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TITLE VERNAL KERATO CONJUNCTIVITIS PURPOSE - To report a rare case of vernal -keratoconjunctivitis with tranta nodules all over

er the upper half of the cornea MATERIAL &METHODS -A 8yr old male child , Torch , Snellen's visual acuity chart , Slit lamp bio-microscopy , Fluorescein strip INTRODUCTION -Vernal keratoconjunctivitis(VKC) is an bilateral , recurrent , Ig-E mediated allergic condition of cornea and conjunctiva that mainly affect young people between age of 3 and 25 yrs. onset before age of 10 years. It is common in dry and warm climate.Itching, redness, watering, photophobia, ropy discharge are common complaints CASE HISTORY - 8yr old male patient named RAVI presented to our OPD with itching, redness, photophobia , watering both eyes on and off since 2yrs . Patient is a known case of vernal -keratoconjunctivitis and is on fluorometholone and olopatidine which he used when symptomatic. On examination patient had minimal edema of both lids with gaint papillae on upper palpebral conjunctiva , limbal papillae and limbal trantas nodules in both eyes. Cornea of the right eye has macular opacity involving the upper half with superficial vascularization with gelatinous tranta like nodules dispersed all over the upper half . Cornea of left eye also has macular opacity with superficial vascularization in the upper half Minimal posterior sub-capsular cataract present in both eyes .Rest of anterior segment with in normal limits both eyes. Vision in right eye is 6/12 and left eye is 6/6 . Patient was started on topical 0.1% cyclosporine drops

DISCUSSION- VKC is of 3types -1.palpebral

2.limbal

3. Mixed

PALPEBRAL TYPE - The conjunctiva develops a papillary response principally at upper tarsal conjunctiva. In severe cases cobble stone appearance is seen LIMBAL FORM - Limbal papillae which tend to be gelatinous and confluent - Horner-Tranta dots, which are collections of epithelial cells and eosinophils, may be found round the limbus MIXED TYPE features of both types are present Associated corneal changes like punctate epitheliopathy, macroerosions, shields ulcerations , plaque , subepithelial scarring and psuedogerontoxon can be seen
Steroids are main stay of treatment along with anti-histaminics and mast cell stabilizers Cyclosporine or tacrolimus can be used in severe, non-responsive or cases which develop complications due to steroids

CONCLUSION - All cases of vernal kerato-conjunctivitis must be regularly followed up to prevent sight threatening complications . Trantas nodules which are usually limited to limbus may sometimes involve the cornea in severe cases

Patients who are unresponsive or in whom allergic process progresses despite topical steroids , must be treated with topical cyclosporine 1% or tacrolimus 0.03%