Vernal Keratoconjunctivitis : A Case Report

Vernal keratoconjunctivitis  is a relatively rare ocular disease that affects the cornea and the conjunctiva. Due to its chronic and potentially debilitating nature, early diagnosis and effective treatment are crucial. It strikes mostly children and early adolescents. Clinicians must understand the clinical signs, symptoms, and treatment alternatives to mitigate the disease progression.

purpose : To report the case of a 7-year-old boy with unilateral vernal keratoconjunctivitis with corneal ulcer.

ophthalmology B department , Speciality Hospital, Ibn Sina,Rabat, Morroco

A 7-year-old boy was brought to the emergency room by his parents for a painful red right eye and intense photophobia for 15 days. He had a history of winter bronchitis; there was a family atopy. Visual acuity was not quantifiable, slit lamp examination revealed conjunctival hyperemia, with a sectorial limbal bulge at 7 o'clock and Trantas nodules. In front of this bulge, there was a juxta-limbic oval vernal plate with corneal neovascularization and follicular-papillary conjunctivitis with giant papillae. The diagnosis of vernal keratoconjunctivitis of sectorial limbal form was made. 

The vernal plaque has been removed under general anesthesia,followed by a subconjunctival injection of corticoids.The bacteriological samples taken and in particular the search for Chlamydia trachomatis were negative.Postoperatively,the child received a local treatment combining an antihistamine,an antibiotic,high-dose corticosteroids in a short and rapidly decreasing course,a healing ointment with vitamin A and wetting agents.One month after surgery,the child was asymptomatic with a clear regression of functional signs. Slit lamp examination revealed that the  vernal plate has given way to a limited non-astigmatogenous corneal cleft.The child was left under long-term antiallergic treatment with topical antihistamines without preservatives.

The management of vernal keratoconjunctivitis includes an allergological assessment to propose possible eviction measures or even desensitization. Basic treatment with antihistamines, antidegranulants, artificial tears and eyewash is systematically recommended. In the presence of a grade 3 vernal ulcer, treatment is primarily surgical and involves debridement associated, if necessary, with an amniotic membrane graft. In case of an allergic flare, local treatment with high-dose corticosteroids in short courses may be necessary.Topical ciclosporin treatment is useful in severe recurrent forms. Regular clinical monitoring is essential to limit parental self-medication and to detect recurrences until adolescence.