From the Guidelines
The term "vernal" in vernal keratoconjunctivitis refers to spring or springtime, indicating the condition's tendency to worsen during this season due to increased environmental allergens like pollen. This chronic allergic eye condition is characterized by intense itching, photophobia, mucous discharge, and cobblestone papillae on the upper tarsal conjunctiva, primarily affecting children and young adults, particularly males 1. The condition tends to be recurrent and seasonal, with symptoms often beginning in spring and potentially continuing through summer, as outlined in the conjunctivitis preferred practice pattern 1.
Key Characteristics of Vernal Keratoconjunctivitis
- Bilateral involvement with palpebral and limbal variants
- Giant papillary hypertrophy of the superior tarsal conjunctiva
- Bulbar conjunctival injection, conjunctival scarring, and watery and stringy mucoid discharge
- Limbal Horner-Trantas dots, limbal "papillae," corneal epithelial erosions, and corneal neovascularization and scarring
- Associated with hot, dry environments and may be linked to hormonal deficiencies or imbalances 1
Clinical Considerations
The name "vernal" directly reflects the seasonal pattern of the condition, although symptoms may persist year-round in some patients, especially those in warmer climates. Understanding the term "vernal" in this context is crucial for diagnosing and managing vernal keratoconjunctivitis, as it highlights the importance of environmental factors and seasonal variations in symptom severity 1.
Management and Treatment
Treatment strategies for vernal keratoconjunctivitis include modifying the environment to minimize exposure to allergens, using cool compresses and ocular lubricants, and employing topical and oral antihistamines and topical mast-cell stabilizers to maintain comfort 1. For acute exacerbations, topical corticosteroids may be necessary, while topical cyclosporine has demonstrated efficacy in reducing signs and symptoms and preventing seasonal recurrences 1.
From the FDA Drug Label
Cromolyn Sodium Ophthalmic Solution USP, 4% is indicated in the treatment of vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis. The term vernal in vernal (seasonal) keratoconjunctivitis stands for seasonal, as it refers to a condition that occurs or worsens during a specific time of the year, typically in the spring or summer. 2
From the Research
Definition of Vernal (Seasonal) Keratoconjunctivitis
- Vernal keratoconjunctivitis (VKC) is a disorder that is often associated with allergens and is seen during the spring season 3.
- The term "vernal" refers to the seasonal nature of the disease, which typically occurs in the spring or warm seasons 4, 5.
- VKC is a bilateral, usually seasonally recurrent, allergic inflammation of the conjunctiva, characterized by limbal gelatinous hypertrophy and/or upper tarsal giant conjunctival papillae 5.
Key Characteristics of Vernal Keratoconjunctivitis
- VKC is a chronic, bilateral, allergic conjunctivitis with episodes of acute exacerbations 6.
- The disease is often associated with a dense mixed cellular infiltrate, pronounced capillary proliferation, fibrosis, and a thickened extracellular matrix 4.
- VKC can cause long-term visual impairment due to corneal complications, including shield ulcers, infectious keratitis, keratoconus, corneal opacities, and limbal stem cell deficiency 6.