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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 3  |  Page : 189-191

A retrospective study about clinical profile of vernal keratoconjunctivitis patients at a tertiary care hospital in Patiala, Punjab, India


Department of Ophthalmology, Government Medical College and Hospital, Patiala, Punjab, India

Date of Web Publication30-Jan-2018

Correspondence Address:
Dr. Harvinder Nagpal
Department of Ophthalmology, Government Medical College and Hospital, Patiala - 147 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_100_17

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  Abstract 


Objective: To study variations in clinical profile of vernal keratoconjunctivitis (VKC) among local population with data collected at our tertiary care hospital over a period of 6 months.
Materials and Methods: A retrospective study was carried out in the Department of Ophthalmology at Government Medical College, Patiala, Punjab, India. A total of 150 patients with VKC were diagnosed on the grounds of their history, the presence of characteristic symptom, and on the basis of their clinical features, over a period of 6 months from March 2017 to August 2017. The history of each patient was taken including a record of age, sex, place of residence, change of place of residence, age at onset of the disease, seasonal variations, associated allergic or “atopic” illnesses, and family history of VKC or associated allergic or atopic conditions. Best-corrected visual acuity was assessed and each patient was thoroughly examined with a slit lamp. Follow-up was done every 4 weeks for 6 months.
Results: Out of 150 patients, 110 (73.33%) were male and 40 (26.67%) were female. The highest incidence of VKC occurred in the age group of 11–15 years. Maximum cases (62%) had palpebral form followed by mixed form (23.33%) and bulbar form (14.67%). Corneal complications occurred in 22 (14.67%) patients; 20 patients had minor complications and 2 had major complications. The minor complications usually consisted of superficial punctate keratopathy (SPK) or other epithelial disturbance. Major complications consisted of superior pannus. Although patients with VKC often give a history of allergy or of atopic diseases such as allergic rhinitis, asthma, or hay fever, in the present study, coexisting allergic conditions could be detected in only 45 (30%) patients.
Conclusion: VKC is a common form of allergic conjunctivitis and the disease tends to occur in males of 11–15 years age group. Most common is palpebral form followed by mixed and bulbar forms. Some cases showed history of atopy and other allergic conditions.

Keywords: Atopy, bulbar, palpebral, papillae, vernal keratoconjunctivitis


How to cite this article:
Nagpal H, Rani N, Kaur M. A retrospective study about clinical profile of vernal keratoconjunctivitis patients at a tertiary care hospital in Patiala, Punjab, India. Kerala J Ophthalmol 2017;29:189-91

How to cite this URL:
Nagpal H, Rani N, Kaur M. A retrospective study about clinical profile of vernal keratoconjunctivitis patients at a tertiary care hospital in Patiala, Punjab, India. Kerala J Ophthalmol [serial online] 2017 [cited 2018 Sep 19];29:189-91. Available from: http://www.kjophthal.com/text.asp?2017/29/3/189/224280




  Introduction Top


Vernal keratoconjunctivitis (VKC) is an ocular allergic disease, observed in children and young adults presenting with complaints of severe itching and photophobia accompanied by ocular discomfort and lacrimation.[1],[2] It is a chronic ocular allergy that affects mostly children and adolescents living in warm or hot climatic conditions.[3] VKC primarily affects boys more than girls in the first decade of life around the age of 7 years. The male:female ratio observed is 2.3:1.[3] The onset of the disease is usually after the age of 5 years and resolves around puberty, only rarely persisting beyond the age of 25 years.[4] Various exogenous as well as endogenous causes have been reported to be associated with the etiopathogenesis of VKC. An immune mechanism is found to be involved in its development as suggested by various studies.[5] Knowledge of clinical profile of the disease in the local population will help in designing preventive measures and also proper management of the disease. The present study was conducted to describe clinical profile of VKC from a tertiary care center in Patiala, Punjab, India.


  Materials and Methods Top


This is a retrospective study conducted in a tertiary care hospital in Patiala, Punjab. It was conducted with data collected from a total of 150 patients with VKC who were diagnosed on the grounds of their history, the presence of characteristic symptoms, and on the basis of their clinical features over a period of 6 months from March 2017 to August, 2017. The history of each patient was taken including a record of age, sex, place of residence, change of place of residence, age at onset of the disease, seasonal variations, associated allergic or “atopic” illnesses, and family history of VKC or associated allergic or atopic conditions. Best-corrected visual acuity was assessed and each patient was thoroughly examined with a slit lamp. Follow-up was done every 4 weeks for 6 months. [Table 1] displays the age and sex distribution at the onset of VKC; the highest incidence of VKC occurred in the age group of 11–15 years. [Table 2] describes the distribution of incidence of various symptoms of the disease in the patient. [Table 3] shows the type of disease encountered. [Table 4] depicts the frequency of various ocular signs. [Table 5] illustrates the corneal involvement in the data collected. [Table 6] shows that 45 of 150 patients had a history of other allergic conditions such as atopy, allergic rhinitis.
Table 1: Age and sex distribution at the time of presentation

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Table 2: Incidence of symptoms

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Table 3: Disease pattern

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Table 4: Ocular signs in vernal keratoconjunctivitis patients

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Table 5: Corneal involvement

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Table 6: Vernal keratoconjunctivitis association with allergic disease

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  Results Top


Of 150 patients, 110 (73.33%) were male and 40 (26.67%) were female. [Table 1] displays the age and sex distribution at the onset of VKC; the highest incidence of VKC occurred in the age group 11–15 years that is 70 cases (46.67%). As shown in [Table 2], according to symptom profile, 110 (73.33%) cases presented with itching while redness was seen in 50 (33.33%) cases and history of photophobia in 32 cases (21.33%), ropy discharge in 45 cases (30%), and watering and burning sensation in 15 cases (10%). Disease pattern as described in [Table 3] depicts palpebral form in 93 cases (62%), bulbar form in 22 cases (14.67%), and mixed form in 35 cases (23.33%). [Table 4] describes the presence of various ocular signs in cases examined, 110 cases (73.33%) had papillae on upper palpebral conjunctiva, 52 cases (34.67%) had conjunctival congestion, 20 cases (13.33%) had SPKs and limbal papillae, and 22 cases (14.67%) had Horner tranta's spots. Corneal complications as shown in [Table 5] occurred in 22 (14.67%) patients; 20 patients had minor complications (SPKs) and 2 had major complications (pseudogerontoxon). Patients with VKC often give a history of allergy or of atopic diseases such as allergic rhinitis, asthma, or hay fever, but in the present study, coexisting allergic conditions could be detected in only 45 (30%) patients as shown in [Table 6].


  Discussion Top


VKC is an allergy-associated recurrent inflammatory disease found predominately in prepubescent males. It is characterized by the bilateral presence of palpebral and/or bulbar conjunctiva papillae, corneal keratopathy, and mild-to-severe itching. VKC is usually considered to be a childhood disease and has been found to resolve usually by the age of puberty. We have observed that 15 cases (10%) in our study group were more than 20 years of age. A hospital-based study done in Pakistan by Shafiq and Shaikh [6] reported a low prevalence of only 6% of patients with VKC to be above the age of 20 years. Leonardi et al.[7] in their study also reported only 4% of patients to be more than 20 years of age. However, an Indian study by Saboo et al.[8] has reported 12% of patients to be above 20 years of age. Male:female ratio in our study was 2.75:1. Most of the studies have reported male:female ratio between 4:1 and 2:1.[9],[10] However, a study by Ukponmwan [11] from Nigeria reported higher ratio of females affected as compared to male (1:1.3). Our study has found a male:female ratio which is in line with most other studies. There is a higher predilection for warm, dry climates, as inflammation trends to decrease in the cooler months of the year. VKC is self-limiting and typically lasts 4–10 years with remission at puberty. The immunopathogenesis is multifactorial. Classically, it has been thought of as a type I IgE-mediated hypersensitivity reaction; however, it has been suggested that there is cell-mediated Th2 involvement. The major symptom is ocular itching. Minor symptoms include photophobia, burning, tearing, mild ptosis, and a thick, ropy, yellow, mucoid discharge. Clinically, there are three forms of conjunctivitis: palpebral, limbal, and mixed. The palpebral form is characterized by polygonal, flat-topped, giant cobblestone papillae of the superior tarsal conjunctiva. Many of the cases from our study showed a mixed presentation regarding limbal and palpebral involvement as noted from presenting symptoms and signs. Complications of visual loss from corneal neovascularization, corneal scars, keratoconus and steroid-induced cataracts, and glaucoma are found in 6% of patients. 30% of subjects in our study were found to be atopic based on the history of hay fever, asthma, and eczema. Studies by Lambiase et al.[12] and Bonini et al.[13] reported associated systemic allergies in 41.6% patients in different series. Pharmacologic therapy is the mainstay of treatment. Topical treatments are more effective than systemic. The first line of treatment is a topical mast cell stabilizer, antihistamine, or mast cell stabilizer/antihistamine combination (olopatadine or lodoxamide). These classes of drugs are safely used long term for moderate-to-severe cases and should be taken 1 month before the seasonal onset of symptoms. Steroid use is limited to severe inflammation and corneal shield ulcers to minimize the iatrogenic harm. Cases not responding to steroids can be treated with cyclosporine. Nonsteroidal anti-inflammatory eye drops are used as a safe alternative in mild cases. Environmental strategies of therapy include avoidance of allergens and triggering factors, cold compresses, and moving to a cooler climate.


  Conclusion Top


VKC is a common form of allergic conjunctivitis, and this disease tends to occur more in males of 11–15-year age group. Some cases showed a history of atopy, other allergic conditions. Our study spans over a period of 6 months and is retrospective in nature focusing on frequency of symptom presentation and the presence of various ocular signs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shoja MR, Besharati MR. Evaluation of keratoconus by videokeratography in subjects with vernal keratoconjunctivitis (VKC). J Res Med Sci 2006;11:164-9.  Back to cited text no. 1
    
2.
Attarzadeh A, Khalili MR, Mosallaei M. The potential therapeutic effect of green tea in treatment of vernal keratoconjunctivitis. Irn J Med Hypotheses Ideas 2008;2:21.  Back to cited text no. 2
    
3.
Leonardi A. Vernal keratoconjunctivitis: Pathogenesis and treatment. Prog Retin Eye Res 2002;21:319-39.  Back to cited text no. 3
    
4.
Ali SS, Ansari MZ, Sharif-ul-Hasan K. Featurs of vernal kerato conjunctivitis in a rural population of Karachi. Pak J Ophthalmol 2006;22:174-7.  Back to cited text no. 4
    
5.
Bisht R, Goyal A, Thakur, Singh T, Sharma, Vijay, et al. Clinico-immunological aspects of vernal catarrh in hilly terrains of Himachal Pradesh. Indian J Ophthalmol 1992;40:79-82.  Back to cited text no. 5
    
6.
Shafiq I, Shaikh ZA. Clinical presentation of vernal keratoconjunctivitis (VKC): A hospital based study. J Liaquat Univ Med Health Sci 2009;8:50-4.  Back to cited text no. 6
    
7.
Leonardi A, Busca F, Motterle L, Cavarzeran F, Fregona IA, Plebani M, et al. Case series of 406 vernal keratoconjunctivitis patients: A demographic and epidemiological study. Acta Ophthalmol Scand 2006;84:406-10.  Back to cited text no. 7
    
8.
Saboo US, Jain M, Reddy JC, Sangwan VS. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India. Indian J Ophthalmol 2013;61:486-9.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Tabbara KF. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol 1999;34:88-92.  Back to cited text no. 9
    
10.
Akinsola FB, Sonuga AT, Aribaba OT, Onakoya AO, Adefule-Ositelu AO. Vernal keratoconjunctivitis at Guinness eye Centre, Luth (a five year study). Nig Q J Hosp Med 2008;18:1-4.  Back to cited text no. 10
    
11.
Ukponmwan CU. Vernal keratoconjunctivitis in Nigerians: 109 consecutive cases. Trop Doct 2003;33:242-5.  Back to cited text no. 11
    
12.
Lambiase A, Minchiotti S, Leonardi A, Secchi AG, Rolando M, Calabria G, et al. Prospective, multicenter demographic and epidemiological study on vernal keratoconjunctivitis: A glimpse of ocular surface in Italian population. Ophthalmic Epidemiol 2009;16:38-41.  Back to cited text no. 12
    
13.
Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, et al. Vernal keratoconjunctivitis revisited: A case series of 195 patients with long-term followup. Ophthalmology 2000;107:1157-63.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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