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Vernal Conjunctivitis

Vernal conjunctivitis is an inflammatory eye condition that affects the conjunctiva and eyelids. The inflammation of the conjunctiva is chronic, severe and persistent. It affects both eyes and worsens from seasonal flares after exposure to an allergen. This condition usually begins in childhood and resolves around puberty, but it may also continue into adulthood.

Vernal conjunctivitis is most often seen in individuals with West African and Mediterranean descent. It occurs more commonly in hot climates and has a higher frequency among young men.

If you suffer from vernal conjunctivitis, you may suffer from severe light sensitivity (photophobia) and itching. You may also complain of droopy eyelids, eyelid spasms
and a sensation of something stuck in your eye. Your eyelid skin and margins may be normal. Often the mucosa of the underside of the upper lid is heaped into giant bumps of mucosal tissue referred to as cobblestones or papillae. Unlike allergic conjunctivitis in which the discharge is clear and very liquidy, you will often have a thick sticky string-like mucous discharge that may need to be removed manually from time to time.

Diagnosis
Diagnosis of vernal conjunctivitis is based on the presentation of typical symptoms. You may have an allergy history or a family history of allergy. Identification and avoidance of relevant allergen(s) is extremely important. Allergy skin testing is the most sensitive method to determine potential sensitivity to particular allergens.

Treatment

• Environmental controls for environmental allergens at home, school, or in the work environment identified as triggering symptoms
  
• When environmental allergen controls prove inadequate in the management of symptoms, consider the following medications:
  
  - Topical antihistamines, decongestants and mast cell stabilizers or dual acting mast cell stabilizers and antihistamines are helpful, but they may take some time for optimal effect.
  
  - In severe cases, a burst of oral corticosteroids or frequent application of topical corticosteroids is needed to relieve unbearable symptoms. Prolonged use of corticosteroids should be avoided because of their association with the complication of glaucoma and/or cataracts.
  
  - Topical cyclosporin A may be useful in severe cases.
  
  - Complication of corneal ulceration may require a combination of antibiotics, corticosteroid ointment and a gauze pressure dressing over the eye.
  
  - Immunotherapy (allergy injections) should be considered to lower your sensitivity to known allergens.