Role of ocular cytology in vernal keratoconjunctivitis

Abstract

Background Children with vernal keratoconjunctivitis (VKC) present symptoms that are similar to other ocular allergies, but more pronounced, and are controlled using topical steroids. To avoid excessive and prolonged use of topical steroid eye drops, over the past 20 years galenic eye drops of cyclosporine with a concentration of 1% to 2% and tacrolimus with a concentration of 0.1% have been introduced as a treatment for the severe and unresponsive forms. The main symptoms of VKC occur most frequently during the spring and tend to get worse during the summer, meaning that affected children tend to avoid exposure to sunlight. The aim of this study was to assess the most common cell types present in the conjunctiva of children with VKC, how ocular treatment can influence them, and whether affected children express a typical conjunctival pattern, which could be useful as a pathognomonic pattern of VKC, allowing us to study this rare eye disease. Method This was a cohort study of 56 children, of whom 17 were not receiving any treatment at the time of testing, 14 were using steroid eye drops or had taken them in the previous 10 days, and 25 were treated with cyclosporine eye drops or tacrolimus eye drops 0.1%. Result Children in group 1 (no topical therapy) express more epithelial cells, neutrophils, mast cells, eosinophils, and lymphocytes than the other two groups. Conclusion Given the ease of performance, when conducting further longitudinal studies, the conjunctival cytology examination could be used, on the one hand, to diagnose VKC, especially when the clinical diagnosis is uncertain, and, on the other, to follow disease evolution and monitor the response to topical treatment.

Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis

“…14,16 In children with VKC, conjunctival cytology has been studied to detect the presence of eosinophils that was absent in normal population. 17 However, to our knowledge, this is the first study reporting CD20 + (B-lymphocyte specific), and CD68 + (macrophage-specific) cellular infiltrates in the histological sections. In VKC sections, cellular infiltrates were predominantly CD3 + , followed by CD20 and CD68.…”

“…14,16 In children with VKC, conjunctival cytology has been studied to detect the presence of eosinophils that was absent in normal population. 17 However, to our knowledge, this is the first study reporting the histological characteristics of fibrovascular pannus in patients with LSCD secondary to VKC and differentiating it from CB.…”

Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms

“…Conjunctival biopsies of VKC patients show an increase in eosinophil infiltration associated with increased tear levels of eosinophil cationic protein (ECP) and major basic protein (MBP) [ 15 , 53 ]. Since eosinophils are absent in the healthy conjunctiva, the presence of eosinophils in conjunctival cytology has been proposed as a marker to confirm the diagnosis of VKC and to monitor response to treatments [ 54 , 55 ]. Eosinophil recruitment in VKC has been associated with increased expression of chemokines by both immune and resident cells, including epithelial cells, vascular endothelial cells, and fibroblasts [ 15 ].…”

Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

“…The immune response in VKC alters the normal cytology of the conjunctiva, resulting in mast cell and eosinophil aggregation, which is otherwise absent in a healthy eye. The presence of these cells is proportional to the severity of clinical signs and symptoms that are experienced [ 77 , 78 ]. Unlike the many more common forms of allergic conjunctivitis, VKC is unique in that it has the potential to lead to sight-threatening complications [ 26 ].…”