2. It is a recurrent, bilateral, interstitial, self
limiting allergic inflammation of the
conjunctiva may have a periodic seasonal
incidence.
It is a type of allergic conjunctivitis.
Occuring with the onset of hotweather,
during summer rather than spring.
Sporadic and non contagious in nature.
Recently it also called as warm weather
conjunctivitis.
3. Sporadically occur in wide geographical
incidence.
More common in indian subcontinent and africa
like tropical countries than europe.
Coloured races are more prone to form limbal
form of disease.
Essentially disease of youth occuring more
frequently in between ages of 5-10 years.
Sex incidence very high pecentages are seen in
males
Family history of allergy found in 40-60
percentages.
4. Three theories are found currently
Due to the action of physical factors like
Heat
Humidity
Light
Due to the endocrine glands and vagotonic states
Manifestation of an allegic condition.
Pollens
Toxins
Dusts
Animal debris,hair
Inhalants
Injestants
Mostly pathogenesis IgE mediated allegic reaction
5.
6. Conjunctval epithelium
Undergoes hyperplasia
Sends downwards projections into the sub epithelial
tissue
Adenoid layer
Marked cellular infiltrations
Eosinophils, plasmacells, lymphocytes,and histiocytes
Fibrous layer
Shows proliferation
Later on undergoes hyaline changes
Conjunctival vessels
Proliferation
Increased permeability and vasodilation.
All these lead to formation of multiple papillae in the
upper tarsal conjunctiva…
7. Marked burning and foreignbody sensation.
Itching sensation.
Mild photophobia.
Lacrimation+watering
Stringy( thick ropy white) discharge and
heaviness of lids.
in the cooler months the conditions subsides
and symptoms persits and is symptomsless
although the lesions persists,but recur with
the return of the heat.
8. Signs may be described under 3 clinical forms
of disease
Palperbral form
Bulbar form
Mixed form
9. Usually upper tarsal conjunctiva of
both eyes involved.
Easily recognised
On everting upper lid the palperbral
conjunctiva is seen to be
hypertropied and mapped out into
polygonal raised are like
cobblestones or pavement stones
fashion.
In severe cases papillae may
hypertropy-produce giant
papillae,cauliflower like
excresenses.
The colour is bluish white,like
milk,and this apppearancce may
also be seen over the lower
palperbral conjunctiva.
The flat topped nodules are hard
consist cheifly of dense fibrous
tissue,but the epithelium over them
thickned giving rise to milky hue.
Histologically they are
hypertrophied papillae not follicles
10.
11. Eosinophillic leukocytes are present in them
in great numbers and found in the secretion
Infiltrationof
lymphocytes,plasmacells,macrophages,basop
hills.
Palperbral form cannot be mistaked if typical
but may resemble trachoma.
12. Recognised by an
opacification of the limbus
with nodules or a wall of
gelatinous thickening at
the limbus
Dusky red triangular
conjestion of bulbar
conjunctiva in palperbral
area.
White dots consisting the
esonophills and epithelial
debris known as horner-
trantas dots if seen at
limbus are a very
characteristic feature.
13.
14.
15. It shows combined features of both
palperbral and bulbar form
16. Mainly due to corneal involvement otherwise
prognosis is good
Vernal keratopathy
Due to corneal involvement in vernal kerato
conjunctivitis
May be primary or secondary due to
extension of limbal lesions.
Includes 5 types of lesions
17. PUNCTATE EPITHELIAL KERATITIS
INVOLVE UPPER CORNEA
MOSTLY WITH PALPERBRAL FORM
STAIN WITH ROSEBENGAL INVARIABLY WITH FLOURESCEIN
ULCERATIVE VERNAL KERATITIS
SHALLOW TRANSVERSE ULCER IN UPPER CORNEA
VERNAL CORNEAL PLAQUES
DUE TO COATING OF BARE AREAS OF EPITHELIAL MACRO
EROSIONS WITH A LAYER OF ALTERED EXUDATES
SUBEPITHELIAL SCARRING
IN A FORM OF RING SCAR
PSEUDOGERONTOXON.
CHARACTERISED BY CUPID BOW OUTLINE.
18.
19. SELF LIMITING
USUALLY BURNS OUT SPONTANEOUSLY AFTER
5 TO 10 YEARS.
20. TRACHOMA
Mainly trachoma with
predominant papillary
hypertrophy from
palperbralform of spring
catarrah
It can be differentiated as
follows
Papillae are large and
usually cobblestone
appearance in spring
catarrah.
Ph of tears alkaline in spring
catarrah while in trachoma
acidic.
Discharge ropy in spring
catarrah
Conjunctival cytology and
labtest in difficult cases.
21. Local therapy
Topical steroids.
Used for all type of spring
catarrah
Beware of steroid induced
glucoma in prolonged use
Measure IOP during
treatment
Frequent instillation 4
houly for 2days, then 3-
4times a day for 2 weeks
Fluorometholone
medrysone.
Betamethosone.
Dextramethosone
Medrysone and
flurometholone are most
safest.
22. Local theraphy
Mast cell stabilizers.
Sodium chromoglycate 2%
drops 4-5 times a day
Topical
antihistaminics.
Acetyl cysteine 0.5%
Mucolytic properties
In early plaque
formation
Topical cyclosporine
1%
In un responsible cases
Steroid resistant cases.
23. Systemic therapy
Oral antihistamininics
Anti allergic
Relive from itching
Oral steroids
Short duration recommended for advanced,very severe
non responsive cases.
24. Treatment for large papillae.
Giant papillae can be tackled by
Supratarsal injection of long acting steroids.
Cryo application
Sugical excision recommended for extra ordinary large papillae
General measures
Dark goggles for photophobia
Coldcompression for soothing effect
Change of place to hot to cold area if possible
Desensitization
Treatment for vernal keratopathy
Punctate epithilial type-no extra treatment instillation of steroid must be increased.
Large vernal plaque-surgery(superficial keratectomy)
Severe shied ulcer-resistant to medical theraphy
Sugery is preffered in debridement,superficial keratectomy,eximer laser,therapeutic keratectomy.
Prophylaxis
beta radiation,disodium chromoglycate 2% 3 to 4 times.