Contributor: Gordon K. Klintworth
Vernal keratoconjunctivitis is a bilateral allergic disease of the conjunctiva and cornea that is most common in the spring, because of airborne allergens, such as pollen. Feature include a stringy, mucous conjunctival discharge, giant papillae at the upper tarsus, and marked intching. Parts of the conjunctiva appear milky appearance with numerous fine papillae may form in the lower palpebral conjunctiva. A pseudomembrane is sometimes present. Several corneal abnormalities develop (including superficial punctate keratitis [keratitis - superficial punctate], epithelial defects, superficial ulcers, micropannus, and a pseudogerontoxon which is often adjacent to Trantas dots). Young males are mainly affected during childhood, but in adults both males and females are equally affected. The condition may start by four years of age and after the third decade the vernal keratoconjunctivitis is uncommon. A personal or family history of atopic disease (such as hayfever , atopic dermatitis [eczema], or asthma) is common. Increased levels of IgE can be detected in the tears and serum of affected individuals.The serum IgE levels are elevated. The conjunctiva of patients with vernal keratoconjunctivitis contains many eosinophils and mast cells, but also lymphocytes, plasma cells and neutrophils.