Larsen Ann Cathrine, Rasmussen Marie Louise Roed
Department of Ophthalmology, Rigshospitalet-Glostrup, University Hospital Rigshospitalet, Valdemar Hansens vej 1-23, 2600, Glostrup, Denmark.
Department of Clinical Medicine, University of Copenhagen, 2100, Copenhagen, Denmark.
Ophthalmol Ther. 2024 May;13(5):1061-1069. doi: 10.1007/s40123-024-00909-y. Epub 2024 Mar 4.
Vernal keratoconjunctivitis (VKC) is a rare yet severe form of allergic conjunctivitis predominantly affecting children, mainly boys, with a global prevalence and a higher incidence in certain geographical regions. The disease is characterized by seasonal exacerbations. VKC presents with ocular surface inflammation leading to various distressing symptoms such as itching, redness, mucous discharge, and pain. The disease primarily manifests bilaterally, though it may initially appear unilaterally. If left untreated, VKC can result in corneal complications, including shield ulcers and vision impairment, affecting daily activities and psychosocial well-being, especially in children. The diagnosis of VKC involves identifying key clinical findings on the ocular surface such as Tranta dots, giant papillae, or shield ulcers. Management follows a stepwise approach, including anti-allergic eye drops, steroid eye drops, and topical medications like cyclosporine, which may take up to 3 months to show efficacy. Allergic sensitization, often to inhaled allergens like pollen and house dust mites, is associated with VKC in half of the cases. Understanding and managing these allergies through measures such as avoidance, sensitization control, and co-treatment of associated conditions like asthma and rhinoconjunctivitis are essential in VKC management. Atopic keratoconjunctivitis (AKC), a related condition associated with atopic dermatitis and asthma, shares similarities with VKC but typically affects young adults. However, there is an observed spectrum between the two diseases, indicating similar treatment strategies for both. VKC treatment requires a patient-centered approach, involving informed and supported parents, considering economic factors due to costly eye drops, and ensuring accessibility and practicality of treatment, especially in children. A multidisciplinary team collaboration, including ophthalmologists, pediatricians, and dermatologists, optimizes patient care. The rewarding aspect of VKC treatment lies in witnessing children regain their quality of life, overcome vision challenges, and thrive in their daily activities. In conclusion, understanding VKC, its associated allergies, and employing a comprehensive, patient-centered approach are crucial in managing this challenging condition, particularly in children, to enhance their vision and overall well-being.
春季角结膜炎（VKC）是一种罕见但严重的过敏性结膜炎，主要影响儿童，以男孩为主，在全球范围内均有发病，在某些地理区域发病率更高。该病的特点是季节性加重。VKC表现为眼表炎症，导致各种令人痛苦的症状，如瘙痒、眼红、黏液分泌物增多和疼痛。该病主要双侧发病，不过最初可能单侧出现。如果不治疗，VKC可导致角膜并发症，包括盾形溃疡和视力损害，影响日常活动和心理社会福祉，尤其是在儿童中。VKC的诊断包括识别眼表的关键临床特征，如Tranta点、巨大乳头或盾形溃疡。治疗采用逐步推进的方法，包括使用抗过敏眼药水、类固醇眼药水以及环孢素等局部药物，可能需要长达3个月才能显示出疗效。在一半的病例中，过敏致敏通常是对花粉和屋尘螨等吸入性过敏原产生反应，与VKC相关。通过避免接触过敏原、控制致敏以及联合治疗哮喘和鼻结膜炎等相关疾病等措施来了解和管理这些过敏反应，对于VKC的治疗至关重要。特应性角结膜炎（AKC）是一种与特应性皮炎和哮喘相关的疾病，与VKC有相似之处，但通常影响年轻人。然而，在这两种疾病之间观察到了一个连续谱，表明两者的治疗策略相似。VKC治疗需要以患者为中心的方法，包括告知并支持家长，考虑到眼药水成本较高的经济因素，并确保治疗的可及性和实用性，尤其是在儿童中。包括眼科医生、儿科医生和皮肤科医生在内的多学科团队合作可优化患者护理。VKC治疗的一个有益之处在于看到孩子们恢复生活质量，克服视力挑战，并在日常活动中茁壮成长。总之，了解VKC及其相关过敏反应，并采用全面、以患者为中心的方法对于管理这种具有挑战性的疾病至关重要，尤其是在儿童中，以提高他们的视力和整体福祉。
