Adult-Onset Vernal Keratoconjunctivitis With Bilateral Grade 2 Shield Ulcers: An Unusual Presentation

To report a rare case of adult-onset VKC presenting with bilateral grade 2 shield ulcers and to emphasize the importance of timely recognition and aggressive therapy.
Vernal keratoconjunctivitis (VKC) is a chronic allergic inflammatory disorder of the ocular surface typically affecting children and adolescents. Adult-onset disease is uncommon and may present with severe corneal complications. Shield ulcers represent a sight-threatening manifestation requiring urgent intervention.

This was a case report conducted at a tertiary eye care center. A 28-year-old male presenting with clinical features suggestive of vernal keratoconjunctivitis (VKC) was evaluated.A detailed ocular history was obtained, followed by comprehensive ophthalmic examination including best-corrected visual acuity assessment using Snellen chart, slit-lamp biomicroscopy, and upper lid eversion to assess tarsal papillae. 

A 28-year-old male presented with bilateral ocular itching, redness, watering, mucoid discharge, photophobia, and blurred vision of 15 days’ duration. Best-corrected visual acuity was 6/6 in the right eye and 6/9 in the left eye. Slit-lamp examination revealed upper lid edema and multiple flat-topped giant papillae (>1 mm) on the superior tarsal conjunctiva in both eyes. Corneal examination demonstrated a 1×1 mm central shield ulcer with grey white deposits in the right eye and two superficial shield ulcers measuring 1×2 mm and 2×3 mm also with grey white deposits in the left eye, consistent with bilateral grade 2 disease.

Adult-onset VKC can present with bilateral severe corneal involvement, increasing the risk of misdiagnosis and delayed treatment. Early, aggressive anti-inflammatory therapy is crucial to prevent permanent visual sequelae. VKC should not be excluded solely on the basis of age.