Vernal keratoconjunctivitis (VKC) is a chronic recurrent inflammatory disease affecting the conjunctiva and, in some cases, the cornea of the eye. This allergic condition is characterized by severe hyperemia, itching, lacrimation and discharge from the eyes. The pathology most often occurs in the spring months, which is reflected in its name, and is usually observed in children and young adults. It should be emphasized that VKC is associated with both environmental and genetic factors, which makes its study multifaceted and relevant. Unlike other types of allergic conjunctivitis, such as seasonal allergic conjunctivitis, vernal keratoconjunctivitis may be accompanied by more severe symptoms and may lead to the development of complications, including corneal opacity.
History of the disease and interesting historical facts
Vernal keratoconjunctivitis was first described in the medical literature over a century ago. In 1882, German ophthalmologist Friedrich Hans Calder described a clinical case of vernal keratoconjunctivitis, distinguishing it as a distinct disease from other forms of conjunctivitis. Since then, clinicians have begun to carefully study the pathogenesis and clinical manifestations of this disease. Interestingly, in some regions of the world, VKC is known by different names, reflecting its association with spring and flowering plants. For example, in some countries it is called “allergic vernal keratitis.” Observations of this disease over the decades have led to a deeper understanding of its etiology, as well as the development of diagnostic and therapeutic methods, although the question of prevention remains open.
Epidemiology
The epidemiology of vernal keratoconjunctivitis shows high incidence, especially in regions with warm climates and in conditions where flowering plants such as ragweed and other allergens actively grow. According to numerous studies, VKC occurs in 0.3-3% children and adolescents, with individuals aged 4 to 20 years being most susceptible to this disease. The incidence rate increases significantly in the spring, at the peak of flowering. The percentage ratio between men and women in incidence is approximately 3:1, which is probably due to differences in the immune response. It should also be noted that a predisposition to the pathology at the beginning can be observed in families with a history of allergic diseases, which emphasizes the role of genetic factors.
Genetic predisposition to this disease
It has become evident today that genetic predisposition plays an important role in the development of vernal keratoconjunctivitis. Studies have identified several genes associated with allergic reactions that may influence the induction and course of the disease. For example, polymorphisms in genes encoding inflammatory cytokines and immune receptors, such as IL-4, IL-5, and IL-13, are associated with increased susceptibility to VKC. It has also been found that mutations in genes responsible for the synthesis of IgE may contribute to increased antibody production in response to allergens, which entails characteristic manifestations of the disease. The results of molecular genetic studies emphasize the importance of identifying such markers for more accurate diagnosis and an individualized approach to treatment.
Risk factors for the development of this disease
There are various risk factors that contribute to the development of vernal keratoconjunctivitis. These include:
- Physical factors: high levels of ultraviolet radiation, pollen and other allergens.
- Chemical factors: exposure to irritants such as smoke, chemical fumes and household allergens.
- Comorbidities: The presence of other allergic disorders (eg, asthma, allergic rhinitis) is often associated with an increased incidence of VKC.
- Climate conditions: High humidity and air temperature can also contribute to an increase in the incidence of the disease.
- Heredity: Having a history of allergies in close relatives can significantly increase the risk of developing VKC.
Diagnosis of this disease
Vernal keratoconjunctivitis is diagnosed based on clinical findings and some laboratory and instrumental studies. Ophthalmologic examinations reveal the main symptoms, such as conjunctival redness, itching, eyelid swelling, eye discharge, and lacrimation. Laboratory tests may include allergy tests to detect specific IgE antibodies, as well as a complete blood count to detect eosinophilia. Radiological examinations are usually not required, but in complex cases, a more detailed assessment using biomicroscopy or other ophthalmologic methods may be required. Differential diagnosis includes exclusion of other possible causes of conjunctivitis, such as infectious or toxic forms.
Treatment
Treatment of vernal keratoconjunctivitis is aimed at relieving symptoms and preventing relapses. General treatment includes avoiding contact with allergens, as well as using protective glasses during the pollen season. Pharmacological treatment may include antihistamines, topical corticosteroids, and anti-inflammatory drugs. Surgical treatment is considered in extremely rare cases when complications such as persistent corneal opacity develop. Immunotherapy therapy is also used, which can significantly reduce the frequency of outbreaks. It is important to note that a comprehensive approach to treatment, focused on individual patient characteristics, helps improve quality of life and reduce visual discomfort.
List of medications used to treat this disease
The main groups of drugs used to treat vernal keratoconjunctivitis:
- Topical antihistamines (eg, Azelastine, Olopatadine).
- Nonsteroidal anti-inflammatory drugs (eg, Diclofenac, Ketorolac).
- Topical corticosteroids (eg, Dexamethasone, Betamethasone).
- Immunosuppressants (eg, cyclosporine A).
- Allergen-specific immunotherapy.
Disease monitoring
Monitoring the course of vernal keratoconjunctivitis includes regular examinations by an ophthalmologist, especially during periods of exacerbation. The main control stages may be:
- Assessment of the severity of clinical manifestations.
- Monitoring the effectiveness of therapy.
- Identification of possible complications such as keratitis or corneal opacity.
The prognosis for most patients is generally favorable, especially with early diagnosis and adequate treatment. However, in some cases complications may develop that can negatively affect vision, especially if treatment recommendations are not followed.
Age-related features of the disease
Vernal keratoconjunctivitis is most commonly seen in children and adolescents over 4 years of age, but can also occur in adults, especially those with a history of allergies. In children, VKC is usually characterized by more pronounced symptoms, such as severe itching and lacrimation, while in adults, more subtle manifestations may predominate. In older people, the disease usually has a milder course, which may be due to changes in the immune response and environmental factors.
Questions and Answers
- What are the main symptoms of vernal keratoconjunctivitis? The main symptoms include itching, redness of the conjunctiva, swelling of the eyelids, profuse discharge from the eyes and lacrimation.
- How is vernal keratoconjunctivitis diagnosed? Diagnosis is based on clinical manifestations, laboratory tests (eg, determination of specific IgE) and exclusion of other forms of conjunctivitis.
- What treatment is recommended for vernal keratoconjunctivitis? It is recommended to avoid contact with allergens, use antihistamines and corticosteroids, and in complex cases, immunotherapy.
- Who is most susceptible to vernal keratoconjunctivitis? Children and adolescents are most susceptible, especially those with a history of allergic diseases.
- What are the possible complications of vernal keratoconjunctivitis? Possible complications include keratitis and corneal opacity, leading to decreased visual function.
