From the Guidelines
Vernal keratoconjunctivitis (VKC) is a chronic form of allergic conjunctivitis that is more common in children and young adults, particularly in hot, dry climates, and is characterized by intense itching, tearing, and mucous discharge.
Key Characteristics of VKC
- It is more prevalent in males and often improves with age, typically resolving by adulthood [ 1 ].
- The condition is driven by a type 1 hypersensitivity reaction with IgE-mediated mast cell degranulation and eosinophil infiltration [ 1 ].
- VKC can have a significant impact on quality of life, with 36% of children with VKC missing 1 or more days of school in the last 3 months for an ocular reason [ 1 ].
Treatment Options for VKC
- Topical cyclosporine 0.05% has been shown to be effective for the treatment of severe vernal conjunctivitis, and can be used to prevent seasonal recurrences [ 1 ].
- Topical antihistamines like olopatadine or ketotifen, and mast cell stabilizers such as cromolyn sodium, can be effective for moderate symptoms [ 1 ].
- Severe cases may require topical corticosteroids like prednisolone acetate 1% or fluorometholone 0.1%, used sparingly under medical supervision due to risks of glaucoma and cataracts [ 1 ].
- Immunomodulators like tacrolimus 0.03% ointment can be used for steroid-sparing effects in persistent cases [ 1 ].
Management Strategies
- Environmental modifications like avoiding allergens and using air conditioning can help reduce symptoms [ 1 ].
- Cool compresses and ocular lubricants can be used to maintain comfort [ 1 ].
- Supratarsal injection of corticosteroid can be considered for severe sight-threatening vernal keratoconjunctivitis that is not responsive to topical therapy [ 1 ].
From the FDA Drug Label
INDICATIONS AND USAGE Cromolyn Sodium Ophthalmic Solution USP, 4% is indicated in the treatment of vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis.
- Vernal keratoconjunctivitis (VKC) is a condition for which Cromolyn Sodium Ophthalmic Solution is indicated as a treatment.
- The label does not provide a definition or description of VKC, only that it is an indication for the use of the drug.
- Therefore, based on this information, the exact nature of VKC cannot be determined from this label alone 2
From the Research
Definition and Characteristics of Vernal Keratoconjunctivitis (VKC)
- Vernal keratoconjunctivitis (VKC) is a recurrent or chronic ocular allergic disease that affects mostly children and young adults living in warm climates worldwide 3.
- It is characterized by seasonal exacerbations, with symptoms including itching, redness, mucous discharge, and pain 4.
- VKC presents with ocular surface inflammation, leading to various distressing symptoms, and can result in corneal complications, including shield ulcers and vision impairment if left untreated 4.
Clinical Manifestations and Diagnosis
- Afflicted patients experience intense itching, tearing, photophobia, and mucous discharge, and usually demonstrate large cobblestone papillae on their superior tarsal conjunctiva and limbal conjunctiva 5.
- The diagnosis of VKC involves identifying key clinical findings on the ocular surface, such as Tranta dots, giant papillae, or shield ulcers 4.
- VKC is a bilateral, seasonal, external ocular inflammatory disease, primarily affecting children, and may be related to atopy, with environmental and racial predilections 5.
Pathogenesis and Treatment
- VKC is a Th2 lymphocyte-mediated disease, with mast cells, eosinophils, and their mediators playing major roles in the clinical manifestation of VKC 3.
- Treatment of VKC follows a stepwise approach, including anti-allergic eye drops, steroid eye drops, and topical medications like cyclosporine, which may take up to 3 months to show efficacy 4.
- Understanding and managing allergies, often to inhaled allergens like pollen and house dust mites, is essential in VKC management, as allergic sensitization is associated with VKC in half of the cases 4.