Vernal Keratoconjunctivitis (VKC)

Vernal Keratoconjunctivitis (VKC)
SYMPTOMS Significant itch | Discharge
SIGNS Ropy discharge | Limbal papillae | large conjunctival papillae in upper eyelid (cobblestone papillae) | Superior corneal ulcer (shield ulcer) | Horner-Trantas dots
WORK-UP Thorough history. Slit lamp examination
Cool compresses | Avoidance of allergen(s)
Topical steroid drops to start: Pred Forte 1gtt OU qid x 2 | Lotemax 1gtt OU qid x 2 weeks | Followed by milder anti-inflammatory eye drops: Pataday 1 gtt OU qAM | Zaditor 1 gtt OU bid | Restasis 1 gtt OU bid
Consider adding a topical antibiotic drop if a shield ulcer is present (i.e. polytrim 1 gtt qid in affected eye).
FOLLOW-UP Every 2 weeks, or every 2-3 days of shield ulcer is present
ADDITIONAL LAB | TESTS If severe, could consider an allergy panel
ETIOLOGY A number of allergens can cause VKC
DIFFERENTIAL DX Giant papillary conjunctivitis | Allergic conjunctivitis | Atopic keratoconjunctivitis (AKC) | Dry eye syndrome | Episcleritis
NOTES Usually self-limiting | Usually affects young males | Best to treat before allergy season starts | Strong association with atopy
AKC is very similar to VKC but usually present in Adults and year-round