Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Abstract

Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.

Examination of corneal microstructure in the quiescent phase of vernal keratoconjunctivitis using in vivo confocal microscopy

“…IVCM examination of the limbal area could have provided additional data about morphological changes since the immunological processes in the limbus are also have great importance in pathophysiology. 38 Although the rare occurrence of VKC might have imposed limitations on the study sample size, our results provide new insight into the course of VKC, and present accurate features of corneal alterations of this ocular surface disease.…”

Therapeutic Targets in Allergic Conjunctivitis

“…Immune-mediated dysfunction of conjunctival fibroblasts, characterized by uncontrolled activation and proliferation of conjunctival fibroblasts, has been implicated in the development of conjunctival fibroproliferative lesions, such as papillae. Because epithelial cells and fibroblasts of the conjunctiva participate in the immunopathogenesis and immunopathological processes of AC, preventing inflammatory mediators from activating these cells can attenuate the pathological and immune mechanisms involved in AC [ 34 ]. As such, pharmacotherapeutic and immunotherapeutic agents that inhibit the effector function of these inflammatory mediators generated in response to allergens can provide therapeutic benefits for patients presenting with clinical expressions of AC.…”

“…Cytokines such as IL-4 act on conjunctival fibroblasts to induce the development of papillary hypertrophy of the palpebral conjunctiva. IL-5 mediates the activation and recruitment of eosinophils, whereas IL-13 induces goblet cells located in the conjunctival epithelium to secrete mucus [ 1 , 34 , 67 ]. Interleukin cytokines, such as IL-4, IL-5, and IL-13, that participate in the pathological and immune mechanisms of AC, signal through type 1 cytokine receptors.…”

Comparision of efficacy and safety of 0.03% and 0.1% tacrolimus ointment in children with vernal keratoconjunctivitis

“… 7 The treatment options of VKC usually include anti-histamines, mast cell stabilizers and non-steroidal anti-inflammatory offered in different permutations and combinations. 8 Moderate to severe sight-threatening cases frequently need topical steroids, or but being chronic disease, long-term use of steroids has notable side effects like glaucoma, cataract and secondary infections. 9 To prevent such complications, steroid-sparing agents like immunosuppressants are a better alternative.…”