Bonini S, Coassin M, Aronni S, Lambiase A
Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University of Rome, Campus Bio-Medico, Rome, Italy.
Eye (Lond). 2004 Apr;18(4):345-51. doi: 10.1038/sj.eye.6700675.
Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. The most common symptoms are itching, photophobia, burning, and tearing. The most common signs are giant papillae, superficial keratitis, and conjunctival hyperaemia. Patients with VKC frequently have a family or medical history of atopic diseases, such as asthma, rhinitis, and eczema. However, VKC is not associated with a positive skin test or RAST in 42-47% of patients, confirming that it is not solely an IgE-mediated disease. On the basis of challenge studies as well as immunohistochemical and mediator studies, a Th2-driven mechanism with the involvement of mast cells, eosinophils, and lymphocytes has been suggested. Th2 lymphocytes are responsible for both hyperproduction of IgE (interleukin 4, IL-4) and for differentiation and activation of mast cells (IL-3) and eosinophils (IL-5). Other studies have demonstrated the involvement of neural factors such as substance P and NGF in the pathogenesis of VKC, and the overexpression of oestrogen and progesterone receptors in the conjunctiva of VKC patients has introduced the possible involvement of sex hormones. Thus, the pathogenesis of VKC is probably multifactorial, with the interaction of the immune, nervous, and endocrine systems. The clinical management of VKC requires a swift diagnosis, correct therapy, and evaluation of the prognosis. The diagnosis is generally based on the signs and symptoms of the disease, but in difficult cases can be aided by conjunctival scraping, demonstrating the presence of infiltrating eosinophils. Therapeutic options are many, in most cases topical, and should be chosen on the basis of the severity of the disease. The most effective drugs, steroids, should however be carefully administered, and only for brief periods, to avoid secondary development of glaucoma.A 2% solution of cyclosporine in olive oil or in castor oil should be considered as an alternative. The long-term prognosis of patients is generally good; however 6% of patients develop corneal damage, cataract, or glaucoma.
春季角结膜炎（VKC）是一种过敏性眼病，尤其好发于年轻男性。最常见的症状是眼痒、畏光、眼烧灼感和流泪。最常见的体征是巨大乳头、浅层角膜炎和结膜充血。VKC患者常有特应性疾病家族史或个人史，如哮喘、鼻炎和湿疹。然而，42% - 47%的VKC患者皮肤试验或放射变应原吸附试验（RAST）并非阳性，这证实其并非单纯由IgE介导的疾病。基于激发试验以及免疫组化和介质研究，有人提出了一种由Th2驱动、肥大细胞、嗜酸性粒细胞和淋巴细胞参与的机制。Th2淋巴细胞既负责IgE的过度产生（白细胞介素4，IL - 4），也负责肥大细胞（IL - 3）和嗜酸性粒细胞（IL - 5）的分化和激活。其他研究表明，神经因子如P物质和神经生长因子（NGF）参与了VKC的发病机制，且VKC患者结膜中雌激素和孕激素受体的过度表达提示性激素可能也参与其中。因此，VKC的发病机制可能是多因素的，涉及免疫、神经和内分泌系统的相互作用。VKC的临床管理需要快速诊断、正确治疗以及预后评估。诊断通常基于疾病的体征和症状，但在疑难病例中，结膜刮片发现浸润的嗜酸性粒细胞有助于诊断。治疗选择众多，多数情况下为局部用药，应根据疾病严重程度选择。然而，最有效的药物——类固醇，应谨慎使用，且仅短期使用，以避免继发性青光眼的发生。橄榄油或蓖麻油中的2%环孢素溶液可作为替代药物。患者的长期预后总体良好；然而，6%的患者会出现角膜损伤、白内障或青光眼。
