Vernal Keratoconjunctivitis: A Systematic Review

Abstract

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral corneal and conjunctival problem which typically presents in young individuals. VKC is characterized by itching, photophobia, white mucous discharge, lacrimation, foreign body sensation, and pain due to corneal involvement of shield ulcers. Vernal keratoconjunctivitis is categorized within ocular diseases. The diagnosis is clinical, as no sure biomarkers pathognomonic of the disease have yet been identified. The VKC therapy relies on different types of drugs, from antihistamines and topical steroids to cyclosporine or tacrolimus eye drops. In extremely rare cases, there is also the need for surgical treatment for the debridement of ulcers, as well as for advanced glaucoma and cataracts, caused by excessive prolonged use of steroid eye drops. We performed a systematic review of the literature, according to PRISMA guideline recommendations. We searched the PubMed database from January 2016 to June 2023. Search terms were Vernal, Vernal keratoconjunctivitis, and VKC. We initially identified 211 articles. After the screening process, 168 studies were eligible according to our criteria and were included in the review. In this study, we performed a systematic literature review to provide a comprehensive overview of currently available diagnostic methods, management of VKC, and its treatments.

Atopic Disease as a Risk Factor for Recurrent Herpetic Keratitis

“…Atopic conjunctival disease is a highly prevalent ocular disorder affecting up to 10.1% of the general population [ 27 , 28 ], with different prevalence according to age. A recent large-scale study reported its prevalence to be 0.3%, 6.6%, 18.3%, 15.8%, 8.1%, and 4.9% in infancy (<1 years), toddlerhood (1–2 years), early childhood (3–5 years), middle childhood (6–11 years), early adolescence (12–18 years), and late adolescence (18–21 years), respectively [ 28 ].…”

Vernal Keratoconjunctivitis: Immunopathological Insights and Therapeutic Applications of Immunomodulators

“…Mild disease is typically managed with topical mast cell stabilizers, antihistamines, or dual-acting agents [ 5 , 110 , 111 ]. Mast cell stabilizers work by inhibiting mast cell degranulation, which thereby prohibits the release of pro-inflammatory mediators [ 4 , 6 ]. Mast cell stabilizers have also been shown to act on additional cells involved in ocular allergy, including neutrophils, macrophages, eosinophils, and monocytes [ 112 ].…”

“…Mast cell stabilizers have also been shown to act on additional cells involved in ocular allergy, including neutrophils, macrophages, eosinophils, and monocytes [ 112 ]. Antihistamines block histamine from interacting with their receptors on immune and non-immune cells [ 4 , 6 ]. Most antihistamines target the H1 receptor to provide acute symptomatic relief, whereas mast cell stabilizers exhibit a slow onset of action and aid in chronic management [ 110 ].…”

“…Most antihistamines target the H1 receptor to provide acute symptomatic relief, whereas mast cell stabilizers exhibit a slow onset of action and aid in chronic management [ 110 ]. Dual-acting agents, which contain both mast cell stabilizers and antihistamines, offer the advantage of providing rapid symptomatic relief, coupled with long-term mast cell stabilization [ 4 , 6 , 110 ]. These agents are well tolerated, and dual-therapy agents are generally preferred over monotherapy with mast cell stabilizers or antihistamines alone [ 112 ].…”

“…VKC is classified into three distinct categories based on the ocular area that is predominantly affected: namely, either limbal, palpebral, or a mixed form of VKC [ 1 , 4 , 5 ]. The palpebral form of VKC is characterized by the presence of giant papillae on the upper tarsal lid, while the limbal form is characterized by the presence of gelatinous limbal infiltrates, and Trantas dots [ 6 ]. Transient yellow-white deposits with an opaque appearance may be present in limbal VKC and are termed Horner–Trantas dots [ 1 , 7 ].…”