This type of article, "High-Yield Overview," aims to briefly summarize the key points of a disease or concept with little explanation. Because there will be other articles that will go into greater detail about these conditions, this will hopefully serve as a quick review of the topic. All of the emphases are mine as little ways to help me remember details I thought were important to know. While I am terming these articles as high-yield, any highlights that are similar to actual OKAP or board exam questions are coincidental and should be taken to mean that you really need to know that material.
- Type I & IV hypersensitivity
- Predominantly male children (2:1 in children, evens out in adulthood)
- Most common cause of ophthalmic morbidity among Palestinians in West Bank/Gaza Strip
- Limbal VKC: African or Asian descent (regardless of location)
- 50% have a family history of allergic disorders
- Associated with a history of atopic disease (most commonly asthma, 1/3 have multiple diseases), keratoconus (15%)
- Conjunctival infiltration of eosinophils (90%), lymphocytes, plasma cells, monocytes
- Typically presents during Spring (hence the name vernal)
- Bilateral (98%) inflammation of cornea & conjunctiva (year round in tropical environments)
- Itching, blepharospasm, photophobia, blurred vision, mucoid discharge, filaments (part of DDx for filament keratopathy)
- Upper > lower palpebral diffuse papillary hypertrophy, bulbar conjunctival hyperemia/chemosis
- Giant papillary conjunctivitis: “cobblestone” in appearance (part of DDx for GPC)
- Atopy less common than in palpebral VKC
- Thickened, gelatinous limbal papillae w/↑ perilimbal conjunctival pigmentation
- Superior pannus: can occasionally have 360° corneal neovascularization
- Horner-Trantas dots: whitish dots of aggregated degenerated eosinophils + epithelial cells
- Shield ulcer: noninfectious epithelial ulcers with underlying stromal opacification
- Recurrent but typically burns out in puberty
- Climate modifications, antihistamines, mast-cell stabilizers (start 2 weeks prior to “season”)
- Topical steroids (pulse therapy): Q 2 hrs x 5-7 days with rapid taper; prednisolone particles stick between papillae (consider using something soluble like dexamethasone phosphate instead)
- Supratarsal subconjunctival steroid injection (for compliance): located superior to upper border of superior tarsus (free from subepithelial adhesions)
- 0.5-1.0 mL of short-acting dexamethasone (4 mg/mL), long-acting triamcinolone (40 mg/mL)
- Topical cyclosporine (2% needed, not Restasis dosages): 2-4x/day
- Side effects: punctate epithelial keratopathy, ocular surface irritation
- Chapter 7: Clinical Approach to Immune-Related Disorders of the External Eye. In: Basic and Clinical Science Course, Section 8: External Disease and Cornea. American Academy of Ophthalmology, 2015.
- Gerstenblith AT, Rabinowitz MP, et al, eds. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 6th Ed. Philadelphia: Lippincott Williams & Wilkins, 2012.
- Bowling B. Kanski’s Clinical Ophthalmology: A Systematic Approach, 8th Ed. China: Elsevier, 2016.