The clinical picture of vernal kerato-conjunctivitis in Uganda.

Abstract

Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, interstitial inflammation of the conjunctiva, resolving spontaneously after a course of several years and characterised by giant papillae (with a cobblestone appearance) on the tarsal conjunctiva, a discrete or confluent gelatinous hypertrophy of the limbal conjunctiva, and a distinct type of keratitis. It is associated with intense itching, redness or brownness, lacrimation, photophobia and a mucinous, ropy discharge containing eosonophils. VKC is a type 1 hypersensitivity reaction but with additional immune mechanisms involved in its pathogenesis. VKC has a global distribution with a widely varying incidence. It is less common in northern Europe and North America, and more common in the African continent, the Mediterranean countries, in Central and South America, and the Indian subcontinent.1,2 All patients in this study were indigenous Africans, and all had been exposed to similar environmental conditions. Vernal keratoconjunctivitis affecting the limbus (left), the conjunctiva and cornea (right). The conjunctiva has pronounced papillae (‘cobblestones’) and fluorescein dye shows a corneal ulcer Photos: John Sandford-Smith