Y. B. Bajantri1, Rajshekar D.2, Hemalatha A.3, Sneha N. Hegde4
BACKGROUND: Ocular allergy is a common disorder which can be debilitating for patients and, at times, challenging for physicians to diagnose and treat. Allergic disease affects 30–50% of the population. Vernal kerato conjunctivitis has predilection for young age group and the diagnosis is generally based on signs and symptoms of the disease. This study is undertaken to stress upon the importance of clinical manifestations, management and prevent the complications of the disease and those secondary to its long-term medication.
AIM OF STUDY: To study the different modalities in management of VKC patients
MATERIALS & METHODS: 74 patients with VKC selected at random, who attended the department of ophthalmology KIMS, Hubli from December 2012 to May 2014. The relevant details of history and clinical examination of the patients were recorded on a specifically designed Proforma. The type and severity of VKC and its association with corneal involvement was noted. Clinical observation and evaluation of clinical signs and symptoms were performed before and after drug therapy at first visit, weekly interval for 2 weeks and at the end of 3 months. Therapeutic options are many, in most cases topical and chosen on the basis of the severity of the disease
RESULTS: 68/74 (91.89%) patients were put on 0.1% olopatadine eye drops 2 times a day at 0 visit. Additional treatment such as 0.5% ketorolac 4 times a day in 13/68 patients, 0.1% bromofenac 2 times a day in 3/68 patients and 0.1% Napafenac 2 times a day in 1/68 patient was added along with olopatadine at visit 0. In 16/68 patients with persistent symptoms with olopatadine alone 0.5% ketorolac was added in subsequent visits. 15/68 patients with persistent symptoms received Flurometholone 0.1% in the subsequent visits along with 0.1% olopatadine. All these patients who received 0.5% ketorolac alone or with other drugs responded well. Fallow – up patients using 0.1% olopatadine showed that there were no side effects and majority of patients responded well. 29/74 (38.18%) patients were treated with topical corticosteroids. 20/74 patients were put on Flurometholone 0.1% 4 times a day. 5/20 patients with severe disease were put on Flurometholone at visit 0 and in remaining 15 patients were treated with Flurometholone in the subsequent visits. All patients responded well except for one patient who had giant papillae with mechanical ptosis required surgical management. 8/74 patients were treated with 0.2% Lotoprednol etabonate4 times a day in the visit 0, 6/8 patients had severe disease when they presented to the hospital. 4/8 responded well to treatment and 4/8 does not responded. Topical 1% cyclosporine A was used in 2 patients. Both the patients do not improve in the study period. 5 patients in this study were treated with systemic antihistaminic. 4/5 patients were feeling symptomatically better. One patient who was refractory to steroid eye drops was treated with 0.03% tacrolimus eye responded well. Mechanical resection of giant papillae was done in one patient and but patient had recurrence after 2months. Later treated with cyclosporine an eye drops and responded for the therapy.
CONCLUSION: The treatment of choice for mild to moderate VKC is a dual acting topical ocular medication (Mats cell stabilizing with antihistamine effect). Mild steroids in mild to moderate cases and potent steroids in severe cases help in rapid relief of symptoms, but should be used with caution. Preventive measures like avoidance of allergen, cold compression provides symptomatic relief. Artificial tear substitutes provide a barrier function and help to improve the first – line defense at the level of conjunctival mucosa. Systemic and or topical antihistamines may be given to relieve acute symptoms. Immuno modulators are helpful in refractory cases.