Current and emerging treatment options for vernal keratoconjunctivitis

ABSTRACT

Introduction: Vernal keratoconjunctivitis (VKC) is a rare, chronic allergic disease affecting children in prepuberal age. The hallmark of VKC is the presence of conjunctival upper tarsal and/or limbal papillary reaction. Recurrences of inflammation are characterized by intense ocular symptoms of itching, redness and photophobia associated with corneal involvement ranging from punctuate keratitis to corneal shield ulcers with risk of visual impairment.

Areas covered: The goals of VKC treatment are to control inflammation, improve quality of life and avoid corneal complications. Topical antiallergic drugs are effective in mild to moderate forms of VKC, while, in the presence of intense symptoms and corneal involvement, short-term, high dose topical steroids are effective in controlling ocular inflammation. However, steroid chronic use leads to severe side effects such as glaucoma and cataract. Topical Cyclosporine A and Tacrolimus showed to be effective as steroid sparing agents, however, they are not yet available in the market for the use in VKC.

Expert opinion: Current treatment of VKC is a severity-based approach, however evidence based guidelines are lacking. Novel molecule, targeting pathogenic mechanisms alternative to immune reaction, may improve the management and outcome if this challenging disease.

KEYWORDS:

• Vernal keratoconjunctivitis
• allergy
• antiallergic drugs
• steroid
• cyclosporine

Article highlights

• VKC is a rare, chronic allergic condition mostly affecting children

• VKC is characterized by recurrences of ocular inflammation with risk of visual impairment

• A severity based VKC grading has been proposed for management of VKC

• Topical antiallergic drugs are effective in mild to moderate forms while more severe forms require the use of topical steroids

• Topical Cyclosporine A or Tacrolimus have been proposed as steroid sparing agents.

• Development of standardized clinical grading and outcome measures are needed for the future clinical trials in VKC

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.