Vernal keratoconjunctivitis (VKC) is a severe perennial or seasonal form of allergic conjunctivitis predominantly affecting children and young adults. Eighty percent of patients are below 14 years of age and boys are usually more affected at 2:1 ratio. The chief symptoms of this disease include severe itching, photophobia, redness, tearing and tenacious (ropy) discharge. The important clinical signs in conjunctiva include cobblestone papillae in the upper tarsal conjunctiva, limbal conjunctival thickening with gelatinous nodules and Tranta's dots. Corneal involvement can occur in the form of punctuate keratitis, shield ulcer, scarring and pannus formation.4 In majority of children, the disease resolves spontaneously between age 2 and 10 years. Eyes with refractory and frequently recurrent VKC often develop potentially blinding complications like corneal vascularization, corneal opacity or signs of steroid over use. SUPRATARSAL INJECTION: Triamcinolone acetonide 0.5ml (1 ml = 40 mg drug, Preservative Free sloution AUROCORT) was injected in potential space between conjunctiva and Muller's muscle, 1 mm superior to upper edge of tarsus with a 27 gauge needle after proparacaine hydrochloride 0.5 % was instilled into the eye 3 times at an interval of 2 minutes. This produced ballooning of the potential space between the conjunctiva and Muller's muscle. No eye dressing or patching was used after giving the injection. Topical steroid medications were discontinued & patients were maintened with Olopatadine (Pataday, Alcon Lab.) eye drop once per day for several weeks. The recalcitrant eyes with VKC invariably develop disease related or treatment related complications with irreparable ocular morbidity and blindness. This poses a challenge for the treating ophthalmologist, especially when the patients with advanced VKC remain markedly symptomatic and debilitated despite maximum medical treatment. Supratarsal injection of triamcinolone acetonide in patients with severe refractory VKC, found it well tolerated and provided high rate of clinical response with lack of complications. However, a curative treatment for refractory VKC remains elusive.
REFERENCES: Saini JS, Gupta A, Pandey SK, et al. Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis. Acta Ophthalmol. Scand. 1999;77:515-518.
Pandey SK, Saini JS, et al. Mitomycin-C and vernal conjunctivitis. Letter to the editor. Ophthalmology. 2000;107:2125-2126.
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