Verneal Keratoconjunctivitis (Spring Cattarrh)

VERNEAL KERATOCONJUNCTIVITIS (SPRING CATTARRH)

• Spring catarrh is an allergic inflammation of conjunctiva.
• Characterized by recurrent, bilateral, interstitial, selflimiting conjunctivitis.
• Aggravated during spring & summer period.
• It is considered to be Type I hypersensitivity reaction (immediate type) to exogenous allergens such as grass pollens.
• More common in boys & affects age group 4-20 years.
• More common in summer, hence the name spring cattarrh looks a misnomer.
• Recently it is being labeled as “Warm weather conjunctivitis”.

CLINICAL FEATURES

• Spring cattarrh is characterized by marked itching & burning.
• Stringy (ropy) discharge, lacrimation, photophobia & heaviness of lids.

Clinically spring cattarrh is divided into three types:

1. Palpebral form:

• Most common type.
• The upper palpebral conjunctiva shows papillae (papillary hypertrophy) with their characterstic appearance:

1. large & flat toped
2. cobble stone appearance (Pavement stone appearance)

• these papilla heal without scarring

2. Bulbar form:

Characterized by:

1. Dusky red triangular congestion of bulbar conjunctiva in palpebral area
2. Gelatinous thickened accumulation of tissue around the limbus
3. Presence of discrete whitish raised dots along the limbus (Tranta’s spot)

3. Mixed form : both bulbar & palpebral manifestations occur together. 

Corneal signs (Vernal keratopathy)

• Punctuate epithelial keratitis
• Ulcerative vernal keratitis: shallow transverse ulcer (Shield ulcer)
• Vernal corneal plaques
• Subepithelial scarring
• Pseudogerontoxon: characterized by a classical “cupid’s bow” outline.

TREATMENT

• Steroids
• Mast cell stabilizers as di-sodium-chromoglycate & olapatadine & idoxamide tromethamine.
• Topical antihistaminics, cyclosporine & vasoconstrictor like nephazoline
• Olaptadine is a new mast cell stabilizer used in spring catarrh.