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Modern Approach to Managing Vernal Keratoconjunctivitis

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Abstract

Vernal keratoconjunctivitis (VKC), an allergic inflammation of the conjunctiva affecting mainly children and adolescents, is categorized under the rubric of allergic conjunctivitis. Lack of uniform diagnostic and predefined staging criteria has been a bottleneck in formulating fixed guidelines to treat VKC. This lack of consensus among clinicians/researchers regarding diagnostic and grading standards has prevented us from making comparisons between the outcomes of different studies. To treat VKC, selection of a drug from many available options should be based on the duration and frequency of symptoms, grade and inflammation of giant papillae, and severity of corneal involvement. Consideration also should be given to the patient’s specific needs. The basic tenet of treatment is optimal control of symptoms with a minimum of toxic side effects resulting from prolonged use of medication.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Kumar S: Vernal keratoconjunctivitis: a major review. Acta Ophthalmol 2009, 87:133–147. This is a comprehensive review.

  2. •• Bonini S, Sacchetti M, Mantelli F, Lambiase A: Clinical grading of vernal keratoconjunctivitis. Curr Opin Allergy Clin Immunol 2007, 7:436–441. This article introduced a new grading system based on severity of disease; a treatment plan for different grades is also discussed.

  3. •• Mantelli F, Santos MS, Petitti T, et al.: Systematic review and meta-analysis of randomised clinical trials on topical treatments for vernal keratoconjunctivitis. Br J Opthalmol 2007, 91:1656–1661. This was a meta-analysis of randomized controlled trials on the efficacy of currently available topical drugs for VKC.

  4. Bielory L: Ocular allergy guidelines: a practical treatment algorithm. Drugs 2002, 62:1611–1634.

    Article  CAS  PubMed  Google Scholar 

  5. Leonardi A: Vernal keratoconjunctivitis: pathogenesis and treatment. Prog Retin Eye Res 2002, 21:319–339.

    Article  CAS  PubMed  Google Scholar 

  6. Soparkar CNS, Wilhelmus KR, Koch DD, et al.: Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants. Arch Ophthalmol 1997, 115:34–38.

    CAS  PubMed  Google Scholar 

  7. Church MK, McGill JI: Human ocular mast cells. Curr Opin Allergy Clin Immunol 2002, 2:419–422.

    Article  PubMed  Google Scholar 

  8. Tabbara KF, Arafat NT: Cromolyn effects on vernal keratoconjuctivitis in children. Arch Ophthalmol 1977, 95:2184–2186.

    CAS  PubMed  Google Scholar 

  9. Bonini S, Barney NP, Schiavone M, et al.: Effectiveness of nedocromil sodium 2% eye drops on clinical symptoms and tear fluid cytology of patients with vernal conjunctivitis. Eye 1992, 6:648–652.

    PubMed  Google Scholar 

  10. Caldwell DR, Verin P, Hartwich-Young R, et al.: Efficacy and safety of lodoxamide 0.1% vs cromolyn sodium 4% in patients with vernal keratoconjunctivitis. Am J Ophthalmol 1992, 113:632–637.

    CAS  PubMed  Google Scholar 

  11. Sorkin EM, Ward A: Ocular sodium cromoglycate, an overview of its therapeutic efficacy in allergic eye disease. Drugs 1986, 31:131–148.

    Article  CAS  PubMed  Google Scholar 

  12. Dahan E, Appel R: Vernal conjunctivitis in the black child and its response to therapy. Br J Ophthalmol 1983, 67:688–692.

    Article  CAS  PubMed  Google Scholar 

  13. Leonardi A, Borghesan F, Avarello A, et al.: Effect of lodoxamide and disodium cromoglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis. Br J Ophthalmol 1997, 81:23–26.

    Article  CAS  PubMed  Google Scholar 

  14. Avunduk AM, Avunduk MC, Kapicioglu Z, et al.: Mechanisms and comparison of anti-allergic efficacy of topical lodoxamide and cromolyn sodium treatment in vernal keratoconjunctivitis. Ophthalmology 2000, 107:1333–1337.

    Article  CAS  PubMed  Google Scholar 

  15. Verin P, Allewaert R, Joyaux JC, et al.; Lodoxamide Study Group: Comparison of lodoxamide 0.1% ophthalmic solution and levocabastine 0.05% ophthalmic suspension in vernal keratoconjunctivitis. Eur J Ophthalmol 2001, 11:120–125.

    CAS  PubMed  Google Scholar 

  16. Owen CG, Shah A, Henshaw K, et al.: Topical treatment for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness. Br J Gen Pract 2004, 54:451–456.

    PubMed  Google Scholar 

  17. Weimer LK, Gamache DA, Yanni JM: Histamine-stimulated cytokine secretion from human conjunctival epithelial cells: inhibition by the histamine H1 antagonist emedastine. Int Arch Allergy Immunol 1998, 115:288–293.

    Article  CAS  PubMed  Google Scholar 

  18. Bielory L, Lien KW, Bigelsen S: Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis. Drugs 2005, 65:215–228.

    Article  CAS  PubMed  Google Scholar 

  19. McGill JI: A review of the use of olopatadine in allergic conjunctivitis. Int Ophthalmol 2004, 25:171–179.

    Article  PubMed  Google Scholar 

  20. Corum I, Yeniad B, Bilgin LK, Ilhan R: Efficiency of olopatadine hydrochloride 0.1% in the treatment of vernal keratoconjunctivitis and goblet cell density. J Ocul Pharmacol Ther 2005, 21:400–405.

    Article  CAS  PubMed  Google Scholar 

  21. D’Angelo G, Lambiase A, Cortes M, et al.: Preservative-free diclofenac sodium 0.1% for vernal keratoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 2003, 241:192–195.

    Article  PubMed  CAS  Google Scholar 

  22. Sharma A: Topical ketarolac 0.5% solution for the treatment of vernal keratoconunctivitis. Indian J Ophthalmol 1997, 45:177–180.

    CAS  PubMed  Google Scholar 

  23. Ilyas H, Slonim CB, Braswell GR, et al.: Long term efficacy of loteprednol etabonalte 0.2% in the treatment of seasonal and perennial allergic conjunctivitis. Eye Contact Lens 2004, 30:10–13.

    Article  PubMed  Google Scholar 

  24. Leonardi A, Papa V, Milazzo G, Secchi AG: Efficacy and safety of desonide phosphate for the treatment of allergic conjunctivitis. Cornea 2002, 21:476–481.

    Article  PubMed  Google Scholar 

  25. Saini JS, Gupta A, Pandey SK, et al.: Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis. Acta Ophthalmol Scand 1999, 77:515–518.

    Article  CAS  PubMed  Google Scholar 

  26. Singh S, Pal V, Dhull CS: Supratarsal injection of corticosteroids in the treatment of refractory vernal keratoconjunctivitis. Indian J Ophthalmol 2002, 50:160–161.

    Google Scholar 

  27. Lisanework M: Supra-tarsal injection of dexamethasone in the treatment of patients with refractory vernal keratoconjunctivitis. Ethiop Med J 2003, 41:19–24.

    PubMed  Google Scholar 

  28. Holsclaw DS, Whitcher JP, Wong IG, Margolis TP: Supratarsal injection of corticosteroid in the treatment of refractory vernal keratoconjunctivitis. Am J Ophthalmol 1996, 121:243–249.

    CAS  PubMed  Google Scholar 

  29. BenEzra D, Pe’er J, Brodsky M, Cohen E: Cyclosporine eye drops for the treatment of severe vernal keratoconjunctivitis. Am J Ophthalmol 1986, 101:278–282.

    CAS  PubMed  Google Scholar 

  30. Abu El-Asrar AM, Tabbara KF, Geboes K, et al.: An immunohistochemical study of topical cyclosporine in vernal keratoconjunctivitis. Am J Ophthalmol 1996, 121:156–161.

  31. BenEzra D, Matamoros N, Cohen E: Treatment of severe vernal keratoconjunctivitis with cyclosporine A eye drops. Transplant Proc 1988, 20:644–649.

    CAS  PubMed  Google Scholar 

  32. Secchi AG, Tognon MS, Leonardi A: Topical use of cyclosporine in the treatment of vernal keratoconjunctivitis. Am J Ophthalmol 1990, 110:641–645.

    CAS  PubMed  Google Scholar 

  33. Leonardi A, DeFranchis G, Fregona IA, et al.: Effects of cyclosporin A on human conjunctival fibroblasts. Arch Ophthalmol 2001, 119:1512–1517.

    CAS  PubMed  Google Scholar 

  34. Pucci N, Novembre E, Cianferoni A, et al.: Efficacy and safety of cyclosporine eye drops in vernal keratoconjunctivitis. Ann Allergy Asthma Immunol 2002, 89:298–303.

    Article  CAS  PubMed  Google Scholar 

  35. Kilic A, Gurler B: Topical 2% cyclosporine A in preservative-free artificial tears for the treatment of vernal keratoconjunctivitis. Can J Ophthalmol 2006, 41:693–698.

    Article  PubMed  Google Scholar 

  36. Avunduk AM, Avunduk MC, Erdol H, et al.: Cyclosporine effects on clinical findings and impression cytology specimens in severe vernal keratoconjunctivitis. Ophthalmologica 2001, 215:290–293.

    Article  CAS  PubMed  Google Scholar 

  37. Spadavecchia L, Fanelli P, Tesse R, et al.: Efficacy of 1.25% and 1% topical cyclosporine in the treatment of severe vernal keratoconjunctivitis in childhood. Pediatr Allergy Immunol 2006, 17:527–532.

    Article  PubMed  Google Scholar 

  38. Kosrirukvongs P, Luengchaichawange C: Topical cyclosporine 0.5 per cent and preservative-free ketorolac tromethamine 0.5 per cent in vernal keratoconjunctivitis. J Med Assoc Thai 2004, 87:190–197.

    PubMed  Google Scholar 

  39. Cetinkaya A, Akova YA, Dursun D, Pelit A: Topical cyclosporine in the management of shield ulcers. Cornea 2004, 23:194–200.

    Article  PubMed  Google Scholar 

  40. Ozcan AA, Ersoz TR, Dulger E: Management of severe allergic conjunctivitis with topical cyclosporine 0.05% eye drops. Cornea 2007, 26:1035–1038.

    Article  PubMed  Google Scholar 

  41. Kumar S: Combined therapy of vernal shield ulcer: a case report. Clin Exp Optom 2008, 91:111–114.

    Article  PubMed  Google Scholar 

  42. Akpek EK, Hasiripi H, Christen WG, Kalayci D: A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis. Ophthalmology 2000, 107:263–269.

    Article  CAS  PubMed  Google Scholar 

  43. Jain AK, Sukhija J: Low dose mitomycin-C in severe vernal keratoconjunctivitis: a randomized prospective double blind study. Indian J Ophthalmol 2006, 54:111–116.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Toronto Western Hospital, 5th Floor West Wing, 339 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada

    Sunil Kumar

  2. West Suffok Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ, UK

    Nitin Gupta

  3. Cambridge and Eye Treatment Centre, Cambridge University Hospitals, Addenbrookes Hospital, Bury St Edmunds, UK

    Anthony J. Vivian

Authors
  1. Sunil Kumar
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  2. Nitin Gupta
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  3. Anthony J. Vivian
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Correspondence to Sunil Kumar.

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Kumar, S., Gupta, N. & Vivian, A.J. Modern Approach to Managing Vernal Keratoconjunctivitis. Curr Allergy Asthma Rep 10, 155–162 (2010). https://doi.org/10.1007/s11882-010-0101-7

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  • DOI: https://doi.org/10.1007/s11882-010-0101-7

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