Vernal Keratoconjunctivitis (VKC)

VKC is most commonly found in boys and often in children with severe eczema (atopic dermatitis). It is believed that the connection with eczema may contribute to the severe inflammatory response that leads to the development of VKC.

When someone with VKC is exposed to airborne allergens, such as dust and pollen, this can worsen their symptoms.

Many people do not recognise when they need to seek help and treat VKC as allergic conjunctivitis, which is the most common allergic reaction affecting the eyes, triggered by allergens such as pollen. It can also be mistaken for infectious conjunctivitis that will need prompt treatment and is often a result of rubbing the eyes with unclean hands.

VKC can be very debilitating with painful, itchy eyes and a mucus-like discharge. Often light hurts the eyes and in worse case scenarios, there can be reduced vision.

It is important to recognise the signs and symptoms of VKC and know when to seek help.

Signs and symptoms of VKC

Symptoms usually affect both eyes and in mild cases, commonly include:

• Itchy, red eyes
• Burning sensation in the eyes
• Watery eyes/small amount of discharge

In more severe cases, symptoms might include:

• Sensitivity to light
• Blurred vision
• Eye pain and discomfort, often described like the sensation of having grit in the eye
• Difficulty opening their eyes
• Stringy or mucus-like discharge from the eyes, particularly after sleeping
• Swollen, cobblestone-like bumps (called papillae) on the inside of the eyelid
• Droopy eyelids

In very severe cases, the corneas may scar (shield ulcers) or clouding of the lens (cataract) may occur, leading to temporarily or permanently reduced vision.

VKC tends to have a seasonal pattern, worsening in the spring and summer months, leading to it also being referred to as Spring Catarrh. However, some people will experience symptoms all year through.

Managing VKC

If you suspect that you or your child might have VKC, visit your GP for a referral to an eye specialist (ophthalmologist). VKC is a rare and serious condition, that requires specialist care.

Once diagnosed, typical routes of treatment that will be considered are:

• Avoiding triggers.
• Lubricant eye drops to sooth the eyes.
• Anti-allergy eye drops (mast cell stabilisers) to reduce the allergic reaction.
• Steroid eye drops to help to reduce inflammation (although this is not a long-term solution)
• Immunosuppressant eye drops to keep the inflammation under control and reduce flare ups.
• Immunotherapy for VKC that is caused by a single allergen.

Allergic eye disease

Allergic eye disease refers to a group of conditions in which the eyes react to allergens present in the environment. It exists in many different forms, of which VKC is one of the rare, more serious conditions. The other forms of allergic eye disease are:

Allergic conjunctivitis

This condition impacts the area beneath the eyelids, reacting to environmental allergens like pollens and house dust mites. This reaction typically manifests as slight redness, swelling, and occasionally, bumpiness. Common symptoms include itching, burning, watering, and redness of the eyes, and eyelid puffiness.

There are two variations that are the most common type of allergic eye problems.

• Seasonal allergic conjunctivitis which is often associated with hay fever, triggered by grass, tree or weed pollens, or other environmental allergens.
• Perennial allergic conjunctivitis (all year round) is usually a reaction to indoor allergens like house dust mites or pet dander.

Atopic Keratoconjunctivitis (AKC)

A more rare and serious form of allergic eye disease, affecting the front surface of the eye and beneath the eye lids. AKC is associated with eczema (atopic dermatitis) and is most common between the ages of 30-50 years.

It is often considered the adult equivalent to VKC, the link between AKC and VKC is explained here.

The link between VKC and Atopic Keratoconjunctivitis (AKC)

Atopic Keratoconjunctivitis (AKC) and VKC are similar forms of rare allergic eye disease. Both are chronic conditions, causing inflammation of the front surface of the eye and beneath the eye lids.

AKC is often thought of as the adult equivalent of VKC, and sometimes follows childhood VKC. AKC and VKC differ in several ways:

• Age: VKC tends to be outgrown by puberty, while AKC is most common between the ages of 30-50 years.
• Seasonal patterns: VKC worsens in the spring/summer months, unlike AKC which generally occurs in the winter.
• Connection to eczema: AKC is often linked with eczema, while eczema may occur in children with VKC but isn’t always present.

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