Allergic KeratoConjunctivitis

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Cleared Controversies Spring catarrh is associated with Corneal opacity > spring season.

	Vernal KeratoConjunctivitis/Spring Catarrh(misnomer)/Warm Weather Conjunctivitis	Phlyctenular KeratoConjunctivitis
Pathology	Allergic inflammation to exogenous allergens such as pollen.	Allergic inflammation to endogenous microbial proteins like staphylococcus proteins(mc),TB proteins,moraxella axenfeld proteins,certain parasitic proteins.
Type of HSR	Type I hypersensitivity reaction(immediate)	Type IV hypersensitivity reaction(delayed)
Age & sex	Boys,4-20 yrs	female(slight),3-15 yrs
General info	recurrent ,interstitial,self limiting,more common in summer	c/b Phlyctens(grey,yellow or pinkish white nodules) on bulbar conjunctiva near limbus
laterality	bilateral	Usually unilateral
Clinical Features	Marked itching & burning, Stringy(ropy)discharge, Lacrimation, Photophobia, Heaviness of lids. Types a.Palpebral form - upper palpebral papillary hypertrophy(cobblestone/pavement stone appearance),heal without scarring. macropapillae with diffuse infiltrate giant papillae b.Bulbar form - Dusky red triangular congestion on bulbar conjunctiva in palpebral area. Gelatinous thickened tissue around limbus. Horner’sTrantas spots : discrete whitish raised dots along limbus.(:composed of degenerated eosinophils) papillae with Horner–Trantas dots c.Mixed form	Itching not prominent, Mild irritation &discomfort, Lacrimation , Phlyctens - surrounded by hyperemia,ulcerate at apex. Limbal phlyctenular conjunctivitis
Corneal signs	Punctate epithelial keratitis Superior punctate erosions and mucus stained with rose Bengal Ulcerative vernal keratitis : shallow transverse ulcers(Shield ulcers) plaque and shield ulcer Vernal corneal plaques, Early plaque Subepithelial scarring, subepithelial scarring following ulceration Pseudogerontoxon : peripheral corneal scar resembling arcus senilis.classical cupid's bow outline. pseudogerontoxon and limbal papillae Alkaline tears.	Miliary ulcer, Ring ulcer, Fascicular ulcer, Scrofulous ulcer, Diffuse infiltrative phlyctenular keratitis
Management	Steroids(limited use). Mast cell stabilizers(DOC) : disodium cromoglycate,olopatadine(new),lodoxamide tromethamine. Topical antihistamines : cyclosporine,vasoconstrictor like naphazoline.	DOC - topical steroids.

Visual loss in spring catarrh is associated with

• Corneal complications
• Scar
• Keratoconus
• Irregular astigmatism

• Topical steroid complications