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Vernal keratoconjunctivitis (VKC)

Vernal keratoconjunctivitis, or VKC, is a severe and recurrent allergic eye condition that mainly affects children (predominantly boys) and young adults.1,2 It results in painful eyes, photophobia (due to intense itching, discomfort/pain caused by light exposure) and if symptoms are inadequately controlled, severe VKC can lead to chronic eye disease throughout adulthood, sometimes resulting in permanent damage to vision.2,3,4

The condition is characterised by severe inflammation of the surface of the eye, including the conjunctiva (conjunctivitis) and cornea (keratitis). There may be seasonal exacerbations (it is sometimes known as ‘spring catarrh’) but the condition may be active all year round if severe.1,5

Forty two percent of those diagnosed with VKC also have other clinical manifestations including asthma, rhinitis, eczema and urticaria with almost half (49%) of those diagnosed having a family history of atopic diseases.5

Prevalence of VKC

The most common age of onset of VKC is before 10 years of age and it normally resolves within 4-10 years, or before puberty.1,2 Boys are affected more frequently than girls.6

VKC is recognised as a rare disease. The estimated prevalence of VKC in Western Europe is 3.2 people per 10,000, and 20-25% of VKC patients have severe VKC, meaning there is corneal involvement.7 Prevalence is more common in regions with a hot and dry climate.7

Impact of VKC

VKC can have a profound effect on a child’s life and development. It can affect school attendance, academic performance and can have a detrimental impact on quality of life. Other limitations include inability to participate in sports or go swimming, and difficulty in making friends.8,9

Living with VKC

Natasha and Harry: A mum’s crusade to find an answer

 

Tracey and Sam: A mum’s journey to help her son overcome his multiple allergies

 

Treatments

There are some treatments for VKC that address the inflammation by altering the immune response, including cyclosporine and tacrolimus. Other anti-allergy pharmacological therapies for VKC have been shown to be effective in mild to moderate forms of the disease, but they do not target the underlying inflammatory process, therefore are less effective in severe VKC. These include:

  • Vasoconstrictors
  • Mast cell stabilisers
  • Antihistamines
  • Non-steroidal anti-inflammatory drugs
  • Corticosteroids
  • Surgical intervention

There are limitations to some therapies such as short duration of action, poor efficacy in controlling the condition and risks associated with long-term use.1,10


References

  1. Kumar S. Acta Ophthalmol 2009;87:133-47
  2. Leonardi A. Ophthalmol Ther 2013;2:73-88
  3. Vichyanond P et al. Pediatr Allergy Immunol 2014;25(4):314-22
  4. Hall H et al. Community Eye Health 2005;18(53):76-8
  5. Bonini S et al. Ophthalmol 2000;107:1157-63
  6. Leonardi A et al. Allergy 2012;67:1327-37
  7. Bremond-Gignac D et al. Br J Ophthalmol 2008;92:1097-102
  8. Sacchetti M et al. Am J Ophthalmol 2007;144:557-63
  9. Marey HM et al. Semin Ophthalmol 2017;32:543-49
  10. Gokhale NS. Indian J Ophthalmol 2016;64(2):145-48