Ocular Allergy Research Articles

A Comparative Study of Olopatadine Hydrochloride and Bepotastine Besilate in the Treatment of Allergic Conjunctivitis

Background -Ocular allergy is a commonly encountered pathology in clinical practice, which often is under diagnosed and consequently undertreated. These are rarely vision-threatening but can significantly decrease the quality of life for patients. Olopatadine and Bepotastine eyedrop have both antihistaminic and mast cell stabilization action. Their use can control acute symptoms and prevent relapses as well. We conducted this single blinded trial directly comparing the efficacy of the two topical anti allergic medications in mild forms of allergic conjunctivitis. Materials and Methods - A single blinded randomised control clinical trial study was conducted in patients visiting OPD of Ophthalmology at the institute for duration of 6 months. All the patients above 18 years of age having mild to moderate allergic conjunctivitis were included in the study. Patients were randomly placed in one of the two groups according to computer generated random numbers and given topical anti-allergic medication for twice daily. Group A was given Topical 0.1% Olopatadine eye drops BD and Group B was given Topical 1.5% Bepotastine eye drops BD. Ophthalmological check-up was done using slit lamp on next day, after 1 week, after 21-28 days. Results - It was seen from the study that on follow up day 1 in patients receiving Bepotastine 1.5% eyedrop, there was 50% relief of symptoms and signs seen in 80% patients while in 60% patients, only 40% relief in symptoms and sign was seen with olopatadine 0.1% eyedrop. On follow up day 7, 90% of symptoms and signs of allergic conjunctivitis were relieved in all patients receiving Bepotastine eyedrop while 80% relief was seen in those receiving olopatadine. Almost 100% relief from signs and symptoms were seen in both the groups on follow up day 21-28th. Conclusion- We conclude from our study that, Bepotastine besilate 1.5% ophthalmic solution is a preferred drug compared to Olopatadine 0.1% in the immediate relief of symptoms and signs of allergic conjunctivitis. It can be used as an initial therapy in the symptom relief and alternative to the topical steroids used in mild-moderate allergic conjunctivitis. Keywords: Allergic conjunctivitis, Ocular allergy, Olopatadine hydrochloride, Bepotastine besilate.

Current clinical approach to pediatric keratoconus patients

Introduction Due to structural differences between pediatric and adult corneas, keratoconus (KC) is considered more aggressive in pediatrics than in adults. It is controversial whether therapeutic intervention in pediatric KC should differ from adult KC. Areas covered We investigate if there is a substantial difference between pediatric and adult KC regarding disease severity and progression rate, factors important for treatment timing and prognosis. Then, feasibility of current treatment modalities is discussed based on current evidence. Expert opinion Despite several conflicting reports, pediatric KC is more severe at initial diagnosis with faster progression. Therefore, pediatric patients should be followed closely for evidence of progression. This can be tracked in a variety of ways, including with the Belin ABCD progression system. Controlling ocular allergy and eye rubbing is the first step in treatment. The epithelium-off Dresden protocol remains the gold standard CXL approach to stop progression in pediatric KC, whereas epithelium-off accelerated CXL might be an alternative. In pediatric patients, both penetrating and lamellar keratoplasty can be challenging; however, lamellar keratoplasty seems to offer the advantage of lower graft rejection rate. Epithelium-on CXL, intracorneal ring segment implantation, excimer laser ablation and CXL protocols are not recommended in pediatric KC. Nevertheless, there remains a need for evidence-based clinical practical guidelines in pediatric KC.

Mesenchymal stem cell therapy for alleviating ocular surface inflammation in allergic conjunctivitis

Allergic eye diseases have become a major concern worldwide, especially in the paediatric population. Vernal keratoconjunctivitis, a seasonal, chronic, bilateral inflammation of the ocular surface, represents one of the most common forms of ocular allergy in subtropical climates which may lead to corneal scarring and blindness if not properly treated. Late diagnosis of the disease and potential side effects of the currently used topical steroids, antihistamines, and mast cell stabilizers necessitates the development of early diagnostic tools and alternate immunosuppressive therapies. Mesenchymal stem cells have shown promising therapeutic potentials due to their tissue repair, anti-allergic, and immunomodulatory properties. However, their role in allergic conjunctivitis/vernal keratoconjunctivitis is poorly explored. Here, it is hypothesized that mesenchymal stem cells or their secreted products alleviate inflammation and promote repair of the damaged ocular surface in allergic conjunctivitis patients. It is presumed that they do so through multiple anti-allergic mechanisms and maintain long-term immunosuppression with significantly reduced or negligible side effects. These cells or their secreted products (extracellular vesicles, growth factors, conditioned medium, inflammatory mediators, and other biomolecules) can be used as topical immunosuppressive medications for effectively treating ocular surface inflammation in allergic conjunctivitis.

A Review of Emerging Tear Proteomics Research on the Ocular Surface in Ocular Allergy.

Simple SummaryOcular allergy is a localised form of allergy occurring on the surface of the eye and surrounding tissues. Typical signs and symptoms of ocular allergy include itching, redness, swelling of the eyelids and inflammation. Emerging studies on ocular allergy have shown that tears collected from ocular allergy sufferers show significantly different protein contents than in healthy populations. Differences in protein contents in tear samples have been hypothesised to be caused by a number of allergy-mediated factors, including long-term inflammation and eye-rubbing. Excessive eye-rubbing due to allergy-associated itch has also been shown to have significant effects on the physical shape of the eye, thereby potentially causing progressive vision problems in ocular allergy sufferers. This review aims to summarise and explore recent findings in ocular allergy protein research. This is to help determine which ocular surface proteins differ between ocular allergy sufferers and healthy controls, and the role each protein may play in the underlying chemistry of ocular allergy. Additionally, potential benefits of expanding the current pool of research into ocular surface proteins in ocular allergy sufferers in terms of diagnosis and treatment of the condition is discussed.Ocular allergy is an immunoglobulin E-mediated Type I hypersensitivity reaction localised to the ocular surface and surrounding tissues. Primary signs and symptoms of ocular allergy include itching, redness, irritation and inflammation. Eye-rubbing caused by itching has been shown to alter ocular surface protein concentrations in conditions linked to ocular allergy such as keratoconus. In keratoconus, the cornea begins to thin and sag over time, leading to progressive vision loss and blindness in severe conditions. Due to the high incidence of ocular allergy sufferers rubbing their eyes in response to symptoms of itching, the protein landscape of the ocular surface may be significantly altered. Differential protein expression caused by long-term inflammation and eye-rubbing may lead to subsequent changes in ocular surface structure and function over time. This review aims to summarise and explore the findings of current ocular allergy proteome research conducted using techniques such as gel electrophoresis, mass spectrometry and lab-on-a-chip proteomics. Proteins of interest for this review include differentially expressed immunoglobulins, mucins, functional proteins, enzymes and proteins with previously uncharacterised roles in ocular allergy. Additionally, potential applications of this research are addressed in terms of diagnostics, drug development and future research prospects.

Self-reported symptoms of ocular allergy and its comorbid factors among residents living near a landfill site in Ghana

ABSTRACT Residents close to landfill sites may be exposed to long-term emitted toxic compounds that may have effects on their eyes. The aim of this study was to determine the prevalence of symptomatic ocular allergy and its comorbid factors among residents living near a landfill site in Ghana. An exploratory cross-sectional design involving 400 inhabitants living around a landfill site was employed. The prevalence of symptomatic ocular allergy was 59.3%. In a bivariate analysis, comorbid conditions including respiratory disease, coughing, flu, cholera, skin disease, diarrhoea, and hypertension predicted symptomatic ocular allergy. However, only cholera remained a significant predictor of symptomatic ocular allergy in the multivariate analysis. Symptomatic ocular allergy was high among inhabitants around the landfill site in Ghana. While proper design and management of landfills in Ghana is crucial, further longitudinal and clinical studies are required to clinically establish the link between landfill and ocular allergy.

Epidemiological Aspects Of Allergic Conjunctivitis.

Allergic conjunctivitis is a common ocular disease which not only affects vision but can also compromise the quality of life of patients to a greater extent. If it is not properly managed it can lead to decreased vision due to corneal complications. This study was conducted to evaluate the epidemiological aspects of allergic conjunctivitis. This cross-sectional study was carried out in the Ophthalmology department of Federal General Hospital, from June 2018 to June 2020. We enrolled 236 patients of allergic conjunctivitis. Data collection form consisted of a structured questionnaire, records of ocular findings using slit lamp biomicroscope and skin prick test results. Data analysis was done using SPSS version 23.0. The mean age (±SD) of study population was 22.71±13.11 years, 60.2% were females. Most common type of conjunctivitis was vernal keratoconjunctivitis (VKC) 46.2%, followed by perennial (27.1%), seasonal (17.4%) and atopic (9.3%). There was significant association of type of conjunctivitis with the age, pvalue< 0.001. VKC was prevalent in patients of age <20 years. There was a significant association of gender with type of conjunctivitis, p-value =0.000. Perennial variety was more prevalent in females while VKC was common in males. Collateral atopy was present in 52.1% patients. Corneal involvement was seen in 17.8% patients. There was a significant association between corneal involvement and interference with daily visual activities, p-value 0.034. SPT was positive in 79.7% patients. Ocular allergies/ conjunctivitis was more prevalent in female population. VKC is the most common type of allergic conjunctivitis, prevalent in males of age <20 yrs. Allergic rhinitis was the most common co-morbidity followed by dermatitis.

Severe Ocular Allergy In Brazilian Children And Adolescents

Severe Ocular Allergy In Brazilian Children And Adolescents

Knowledge and awareness of ocular allergy among Jeddah population.

Background:Ocular allergy is one of the common conditions that affects patients from different age groups. Public awareness about the disease is crucial for reducing the incidence of ocular allergy.Aim:The present study aims to evaluate the knowledge level of the general population in Jeddah, Saudi Arabia toward ocular allergy.Methodology:This is a cross-sectional study that included the distribution of an online survey to the public living in Jeddah. The survey included questions to identify common demographics, knowledge, and awareness about ocular allergy signs and symptoms, prevention and treatment, and sources of information. Statistical analysis included descriptive and comparative analysis using Chi-square test and one-way ANOVA test. SPSS version 26 was used for data analysis.Results:In total, 1207 responded to this survey and were included in the analysis. Among them, 71% were females, 36.8% were in the age group of 15–25 years, 74.9% had a bachelor’s degree, 60.4% were non-medical specialists, 13.2% were from the faculty of medicine. More than half of the participants were aware that ocular allergy affects millions of people globally every year. It is one of the most common eye conditions, itching is the primary source of discomfort, 15%–20% of the world population have ocular allergy, the disease causes discomfort and pain within the eye caused by frequent rubbing of the eye, and that symptoms of ocular allergy include redness, itching, tearing, discharge, blurred vision, and photophobia. Further, 64.9% thought that avoiding the source of triggers can help prevent ocular allergy. Social media was the most common source of information among 19.3%. The average score was 15.6 ± 6.1 out of 27 points; 42.6% of the responders had fair knowledge (50%–75%) about ocular allergy. The age group of 15–25 years (P < 0.001), bachelor’s degree holders (P = 0.013), and individuals with a medical background (P = 0.003) were associated with significantly higher mean scores. Males (P = 0.003), age group of 15–25 years (P = 0.024), individuals with a medical background (P < 0.001) had significantly good knowledge about ocular allergy.Conclusion:The knowledge level of the general population about ocular allergy in Jeddah, Saudi Arabia is fair and requires improvement.

Incidence of allergic conjunctivitis in patients with allergic rhinitis: A randomized observational study

Background: Although nasal allergy has been prominent in allergy research, ocular allergy is increasingly recognized as a distinct symptom complex that imposes its own disease burden and reduction in patients' quality of life. In the past year, knowledge of the relationships between allergic conjunctivitis (AC) and allergic rhinitis (AR) has increased. AC is commonly manifesting as itchy or watering or red eye, comprising the symptoms of the total ocular symptom scores (TOSS). Allergic conjunctivitis is highly prevalent and has a close epidemiologic relationship with allergic rhinitis. Both conditions also exhibit similar pathophysiologic mechanisms. Therefore, the objective of the present study was to identify the incidence of AC in patients with AR. Methods: This randomized observational study was conducted on 150 patients for a 6 month period from June to November 2021, having diagnosed AR and attending the outpatient clinic of our department. The patients were directly questioned if they had AC, clarified by using standard screening questions of red, itchy and watery eyes and quantified by TOSS and were asked about indirect symptoms that may be attributable to AC. Results: Among the 150 patients, 54.66% of patients identified AC on direct questioning; additional symptoms were squint at 41.33% and blinking at 52.66%. Olopatadine, significantly reduced TOSS scores within 5 minutes of treatment and 82.66% showed improvement, which identified 44.66% silent sufferers of AC. A total of 94% AC subjects were identified through TOSS symptoms and totally 96.66%, detecting additional symptoms. Conclusions: The screening questions could identify only about 54.66% of the patients with AC. Additional specific questioning and a therapeutic challenge in suspected patients can help identify patients who may benefit from treatment of AC.

Evaluation of corneal tomography in children and adolescents without ocular or systemic allergy.

To determine normal corneal tomographic parameters in children and adolescents without corneal disease or atopy diagnosis. This descriptive cross-sectional study evaluated patients aged 8-16 years who underwent a complete slit-lamp biomicroscopic examination and tomographic corneal evaluation by a dual Scheimpflug analyzer, excluding those with ocular disease (including allergic conjunctivitis) or a positive prick test for systemic atopies. A total of 170 patients were evaluated, and 34 patients (68 eyes) were analyzed once the exclusion criteria were applied. The sample's mean age was 10.76 ± 2.31 years; with 19 (55.9%) men and 15 (44.1%) women. The mean keratometry in the flat meridian (Kflat), steep meridian (Ksteep), and maximum (Kmax) were 42.37 ± 1.63D, 43.53 ± 1.65D, and 43.90 ± 1.73D, respectively. The mean values for corneal asphericity (ε2) and thinnest point were 0.28 ± 0.11 and 550.20 ± 37.90 μm, respectively. The inferior-superior asymmetry ratio (I-S) and coma were 0.74 ±0.59D and 0.28 ± 0.12D, respectively. The knowledge of normal corneal tomographic parameters and their variation in children and adolescents without corneal disease or atopy may be useful for diagnosing keratoconus and initiating early disease treatment.

Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy - On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy - On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

A Study of Clinical Profile and Management of Allergic Conjunctivitis in Rural Tertiary Care Centre

Background: Among the allergic diseases witnessed over the last few decades, ocular allergy is one of the most common conditions. Many factors like pets, dust, pollen, grain exposure, air pollution play a role in allergies. Ocular allergy impairs the daily routine activities, and if left undertreated, it may progress to atopic keratoconjunctivitis, resulting in vision impairment. This study aimed to observe an association of dry eye in allergic conjunctivitis and management of allergic conjunctivitis cases reporting in tertiary health care Centre.&#x0D; Materials and Methods: This will be a cross sectional observational research conducted at AVBRH, Wardha. Baseline data of 85 enrolled patients will be collected after obtaining their informed written consent and all procedures will be explained to patients. Patients included in study will undergo Comprehensive ophthalmic examination, slit lamp examination, fundoscopy, tear break up time and Schirmer’s test with topical anaesthesia. Follow-up of all patients will be done at 1, 3, 6, and 8 weeks. Data on medical history, allergies, and lifestyle factors will be collected using a pretested standard questionnaire.&#x0D; Expected Results: Estimation of correlation between dry eye in allergic conjunctivitis and efficacy of different standard drugs in the treatment of allergic conjunctivitis.

Immunoreactivity against Dermatophagoides pteronyssinus Assessed by the Leukocyte Adherence Inhibition Test in Patients with Intrinsic Atopic Dermatitis and Correlated “Intrinsic” Non–IgE-mediated Allergic Conditions

Background: Due to the lack of standardized laboratory procedures able to demonstrate specific immune responses against the culprit allergens, the non—IgE-mediated allergy syndromes are a group of conditions diagnosed mostly by clinical examination and exclusion criteria.&#x0D; Objective: To evaluate the opportunity of the Leukocyte Adherence Inhibition Test (LAIT) to discriminate specific immunoreactivity against Dermatophagoides pteronyssinus (Dp) in a group of patients with non–IgE-mediated chronic allergic conditions.&#x0D; Methods: Ex vivo challenge tests performed with Dp were monitored by LAIT in patients presenting diverse non–IgE-mediated allergic conditions: intrinsic Atopic Dermatitis (iAD), intrinsic Allergic Rhinitis (iAR), intrinsic Ocular Allergy (iOA), intrinsic Chronic Pharyngitis (iCP), and intrinsic Asthma (iAS).&#x0D; Results: The mean LAI of the control group was 7%; the mean LAI of the iAR group was 34%; the mean LAI of the iCP group was 44%; the mean LAI of the iAS group was 45%; the mean LAI of the iOA group was 47%; the mean LAI of the iAD group was 55%. The non-parametric Wilcoxon-Mann-Whitney U test comparing the control group with each other group showed significance with p-value &lt; α = 0.05 for all groups.&#x0D; Conclusion: The Leukocyte Adherence Inhibition Test is an easy, quick, and inexpensive ex vivo immunoassay with the potential to predict individual immunoreactivity against HDM allergens in real-world patients with non–IgE-mediated allergies.

Corneal Scheimpflug topography values to distinguish between normal eyes, ocular allergy, and keratoconus in children

To identify and compare keratometric, corneal thickness, and elevation parameters and indices among healthy children, ocular allergy, and keratoconus using the OCULUS Pentacam Scheimpflug topography system. This study included healthy children, children with ocular allergy (OA) without keratoconus, and children with keratoconus (KC). The study design consisted of a prospective evaluation and review of medical records from a Brazilian ophthalmology department. The exclusion criteria were inability to undergo the ocular exam, other ocular diseases, contact lens wear, and topographic corneal ectasia. The effect of each corneal parameter was evaluated using univariate and multivariate logistic regression models adjusted for sex and age, and ROC curves were used to assess the ability each variable to discriminate among groups. A total of 182 subjects were included: healthy children (n = 99), children with OA (n = 32), and children with KC (n = 51). Groups differed in terms of sex, with more males in the OA group (73.2%) and the KC group (67.7%) than in the control group (40.9%). All corneal parameters studied differed significantly between the control and KC groups, and between the OA and KC groups; they also differed significantly between the three groups in terms of astigmatism, q-value, CCT, TP, BAD-D, and ARTmax values. We present the first study to describe and compare corneal tomographic parameters in healthy children, OA, and KC. Keratometry indices, ACD, ARTmax, AETP, and PETP were found to be the most useful for differentiating between healthy and KC children.IBR registry number: CAAE 54921916.9.0000.5404.

Epithelial barrier dysfunction in ocular allergy.

The epithelial barrier is the first line of defense that forms a protective barrier against pathogens, pollutants, and allergens. Epithelial barrier dysfunction has been recently implicated in the development of allergic diseases such as asthma, atopic dermatitis, food allergy, and rhinitis. However, there is limited knowledge on epithelial barrier dysfunction in ocular allergy (OA). Since the ocular surface is directly exposed to the environment, it is important to understand the role of ocular epithelia and their dysfunction in OA. Impaired epithelial barrier enhances allergen uptake, which lead to activation of immune responses and development of chronic inflammation as seen in allergies. Abnormal expression of tight junction proteins that helps to maintain epithelial integrity has been reported in OA but sufficient data not available in chronic atopic (AKC) and vernal keratoconjunctivitis (VKC), the pathophysiology of which is not just complex, but also the current treatments are not completely effective. This review provides an overview of studies, which indicates the role of barrier dysfunction in OA, and highlights how ocular barrier dysfunction possibly contributes to the disease pathogenesis. The review also explores the potential of ocular epithelial barrier repair strategies as preventive and therapeutic approach.

Changes in Anterior and Posterior Corneal Elevation in Patients With Allergic Conjunctivitis.

Purpose: To evaluate corneal elevation changes in patients with allergic conjunctivitis (AC) and to analyze their correlations with ocular allergy signs and corneal biomechanical alterations.Methods: Thirty patients (30 eyes) with AC and twenty normal subjects (20 eyes) were included in this prospective study. All participants underwent a complete ocular examination, including corneal tomography by Pentacam and corneal biomechanics evaluation by Corvis ST. AC patients were evaluated for their eye rubbing frequency and ocular allergic signs.Results: The elevation at the thinnest location (TE) and the central location (CE), the elevation difference at the thinnest location (TED) and the central location (CED), and the mean value of elevation difference in the central 4 mm zoom (MED) of both the anterior and posterior corneal surface were significantly higher in the AC group than in the normal group (p < 0.05 for all). In AC patients, only anterior corneal elevation parameters were positively correlated with eye rubbing frequency and ocular allergy sign severity (p < 0.05 for all), while the tomography and biomechanical index (TBI) was positively correlated with the elevation parameters of both the anterior and posterior corneal surfaces (p < 0.05 for all).Conclusion: AC patients carry an increased risk of corneal ectasia. Posterior corneal elevation parameters are sensitive and reliable predictors of keratoconus (KC) risk in AC patients.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04299399, identifier [NCT04299399].

COMPARATIVE STUDY OF THE EFFICACY OF TOPICAL LOTEPREDNOL ETABONATE AND FLUOROMETHOLONE IN THE TREATMENT OF VERNAL KERATOCONJUNCTIVITIS : A RANDOMISED CONTROLLED STUDY

Introduction:Vernal keratoconjunctivitis(VKC) is a chronic, recurrent, inammatory disease of ocular surface showing seasonal exacerbation, affecting young children. Topical steroids are the mainstay in the treatment of ocular allergy, but their use should be judicious since they carry serious side effects . Loteprednol and uorometholone carry better safety prole. Present study was conducted with the aim of comparing the efcacy of these two widely used steroids.Objectives:To compare total subjective symptom score (TSSS), total objective sign score (TOSS) and side effects of medications before and after treatment at each visit.Materials &amp; Methods:A prospective randomised controlled study was performed on 92 patients of VKC over four weeks. Patients were allotted to either of the two arms of treatment (i.e. LP 0.5% or FML 0.1%). Subjective and objective assessments of the signs and symptoms of VKC were done using standard scoring methodologies at 7, 14, 21 and 28 days post treatment. The main outcome measure was measured in terms of TSSS and TOSS before and after treatment at each visit. Secondary outcomes included side effects. Statistical analysis of the data collected was carried out.Results: Loteprednol showed greater reduction in symptoms initially but by the end of study there was no statistically signicant difference in effect between the two drugs.Conclusions: Final improvement in clinical features and safety prole, at the end of 4 weeks was similar in eyes treated with either of the two drugs. Hence, both the drugs can be safely used in the treatment of VKC.

Corneal Lymphangiogenesis: Current Pathophysiological Understandings and Its Functional Role in Ocular Surface Disease.

The cornea is a transparent and avascular tissue that plays a central role in light refraction and provides a physical barrier to the external environment. Corneal avascularity is a unique histological feature that distinguishes it from the other parts of the body. Functionally, corneal immune privilege critically relies on corneal avascularity. Corneal lymphangiogenesis is now recognized as a general pathological feature in many pathologies, including dry eye disease (DED), corneal allograft rejection, ocular allergy, bacterial and viral keratitis, and transient corneal edema. Currently, sizable data from clinical and basic research have accumulated on the pathogenesis and functional role of ocular lymphangiogenesis. However, because of the invisibility of lymphatic vessels, ocular lymphangiogenesis has not been studied as much as hemangiogenesis. We reviewed the basic mechanisms of lymphangiogenesis and summarized recent advances in the pathogenesis of ocular lymphangiogenesis, focusing on corneal allograft rejection and DED. In addition, we discuss future directions for lymphangiogenesis research.

Demographic study of vernal keratoconjunctivitis in tertiary eye centre in Eastern India

Vernal keratoconjunctivitis (VKC) is a chronic form of ocular allergy that can potentially cause severe visual complications, affecting mainly children and young adults. The objective of this study is to evaluate the age group involved, sex predilection, occupation, seasonal variations, type of disease and prevalence of corneal involvement in cases presented to tertiary eye care centres of Eastern India.A total of 180 patients with signs and symptoms of VKC, who presented between April 2019 to March 2021 were studied. Patients who were not having any systemic or ocular illness and not received systemic or ocular medications during the four weeks, were included in the study. Most of the patients were found to be between 6 to 15 years (67.22%) age group and 70% are male. 71.66% of the patients were school going children. Majority of the patients were presented in the month of April to September (71.11%) i.e. during warm weather. Bulbar variety (42.22%) are most common type of VKC and 68.51% cases had corneal involvement at presentation.Vernal Keratoconjunctivitis is the disease of childhood, mostly during school going age and more commonly affects males. It is usually bilateral and more prevalent during hot and humid climate.

Editorial introductions.

Editorial introductions.