Vernal Keratoconjuctivitis: A Review

Abstract

Vernal keratoconjunctivitis (VKC) is a recurrent seasonal disease of childhood, characterized by severe bilateral inflammation of the conjunctiva and by giant papillae of the superior tarsal conjunctiva, gelatinous hypertrophy of the limbus, and keratopathy. Clinical and immunohistochemical studies suggest that IgE-dependent (type I allergic) and IgE-independent (type IV allergic) mechanisms are involved in the immunopathogenesis of VKC, in which various inflammatory cells, including different T cell subpopulations play an active role via a cascade of chemical mediators. Endocrine, genetic, neurogenic, environmental and socioeconomic risk factors have been identified. The clinical course of this disease is usually benign and self-limiting, but a minority of patients will face very debilitating and sight threatening complications. The variety of currently available drugs to treat VKC include anti-histamines, mast-cell stabilizers, dual acting agents, corticosteroids and immunomodulators but none is enough to treat all aspects of the multifaceted pathophysiology of VKC. More selective drugs like anti-chemokine receptor antibodies and leukotriene receptor antagonists are under evaluation. Cyclosporine has been shown to be effective in the treatment of VKC but further randomized control trials are required to establish the minimum effective concentration. The purpose of this paper is to describe the clinical expression of VKC, to discuss its pathogenic mechanisms, and to suggest novel therapeutic strategies.