Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, inflammatory disease of the cornea and conjunctiva mostly affecting boys in prepubertal age. VKC recurrence is characterized by intense symptoms of itching, redness, and photophobia associated with corneal damage, impairment of visual function, and quality of life. The pathogenesis of VKC has not yet been completely understood, and it is still controversial. In fact, VKC is considered an ocular allergic disease due to the involvement of immunoglobulin E, eosinophils, and mast cells, and of a lymphocyte T-helper type 2 reaction. However, approximately half of VKC patients have negative allergological history and testing, suggesting that other pathogenic mechanisms participate in VKC development and severity. Specifically, evidence suggests that genetic, endocrine, neuronal factors and an imbalance of innate immunity are involved in the pathogenesis of VKC. The purpose of this review is to summarize evidence on the pathogenic role of innate immunity, neuroimmune reaction, and hormonal changes in VKC. Increasing understanding of the pathogenic mechanisms behind VKC may lead to the identification of novel biomarkers for diagnosis and/or potential therapeutic targets in order to improve the management of this challenging condition.
Highlights
Vernal keratoconjunctivitis (VKC) is a rare, sight-threatening, chronic, inflammatory disease of the cornea and conjunctiva characterized by recurrent flare-ups of ocular surface inflammation, causing intense ocular symptoms of itching, redness, and photophobia associated with corneal damage and impairment of visual function and quality of life [1,2,3].VKC is a clinical form of allergic conjunctivitis diseases, together with seasonal and perennial allergic conjunctivitis (AC) and atopic keratoconjunctivitis (AKC) [4]
Evidence suggests that genetic, endocrine, neuronal factors and an imbalance of innate immunity are involved in the pathogenesis of VKC
The demographical, geographical, and clinical characteristics of VKC suggest that other endocrine, environmental, and/or genetic factors may play a role in the pathogenesis of this challenging condition
Summary
Vernal keratoconjunctivitis (VKC) is a rare, sight-threatening, chronic, inflammatory disease of the cornea and conjunctiva characterized by recurrent flare-ups of ocular surface inflammation, causing intense ocular symptoms of itching, redness, and photophobia associated with corneal damage and impairment of visual function and quality of life [1,2,3]. VKC shares some clinical features and pathogenic mechanisms with other forms of AC, including ocular itching, swelling, redness, and conjunctival papillary reaction associated with immunoglobulin (Ig) E-mediated release of histamine and other allergic reaction mediators from mast cells [4]. This is likely not the only mechanism involved in VKC immunopathogenesis, as only 50% of cases of VKC show allergic sensitization [4]. The aim of this review is to describe the most
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