Vernal keratoconjunctivitis (VK) is a chronic, severe allergic condition affecting the eyes. The disease causes inflammation of the protective outer layer of the eye — the cornea — as well as the mucous membranes, or conjunctiva. The term “vernal” means “spring” and refers to the seasonal nature of the condition.
Vernal keratoconjunctivitis usually begins in early childhood and typically clears up once a person reaches puberty. However, some people continue to experience the condition into adulthood.
Prompt diagnosis and treatment of VK is essential to prevent permanent eye damage.
This article outlines the symptoms, causes, and risk factors for VK. We also list the treatment options for VK according to the severity of the disease, and discuss the outlook for people living with the condition.
- intense itching
- a sensation of having a foreign body in the eye
- watery eyes
- thick, ropy mucus discharge, particularly upon waking
- blurred vision
- sensitivity to light, called photophobia
Symptom flare-ups typically occur in warm weather or can be present year-round, particularly in tropical areas.
People who experience symptoms of VK should consult a doctor. Following a diagnosis of VK, a person can begin treatment to help alleviate symptoms and prevent permanent eye damage.
Below are the causes of VK and the risk factors for developing the disease.
Vernal keratoconjunctivitis occurs when inflammatory cells infiltrate the conjunctiva of the eye. These inflammatory cells include:
- activated CD4+ lymphocytes
Vernal keratoconjunctivitis is
Exposure to the following environmental allergens can also increase the likelihood of VK:
- pet dander
- tobacco smoke
People with VK should try to avoid allergens that trigger symptoms. They should also consider washing their hands frequently and avoid touching or rubbing their eyes.
Dry, hot climates can also contribute to VK. People with the condition can help reduce flare-ups by staying inside on hot days or wearing sunglasses to protect the eyes.
The treatment for VK depends on the severity of the disease. Clinicians propose a
- preventing flare-ups of the condition
- alleviating symptoms
- reducing inflammation
- preventing irreversible damage to the cornea and associated vision loss
The following treatments may be beneficial during all stages of the disease:
- cold compresses
- eye lubricants
- lid scrubs
Doctors will prescribe VK treatments according to the severity of the disease. Below are some treatment options for mild, moderate, and severe VK.
To alleviate itching, doctors may prescribe topical antihistamines, such as levocabastine and emedastine.
Some people use lubricating eye medications, such as artificial tears, gels, or ointments. These medications are suitable adjunctive treatments for mild VK, but they are often
Topical over-the-counter (OTC) decongestant eye drops have
Doctors may prescribe one or more of the following treatments for moderate VK:
Mast cell stabilizers
Doctors may prescribe topical mast cell stabilizers. These agents help reduce histamine release from cells called “mast cells,” thereby reducing eye inflammation, redness, and itching.
Examples of mast cell stabilizers include:
Dual activity topical antihistamine/mast cell stabilizers
Dual activity topical antihistamine/mast cell stabilizers are also available. Agents include:
Nonsteroidal anti-inflammatory drugs
Doctors will avoid prescribing NSAIDs in people who already have corneal involvement.
The dosing of NSAIDs is
Doctors may prescribe topical corticosteroids to reduce inflammation of the eye. Typically, they will begin by prescribing these drugs in high doses and quickly taper the dosage off. Dosing is
Topical corticosteroid agents include:
Applying topical corticosteroids to the eye can cause side effects, such as cataracts and glaucoma. As such, people should use the lowest dose possible for the shortest period necessary to control symptoms.
Immunomodulators are drugs that help modify the function of the immune system. A
According to the review, the side effects of cyclosporine are less severe than those of corticosteroids. A doctor may prescribe the two treatments in combination, where necessary.
Resistant cases of VK, or those with corneal involvement, may require treatment with one or more of the following:
- oral corticosteroids
- oral cyclosporine
- allergen-specific immunotherapy
- monoclonal antibodies (
- surgery to remove corneal plaques
To diagnose VK, a doctor will begin by:
- taking a detailed medical history
- asking about a person’s symptoms and when they started
- conducting a physical examination
To help determine the cause of conjunctivitis, the doctor will ask about the following:
- contact lens use
- exposure to chemicals
- contact with people who have an active eye infection
A doctor can confirm a diagnosis of VK by inspecting the conjunctiva for signs of the following:
- Papillae: These are pimple-like projections that can vary in size, with large papillae taking on a cobbled appearance.
- Trantas dots: These are chalky-white nodules that appear on the edges of the conjunctiva.
A doctor can also assess if there is any corneal involvement, such as corneal ulcers or plaques.
Doctors can differentiate VK from other types of allergic conjunctivitis because VK does not affect the eyelid margin.
Vernal keratoconjunctivitis (VK) is an inflammatory eye condition that can affect both the conjunctiva and cornea of the eye. It is usually caused by exposure to allergens.
Vernal keratoconjunctivitis usually develops in childhood, and most cases resolve after puberty. However, some people continue to experience the disease into adulthood.
People who experience symptoms of VK should see their doctor as soon as possible for a diagnosis and appropriate treatment. Prompt treatment can help alleviate inflammation and reduce the risk of permanent eye damage.