Vernal conjunctivitis is a seasonal allergic eye disease that occurs in spring and summer, characterized by damage to the conjunctiva and often the cornea. It occurs mainly in children 4-10 years old (usually boys) living in countries with a warm climate. Clinical signs – increasing itching of the eyelids, the appearance of photophobia, lacrimation, the development of blepharospasm. Diagnosis is based on the collection of anamnesis, examination data (papillary hypertrophy, conjunctival deformity, there may be signs of keratitis), eosinophilia and an increase in the level of IgE in the blood are characteristic. Treatment includes eye protection from solar radiation, taking antihistamines, mast cell stabilizers, glucocorticoids.
H10.1 Acute atopic conjunctivitis
Vernal conjunctivitis (vernal keratoconjunctivitis, spring catarrh) is one of the forms of allergic conjunctivitis that occurs in the warm season (mainly in March-July) and manifests itself as a lesion of the conjunctiva and the cornea of the eye. The main causal factors are increased solar insolation, hereditary predisposition and changes in hormonal status. Vernal conjunctivitis occurs, as a rule, in children aged 4 to 10 years, less often in 15-20 years. The vast majority of patients with spring catarrh are boys living in countries with hot climates (from 1 to 7% of the population). In regions with cold and temperate climates, the disease is much less common – in 0.01-0.2% of children and adolescents. Most often, the disease gradually passes during puberty.
To date, the etiology of the disease has not been clarified. The role of hereditary predisposition is assumed (allergic reactions in parents and family members of a patient with Vernal conjunctivitis are much more common than in relatives of healthy individuals). Undoubtedly, the adverse effect on the conjunctiva of increased solar insolation, which is confirmed by the increased incidence of spring catarrh in countries with hot climates. Endocrine factors, hormonal restructuring of the body (the onset of the disease in childhood and its regression during puberty) also play a role.
In the mechanism of development of vernal conjunctivitis, the leading role is played by delayed allergic reactions that develop in response to excessive insolation. Chronic inflammatory process captures the conjunctiva and the cornea of the eye, causing over time partial replacement of the mucous membrane with connective tissue, papillary hypertrophy, conjunctival deformation, and with the development of complications – the appearance of ulcers on the cornea.
Symptoms of vernal conjunctivitis
Vernal catarrh begins in children from the age of 3-4 years and quickly turns into a chronic form with exacerbations in the spring and summer period. The main symptoms are increasing itching in the eye area, which increases in the evening, the appearance of a burning sensation, the presence of a foreign body, lacrimation when going outside in sunny weather. Photophobia develops rapidly, blepharospasm and ptosis of the upper eyelids can be observed. In clinical ophthalmology, conjunctival (tarsal), limbal and mixed forms of vernal conjunctivitis are distinguished.
- With the tarsal (palpebral) form of spring catarrh, papillary hypertrophy (“cobblestone pavement”) prevails, thickened jelly-like growths are formed, most pronounced on the upper eyelid and leading to conjunctival deformation. On the surface of the mucous membrane of the eyelid, a mucous discharge is visible in the form of separate threads or spiral clusters. These viscous adhesive threads irritate the conjunctiva and increase itching.
- The limbal form of vernal conjunctivitis is manifested by the development of an allergic inflammatory process in the prelimbal region (corneal-scleral junction) and the limb itself, followed by papillary overgrowth and deformation of the mucous membrane. The hypertrophied tissue has a yellow-gray or pinkish-gray color, acts as a dense roller, towering over the limb. On the surface of the conjunctiva, white dots and Trantas spots can be found, and when the condition improves, there are depressions in the limb.
- With a mixed form of vernal conjunctivitis, the clinical signs of tarsal and limbal forms of spring catarrh are combined. All forms of the disease are characterized by corneal damage, which in severe cases is manifested by the development of spot keratitis, turbidity and ulceration of the cornea.
During the diagnosis of vernal conjunctivitis, the patient must be examined by an ophthalmologist, as well as an allergist-immunologist. Anamnesis data are taken into account (detection of cases of atopy in relatives, seasonality and connection with ultraviolet solar radiation, the development of the disease mainly in boys before puberty), the characteristic clinical picture of spring catarrh. Ophthalmological examination of patients with vernal conjunctivitis reveals typical hypertrophied papillary formations on the mucous membrane of the upper eyelids and eyes, as well as signs of damage to the cornea – spot erosion and corneal ulcers.
To clarify the diagnosis of vernal conjunctivitis, biomicroscopy of the eye is performed, tear fluid and conjunctival scrapings are examined (as a rule, eosinophilia is detected). There is often an increase in the content of eosinophils in peripheral blood and the level of immunoglobulin E in blood serum.
Differential diagnosis of vernal conjunctivitis is carried out with other eye diseases – infectious, allergic, drug-induced conjunctivitis, keratitis, trachoma, other allergic diseases, in the clinical picture of which there may be signs of conjunctival lesions (rhinosinusopathy, bronchial asthma, etc.).
Treatment of vernal conjunctivitis
To minimize the negative effect of ultraviolet radiation on the eyes of patients with vernal conjunctivitis, it is recommended to wear sunglasses and limit the time spent outdoors during the daytime. In severe cases, when you are in areas with a hot climate, you sometimes have to change your country of residence.
From medications in allergology with spring catarrh, long-term use of antihistamines and mast cell stabilizers in the form of drops (sodium cromoglycate, olopatadine, etc.) is practiced, although their effectiveness is not as high as with typical allergic conjunctivitis. To reduce itching, a 3% solution of sodium bicarbonate in drops or lotions from a weak solution of boric acid is used.
The basis of the treatment of vernal conjunctivitis is the long–term use of glucocorticoid hormones in the form of solutions and ointments for topical use (dexamethasone, hydrocortisone, etc.). With the development of adverse reactions and the presence of contraindications, it is possible to replace glucocorticoids with topical nonsteroidal anti-inflammatory drugs – eye drops based on diclofenac, ketorolac.
With concomitant keratoconjunctivitis, metabolic agents (vitamins and dexpanthenol in the form of eye drops) are used. With long–term non-healing corneal ulcers, surgical intervention is possible – excimer laser phototherapy keratectomy.
Prognosis and prevention
The prognosis for vernal conjunctivitis is generally favorable. In most cases, during adolescence, the disease passes without any consequences. For prevention, it is recommended to limit the time spent by children in direct sunlight in spring and summer in areas with increased solar insolation, wear sunglasses.