Treatments for GPC: stop CL, try cold artificial tears. If does not help, we try steroid, and/or Restasis. Then try other CL material when quiet.
Great references below:
- Age and sex – 4–20 years; more common in boys than girls.
- Season – More common in summer. Hence, the name Spring catarrh is a misnomer. Recently it is being labelled as Warm weather conjunctivitis.
- Climate – More prevalent in the tropics. VKC cases are mostly seen in hot months of summer, therefore, more suitable term for this condition is “summer catarrh” Ref.
- Conjunctival epithelium undergoes hyperplasia and sends downward projection into sub-epithelial tissue.
- Adenoid layer shows marked cellular infiltration by eosinophils, lymphocytes, plasma cells and histiocytes.
- Fibrous layer show proliferation which later undergoes hyaline changes.
- Conjunctival vessels also show proliferation, increased permeability and vasodilation.
- Symptoms- VKC is characterised by marked burning and itchy sensations which may be intolerable and accentuates when patient comes in a warm humid atmosphere. Associated symptoms include mild photophobia, lacrimation, stringy discharge and heaviness of eyelids.
- Signs of VKC can be described in three clinical forms.
- Palpebral form- Usually upper tarsal conjunctiva of both the eyes is involved. Typical lesion is characterized by the presence of hard, flat-topped papillae arranged in cobblestone or pavement stone fashion. In severe cases papillae undergo hypertrophy to produce cauliflower-like excrescences of ‘giant papillae’.
- Bulbar form- It is characterised by dusky red triangular congestion of bulbar conjunctiva in palpebral area, gelatinous thickened accumulation of tissue around limbus and presence of discrete whitish raised dots along the limbus (Tranta’s spots).
- Mixed form- Shows the features of both palpebral and bulbar types.
- Punctuate epithelial keratitis.
- Ulcerative vernal keratitis.
- Vernal corneal plaques.
- Subepithelial scarring.
- Local therapy- Topical steroids are effective. Commonly used solutions are of fluorometholone, medrysone, betamethasone or dexamethasone. Mast cell stabilizers such as sodium cromoglycate (2%) drops 4–5 times a day are quite effective in controlling VKC, especially atopic ones. Azelastine eyedrops are also effective. Topical antihistamines can be used. Acetyl cysteine (.0.5%) used topically has mucolytic properties and is useful in the treatment of early plaque formation. Topical Cyclosporine is reserved for unresponsive cases.
- Systemic therapy- Oral antihistamines and oral steroids for severe cases.
- Treatment of large papillae- Cryo application, surgical excision or supratarsal application of long-acting steroids.
- General measures include use of dark goggles to prevent photophobia, cold compresses and ice pack for soothing effects, change of place from hot to cold areas.
- Desensitization has also been tried without much rewarding results.
- Treatment of vernal keratopathy- Punctuate epithelial keratitis require no extra treatment except that instillation of steroids should be increased. Large vernal plaque requires surgical excision. Ulcerative vernal keratitis require surgical treatment in the form of debridement, superficial keratectomy, excimer laser therapeutic keratectomy, as well as amniotic membrane transplantation to enhance re-epithelialisation.
- PROSE (prosthetic replacement of the ocular surface ecosystem) treatment, an iterative medical process that uses custom designed and fabricated prosthetic devices, maintains ocular surface health and improves vision in individuals with VKC.
- Shah, Syed Imtiaz Ali (2014). Concise Ophthalmology (4th ed.). Paramount. p. 31. ISBN 978-969-637-001-7.
- Rathi VM, Sudharman Mandathara P, Vaddavalli PK, Dumpati S, Chakrabarti T, Sangwan VS (May 2012). “Fluid-filled scleral contact lenses in vernal keratoconjunctivitis”. Eye & Contact Lens 38 (3): 203–6.doi:10.1097/ICL.0b013e3182482eb5. PMID 22367220.
Very large papillae in the everted upper lid of a patient who wears hydrogel (soft) contact lenses.Giant papillary conjunctivitis (GPC) response (slightly out of focus) seen in the upper lid of a young patient recovering from cataract extraction with an exposed suture barb (in focus).
Other diseases that cause conjunctivitis and ocular itching/mucus – Typically ocular allergies (hay fever conjunctivitis) but also viral and bacterial conjunctivitis and blepharitis
Other diseases that cause papillary changes in the tarsal conjunctiva of the lids, especially vernal andatopic conjunctivitis
Other giant papillary-forming disorders by the creamy white appearance of the giant papillae center/top
Other diseases that cause follicular changes, which can easily be confused with papillary changes, in the palpebral conjunctivae of the lids –Viral conjunctivitis (adenovirus and herpes), chlamydial infections, and Gel-Coombs type IV hypersensitivity and toxic reactions, particularly to contact lens solutions
Other causes of contact lens intolerance, such as poor fit, dry eyes, and blepharitis