the diagnosis non always so clear, such as VKC and AKC overlaps or adult-like VKC disease. Each of these phenotypes may be sustained by different mechanisms which are still not well defined but not only related to a type 2 inflammation. The further challenges will be to correlate clinical or molecular biomarkers to a single subtype or disease severity. SummaryDefinite criteria of chronic allergies will further guide to more specific therapeutical approaches.

Vernal Keratoconjunctivitis: Immunopathological Insights and Therapeutic Applications of Immunomodulators

“…Corneal involvement occurs in around 50% of patients and is common in the tarsal, mixed, and perennial forms of the disease [ 9 , 101 ]. Corneal changes include punctate epithelial keratitis, macroerosions, neovascularization, microbial keratitis, shield ulcers, scarring, and plaque formation [ 1 , 101 , 102 ]. IL-5 derived from degranulating mast cells and Th2 cells recruits and activates eosinophil, a granulocyte that participates in the inflammation-associated damage and remodeling of the ocular surface observed in chronic forms of ocular allergy such as vernal keratoconjunctivitis [ 103 , 104 , 105 ].…”

“…Persistent corneal epithelial compromise extending into the Bowman’s layer, along with degradation of the collagen type 1 present in the corneal stroma, can lead to an oval-shaped defect with elevated margins and can present as a shield ulcer, a vision-threatening complication of VKC [ 9 , 107 ]. Patients may also present with pseudogerontoxon, which appears as a gelatinous grey-white segment in the peripheral corneal stroma and is the result of lipid deposition from chronic increased limbal vasopermeability ( Figure 2 ) [ 1 , 101 ]. It is of note that vascular endothelial cells express receptors for IL-4 and histamine.…”

Allergic Conjunctivitis: Review of Current Types, Treatments, and Trends

“…AKC is a bilateral, chronic, inflammatory condition of the ocular surface [ 32 , 40 ]. Most patients present with accompanying systemic conditions such as atopic dermatitis and eczema [ 40 , 41 ].…”

“…AKC is a bilateral, chronic, inflammatory condition of the ocular surface [ 32 , 40 ]. Most patients present with accompanying systemic conditions such as atopic dermatitis and eczema [ 40 , 41 ]. Signs of blepharitis and scurf are also commonly found on the lashes with severe corneal findings such as neovascularization, scarring, and thinning [ 41 ].…”

Vernal Keratoconjunctivitis in Sudan and Its Impact on Visual Acuity

“…The condition mostly manifested by intense pruritus, erythema, sensitivity to light, and the secretion of mucus. Upon examination, the observed indications primarily included Pseudojerontoxon, tarsal papillae, and ocular findings such as opacity and ulceration [4] . The majority of patients experiencing visual impairment exhibited corneal problems, specifically keratoconus [5] .…”