Vernal Keratoconjunctivitis Research Articles

Rasch analysis of quality of life in children with vernal keratoconjunctivitis (QUICK) questionnaire

ABSTRACT Clinical relevance A validated questionnaire measures the construct accurately, helps clinician to support decision making, facilitates assessment and monitoring of patients, guides clinical trial and promotes patient-centred care. Background To assess the psychometric properties of the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire among Indian children with Vernal Keratoconjuntivitis (VKC) using Rasch analysis. Methods This study used a questionnaire validation study design. The QUICK questionnaire for VKC was translated to two local languages using back translation process and administered to the Indian children (aged 5–15 years) diagnosed with VKC between June 2021 and March 2022. The study took place at a tertiary eye care hospital in Chennai, India. The psychometric properties were assessed based on six indicators namely rating scale behaviour, measurement precision, item fit, unidimensionality, targeting and Differential Item Functioning (DIF). Results Fifty six children with VKC (mean age 10.5 years and 77.8% males) filled the questionnaire. The analysis of overall QUICK questionnaire (16 items) revealed an ordered threshold for the rating scale, no noticeable DIF and excellent person-item targeting (0.15). However, the questionnaire showed inadequate person separation (PSI 1.82 and PSR 0.77), four misfit items and lack of unidimensionality (eigenvalue 2.80). Eliminating misfit items and contrasting items resolved multidimensionality, leaving nine items related to the symptoms domain in the questionnaire. However, the person separation (PSI 1.52 and PSR 0.70) remained below 2.0. Conclusion The resultant 9-item QUICK questionnaire discriminates only low and high performers among VKC patients. Thus, it may be used solely to assess the symptoms domain in Health Related Quality of Life (HRQoL). This questionnaire requires addition of items in other domains pertaining to HRQoL to make it holistic.

Health-related Quality of Life in Children with Vernal Keratoconjunctivitis in Malaysia.

There has been a lack of data on health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC) from Southeast Asia. This study evaluated the levels (mean total score and subscales score) of HRQoL, comparing the VKC and normal children groups, and within the VKC severity groups. A cross-sectional study was conducted in two tertiary hospitals, specifically the pediatric ophthalmology services at Hospital Selayang and Universiti Sains Malaysia, spanning from 2019 to 2020. Participants aged between 8 and 15 years were categorized into two groups: those diagnosed with VKC and healthy children serving as the control group. Each participant completed the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire, consisting of 16 questions, divided into two subscales: 12 questions focusing on symptoms and four questions for daily activities. A total of 240 children took part in the study, with 120 children diagnosed with VKC and another 120 in the control group. The mean age of participants with VKC was 11.21 ± 1.91 years, with a male predominance of 4:1 compared to female. Tearing (98.4%) and itchiness (98.3%) emerged as the most prevalent symptoms affecting HRQoL, while the most challenging activities were outdoor play (36.6%) and participation in recreational water activities (34.2%). The mean total score was significantly higher in the VKC group compared to the control group. Additionally, both the mean total score and all subscale scores were significantly higher in the severe type compared to the mild-moderate type. VKC significantly reduce the HRQoL among Malaysian children, and the negative impact increases with the disease severity.

Clinical Manifestations of Vernal Keratoconjunctivitis and Its Effects on School Attendance and Access to Medical Care in School Children of Western Uttar Pradesh

Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic ocular condition affecting school-age children, particularly in hot, allergen-rich regions. It presents with symptoms such as intense itching, tearing, foreign body sensation, and sticky discharge, causing discomfort and management challenges in resource-limited settings. VKC impacts public health significantly due to its high prevalence and effect on academic performance and school attendance. Method: This cross-sectional study included 1521 school children aged 6 to 16 years in Western Uttar Pradesh. Comprehensive eye examinations were conducted, and VKC was diagnosed based on conjunctival and limbal papillae. A structured questionnaire collected data on socio-demographic factors, medical care access, and VKC's impact on daily life and school attendance. Descriptive statistics and Pearson chi-square tests were used for analysis. Result: Of the participants, 242 (15.9%) had VKC, with a higher prevalence among boys (56.2%). Most cases were mild (66%), with 34% severe. Symptoms included itching, stinging, tearing, photophobia, and discharge. Severe VKC resulted in higher rates of constant eye rubbing and tear production. School absenteeism was significantly higher in severe cases (78%) compared to mild cases (47%) (P<0.001). Severe VKC also led to more frequent medical consultations (52% vs. 22%, P=0.01). Conclusion: VKC significantly affects school attendance and medical care utilization among children in Western Uttar Pradesh. Improved management practices, better access to medical care, and enhanced support systems are essential for affected children and families.

Association Between Pterygium and Ocular, Periocular, and Systemic Inflammatory Conditions: a Large-Scale National Study.

The purpose of this study was to examine the incidence of ocular, periocular, and systemic inflammatory conditions among patients with pterygium and assess if these conditions are risk factors of pterygium development. A case-control study was conducted using electronic medical records from Clalit Health Services in Israel between 2001 and 2022. Patients diagnosed with pterygium were included; for each case, 3 controls were matched based on birth year, sex, and ethnicity. Mixed models were used to assess differences in the groups' demographic characteristics of ocular and systemic diseases. Generalized estimating equation logistic regression was used to estimate the odds ratios (ORs) and adjust for confounders. A total of 94,652 patients diagnosed with pterygium and 378,608 matched controls were included in the study. The average age of patients with pterygium was 53 ± 16 years; 54% were male. A significant association was found between pterygium and vernal keratoconjunctivitis (OR 2.12, 95% confidence interval [CI], 1.90-2.36), chronic allergic conjunctivitis (OR 1.69, 95% CI 1.58-1.82), blepharitis (OR 1.66, 95% CI 1.61-1.70), and chalazion (OR 1.27, 95% CI 1.23-1.33). A significant association was also found between pterygium and systemic conditions as unspecified systemic allergy (OR 1.08, 95% CI 1.04-1.13), asthma (OR 1.08, 95% CI 1.04-1.11), and atopic dermatitis (OR 1.14, 95% CI 1.08-1.19). Various inflammatory and allergic diseases-ocular, periocular, and systemic-increase the risk of pterygium. Further research is needed to investigate the role of inflammation in pterygium development.

To study efficacy of tacrolimus (0.03%) Eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis

VKC (Vernal keratoconjunctivitis) is a chronic, bilateral ocular inflammatory disorder that primarily impacts young patients. Management of VKC is challenging due to its complex immunological etiology and chronic inflammatory components. This prospective, single-center, randomized study was executed at the Outpatient Department of Ophthalmology, SGT Medical College, Hospital and Research Institute (FMHS), Budhera, Gurugram, for a duration of 18 months. A total of 102 clinically diagnosed VKC patients, aged above 5 years, have been then randomly divided into 3 groups (34 each). Group A received fluorometholone (0.1%) eye drops, Group B received cyclosporine (0.1%) eye drops, and Group C received tacrolimus (0.03%) eye ointment. Patients were evaluated at days 0, 7, 14, 28, 35, and two weeks post-medication using the Clinical Scoring System by Bleik and Tabbara to assess TSSS (Total Subjective Symptom Score) and TOSS (Total Objective Ocular Sign Score). Most patients were between 6-10 years old, with over 78% being males. Group A showed significant symptom reduction from the first week (mean TSSS reduction from 2.29±0.46 to 0.21±0.41, p<0.0001), while Groups B and C showed significant improvements from the second week (Group B: mean TSSS reduction from 2.5±0.51 to 0.12±0.33, p<0.0001; Group C: mean TSSS reduction from 2.29±0.46 to 1.00±0.00, p<0.0001). Conjunctival hyperemia and tarsal papillae improvements were more pronounced in Group B as compared to Groups A & C. No ocular complications were found, except for dose-dependent irritation in Group C. While fluorometholone (0.1percent) eye drops provided early symptom relief, its effects were not sustained. Cyclosporine (0.1percent) eye drops and tacrolimus (0.03percent) eye ointment showed delayed but sustained efficacy, making them suitable for long-term treatment of moderate to severe VKC. Fluorometholone may be used initially alongside immunomodulators for rapid symptom relief, followed by tapering as immunomodulators take effect.

Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy.

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.

Tear film parameters and meibography in eyes of children with vernal keratoconjunctivitis.

To study tear film parameters and Meibomian glands in pediatric patients with vernal keratoconjunctivitis (VKC). Forty-four eyes of 22 patients with VKC and 44 eyes of 22 age-matched controls were studied in a hospital-based cross-sectional study. Each subject underwent a complete ophthalmological examination including slit-lamp biomicroscopy, non-invasive break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining, and Schirmer's test. Non-contact meibography was performed using a Sirius topographer. All patients had VKC grades between 1 and 3 (Bonini scale). The mean NIBUT for cases was 8.83 ± 4.02 s and in controls, it was 15 ± 2.8 s (P value < 0.001). The mean FBUT for cases was 9.41 ± 3.45 s and in controls, it was 16.7 ± 2.5 s (P value < 0.001). Schirmer's values were 32 ± 3.1 mm in cases and 21.4 ± 4.1 mm in controls, which were significantly higher (P value < 0.001). Also, 22.72% of the cases had corneal fluorescein staining in the form of superficial punctuate keratitis, whereas none of the control groups showed corneal staining. The examination of Meibomian glands using non-contact meibography showed a mean Meibomian gland dropout in the upper lid to be 29.7 ± 14.4% in VKC cases and 10.5 ± 3.2% in controls (P value < 0.001). Meibography of the lower lid showed 25.9 ± 10.2% dropout in cases and 20.5 ± 6.1% in controls (P value = 0.004). Tear film parameters were significantly deranged in children with VKC in the active stage as compared to age-matched controls. Children with VKC also had a higher Meibomian gland dropout.

To evaluate the effects of the application of 0.03% tacrolimus ointment in patients of vernal keratoconjunctivitis at a tertiary care hospital

Context: The aim of this study was to evaluate the effect of the application of 0.03% tacrolimus eye ointment in treating patients diagnosed with vernal keratoconjunctivitis (VKC) specifically within a tertiary care hospital setting. Materials and Methods: From October 2019 to October 2021, a prospective observational study took place at the department of ophthalmology in a tertiary care center. The study involved 42 consecutive VKC cases that had not seen relief with antihistaminics, mast cell stabilizers, or topical steroids. When steroid is applied in VKC patient it leads to various complications. So, in steroid refractory VKC tacrolimus application is used. Treatment involved applying topical 0.03% tacrolimus ointment was an effective and safe treatment. The study assessed changes in symptoms and signs posttreatment and monitored potential complications at 1, 4, 7, 10, and 14 weeks into the treatment during follow-up sessions. Results: The mean age of the patients was 10.7 ± 3.3 years. Following the administration of 0.03% tacrolimus, all signs and symptoms such as itching, foreign body sensation, tearing, photophobia, papillae, conjunctival hyperemia, limbal edema, Horner-Trantas dots, as well as keratitis (superficial punctate keratitis) showed significant improvement (P &lt; 0.001). Conclusion: The application of 0.03% tacrolimus has been found effective in reducing the symptoms and signs of VKC, particularly in cases refractory to steroids, with very few cases reporting minimal side effects. This study emphasizes the crucial role of tacrolimus in preventing the severe visual complications often linked to this disease.

Current Management of Fluorometholone Steroids in Pediatric Vernal Conjunctivitis: A Literature Review

Vernal conjunctivitis is a rare allergic eye disease, usually affecting children in the prepubertal years and can last between 5 to 10 years. Treatment of this condition is often challenging, requiring effective therapies to reduce symptoms. This literature review, conducted between 2015 and 2023, aimed to evaluate the effectiveness of fluorometholone steroid use in the treatment of pediatric vernal conjunctivitis. Recent studies comparing the effectiveness of Fluorometholone 0.1% in the treatment of Vernal Keratoconjunctivitis (VKC) were analyzed. The results showed that Fluorometholone was effective compared to Cyclosporine in reducing VKC symptoms. However, the use of Fluorometholone should be done with caution due to potential side effects such as increased intraocular pressure and risk of infection.Fluorometholone is an effective treatment option for vernal conjunctivitis in children. However, it is important to have close monitoring by an ophthalmologist to avoid serious side effects. With careful monitoring and proper dose adjustment, Fluorometholone can be a safe and effective therapy in managing this condition.

Screening Preadolescents for Keratoconus Risk Factors in a Low-Resource Setting.

Diagnosis of keratoconus (KC) involves the identification of corneal signs, refraction, and corneal imaging. The prevalence of KC ranges between 0.4 per 100,000 and 4,790, depending on geographical location and ethnicity. Diagnosis of KC should occur early for appropriate management with relatively affordable, accessible options to prevent visual impairment in low-income settings. Written consent and assent were obtained from subjects before a questionnaire was administered to collate demographics, general and ocular history of subjects, and keratoconus risk factors. A novel scoring system was applied to identify subjects at a higher risk of developing KC and document KC risk factors prevalent in Harare using an informed risk score calculation. Thousand one hundred fifty-three subjects aged between 6 and 12 years were seen. The prevalence of KC was found to be 626/100,000 in primary school children resident in Harare. Reduced visual acuity, vernal keratoconjunctivitis, itchy eyes, eye rubbing, and atopy are the most prevalent KC risk factors identified in this community. Informed risk score calculation proved valuable in the screening for KC. The prevalence of KC in primary school children in Harare is 626/100,000, which is relatively high. School-aged children stand to benefit from the early screening for KC based on evidence-based practices in the absence of advanced clinical instrumentation.

Effect of Topical (0.03%) Tacrolimus Eye Ointment in the Management of Vernal Keratoconjunctivitis

Background: Vernal keratoconjunctivitis (VKC) is a chronic, severe ocular inflammatory disorder predominantly affecting children and young adults. Current treatments, including antihistamines and corticosteroids, can have significant side effects, particularly with long-term use. Tacrolimus, a macrolide immunosuppressant, has emerged as a promising alternative due to its ability to inhibit T-cell proliferation and cytokine release, key factors in VKC pathogenesis. Objective: To determine the efficacy and safety of 0.03% tacrolimus eye ointment in the management of vernal keratoconjunctivitis compared to standard steroid-based treatment. Methods: This quasi-experimental study was conducted at the Department of Ophthalmology, Pak-Emirates Military Hospital, Rawalpindi, from January 2022 to May 2024. A total of 40 patients (80 eyes) diagnosed with VKC were included. Patients aged 5 to 60 years with bilateral VKC and no prior treatment in the last month were enrolled. Exclusion criteria included concurrent eye infections, use of contact lenses, systemic comorbidities, and previous ocular surgeries. The intervention group received 0.03% tacrolimus ointment twice daily for two months, followed by once daily for two months, and then on alternate days for the final two months. The control group received a combination of 0.1% fluorometholone eye drops, 0.3% tobramycin/0.1% dexamethasone ointment, and 0.1% olopatadine, with steroid tapering after two weeks. Patients were followed up at two weeks, one month, three months, and six months. The primary outcome was the change in symptom and sign scores from baseline to six months. Data were analyzed using SPSS version 25, with statistical significance set at p≤0.05. Results: The median age of the study population was 15.50 years (IQR: 10.00), with 57.4% female. The tacrolimus group showed significant improvement in eye discharge (p=0.033), itching (p=0.004), lacrimation (p=0.008), and foreign body sensation (p=0.015) compared to the control group. The average symptom score decreased more significantly in the tacrolimus group (p&lt;0.001). Clinical signs such as punctate keratitis (p=0.031) and papillae (p=0.018) also showed greater resolution in the tacrolimus group, with a significant reduction in the average sign score (p=0.009). Conclusion: Topical 0.03% tacrolimus eye ointment is an effective and safe treatment for VKC, providing superior symptom relief and clinical improvement compared to standard steroid-based therapy. It offers a promising alternative for long-term management of VKC, with fewer side effects than traditional corticosteroids.

The Analysis Study of Effectiveness and Safety of Topical Treatment for Vernal Keratoconjunctivitis: A Comprehensive Systematic Review

The Analysis Study of Effectiveness and Safety of Topical Treatment for Vernal Keratoconjunctivitis: A Comprehensive Systematic Review

Visual outcome in Keratoconus with spherical rigid gas permeable contact lens

Introduction: Keratoconus is a bileteral asymetric progressive ecteria of cornea commonly associated with vernal keratoconjunctivitis and Atopic dermatitis. Rigid gas permeable (RGP) contact lens is the first choice for refractive correction in keratoconic eyes. The visual outcome in Keratoconus with spherical RGP contact lens along with the mean age of presentation, gender predominance, ethnicity, associated conditions, refractive error and corneal astigmatism was evaluated. Methods: The records of the Keratoconus patients attending cornea and contact lens clinic for last 6 years were reviewed and analyzed using SPSS-14 software. Data on laterality, race, age, gender, refractive error, visual acuity (VA), associated conditions and contact lens parameters were obtained. A total of 22 patients with 38 keratoconic eyes were included in the study. Results: The mean age of Keratoconus presentation was 18.11 ± 4.45 years. Sixteen cases (72.73 %) were bilateral; 6 (27.27 %) were unilateral. Mean uncorrected visual acuity (UCVA) was 0.86 ± 0.40 Log MAR. Mean spectacle visual acuity was 0.54 ± 0.38 Log MAR. Mean visual acuity with spherical RGP contact lenses was 0.08 ± 0.14 Log MAR. The difference between mean spectacle visual acuity and mean VA with spherical RGP contact lens was statistically significant (p &lt; 0.001). Conclusion: In all stages of Keratoconus, improvement in visual acuity with spherical RGP contact lens was highly significant.

Comparison of efficacy of topical bepotastine besilate and alcaftadine in patients with vernal keratoconjunctivitis

Comparison of efficacy of topical bepotastine besilate and alcaftadine in patients with vernal keratoconjunctivitis

Clinical profile and management of vernal keratoconjunctivitis in a tertiary health care center, North Karnataka

Clinical profile and management of vernal keratoconjunctivitis in a tertiary health care center, North Karnataka

JACQLQ subjective symptom questionnaire score and clinical test results for patients with allergic conjunctival disease

We investigated the relationship between subjective symptoms and objective findings in patients with allergic conjunctival diseases (ACD) and test results for tear total IgE (t-tIgE), conjunctival eosinophils (c-Eo), serum total IgE (s-tIgE), serum-antigen specific IgE (s-sIgE), and serum eosinophils (s-Eo). Subjective symptoms and objective findings of patients with ACD were evaluated using Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ), which described disability score and emotional score written by patient and clinical findings score written by ophthalmologist. We investigated the relationship between questionnaire scores and laboratory data for t-tIgE, c-Eo, s-tIgE, s-sIgE, and s-Eo. Scores of impediments to life and of moods were highest in vernal keratoconjunctivitis among ACD. Cases with positive pollen-sIgE showed significantly more nasal symptom score than those with negative pollen-sIgE (P < 0.05). Cases with positive t-tIgE or c-Eo showed significantly more objective symptoms’ JACQLQ score than those with negative t-tIgE or c-Eo (P < 0.05), respectively. Cases positive for house dust/mite-sIgE, showed significantly more objective symptoms’ JACQLQ score than those without for house dust/mite-sIgE (P < 0.05). These results indicate that ACD could be analyzed more accurately by the combination of JACQLQ and laboratory data.

Clinical profile and outcomes of rejection after deep anterior lamellar keratoplasty in keratoconus.

To report the clinical features and management outcomes of rejection after deep anterior lamellar keratoplasty (DALK). The clinical features, indications, predisposing risk factors, management, and outcome of six eyes of six patients with rejection after DALK were analyzed retrospectively. The median time of rejection from the day of surgery was 12 (range 3-36) months. Median duration of symptoms was 4 (range 2-28) days. The indication for DALK was keratoconus in all eyes. The clinical features at presentation included graft haze, vascularization, and melt at the graft-host junction. The risk factors noted were noncompliance to steroids in all eyes, vernal conjunctivitis (four eyes), and eccentric graft (one eye). The rejection episode reversed with topical steroids in all eyes and intravenous methylprednisolone in one eye. One eye developed secondary fungal keratitis after initial recovery and one eye had a second episode of rejection 3 months later, which resulted in progressive vessels and lipid keratopathy in the visual axis. The median best corrected visual acuity was 20/40 (range 20/30-20/200). Severe stromal rejection can present with graft melt. Repeat episodes of rejection can occur on sudden cessation of topical steroids. Prompt recognition of clinical signs and symptoms with timely management helps in quick reversal of the rejection episode. Reversal of graft rejection results in good visual outcomes.

Clinical pattern of vernal keratoconjunctivitis in children – A cross-sectional study

Background: Vernal keratoconjunctivitis (VKC), a chronic and bilateral allergic eye condition, predominantly affects young males and is more prevalent in hot, humid regions with high allergen exposure. It manifests with itching, light sensitivity, burning sensations, and tearing. The three main clinical forms include limbal or bulbar, palpebral or tarsal, and mixed presentations. Aims and Objectives: This study aimed to describe the clinical patterns of VKC in children at a tertiary care hospital in Andhra Pradesh. Materials and Methods: This cross-sectional observational study was conducted in a hospital setting at the Department of Ophthalmology, SV Medical College in Tirupati, Andhra Pradesh, between January 2021 and January 2022. Ninety children aged 5–12 years with symptoms of allergic conjunctivitis were enrolled in the study. The Bonini grading system was used to grade the severity of the disease based on clinical manifestations at the time of initial presentation. Results: Mean age of disease onset was 8.6±2.3 years, with a male-to-female ratio (M: F) of 2.1:1. The majority of the subjects experienced seasonal occurrence 69 (77.0%), whereas 21 (23%) had perennial occurrence. The commonly reported symptoms included itching (83%), redness (73%), watering (73%), and discharge (47%). A significant number of patients (60, 69%) had a mixed type of disease that affected both the tarsal and bulbar conjunctiva. Conclusion: VKC predominantly affects young males, displaying a seasonal distribution and showing less allergic association, consistent with patterns observed in other tropical regions. Most patients had mild VKC at presentation, and a mixed-form pattern was most frequently observed.

Pediatric keratoconus in a tertiary eye hospital in Eastern province, Saudi Arabia: Patient characteristics and management outcomes.

This study investigates pediatric keratoconus in a tertiary eye hospital in Eastern Province, Saudi Arabia, aiming to understand the presenting features and treatment outcomes in this high-prevalence region. The research addresses pediatric keratoconus clinical profile and management strategies. A retrospective cohort study was conducted from 2022 to 2023, reviewing medical records of pediatric keratoconus patients. Demographic data, clinical characteristics, risk factors, presenting symptoms, and treatment outcomes were recorded. Severity staging was performed based on Amsler-Krumeich's classification. The study included 218 eyes from 109 pediatric keratoconus patients, with 65% of male and 35% of female patients. Decreased vision was the most common symptom (92%), and risk factors included a family history of keratoconus (9%) and vernal keratoconjunctivitis (6%). Stage 1 was the most frequent in both age groups (<14 years and ≥ 14 years). Treatment strategies included corneal collagen cross-linking (CXL), hard contact lenses, corneal rings, deep anterior lamellar keratoplasty (DLK), and penetrating keratoplasty. Significant improvements were observed in visual acuity, refractive errors, and tomographic parameters following these interventions. This study provides valuable insights into pediatric keratoconus in Saudi Arabia, emphasizing the importance of early diagnosis and interventions for better outcomes. Larger, multicenter prospective studies are essential for a comprehensive understanding of pediatric keratoconus and its optimal management. The findings contribute to the knowledge base and guide future research to improve patient quality of life.

Evaluation of Meibomian Gland Structure and Function in Patients with Vernal Keratoconjunctivitis Using Non Contact Meibography and Lipid Layer Interferometry

ABSTRACT Purpose This study evaluated the structural and functional impact of vernal keratoconjunctivitis (VKC) on meibomian glands (MGs) using a combination of noncontact meibography and lipid layer interferometry. Methods In this observational study 50 patients with moderate persistent or severe VKC and 50 age-matched controls underwent MG imaging and lipid layer thickness (LLT) measurements with Lipiview II. Image J software was used to assess MG loss (meibograde) in both lids. All patients underwent dry eye evaluation comprising tear break-up time (TBUT), ocular surface staining (OSS), Schirmer I scoring, and meiboscoring (expressibility and quality of meibum secreted). Results Meibograde, OSS score, and meiboscore was higher in cases (2.68 ± 0.96, 0.580 ± 1.07, and 0.56 ± 0.95 respectively) than controls (1.80 ± 0.67, 0.00 ± 0.00, 0.22 ± 0.47 respectively) (p < 0.001, 0.001, 0.025 respectively). LLT and TBUT was lower in cases (54.58 ± 9.43 nm and 4.92 ± 3.09 sec respectively) than controls (70.14 ± 22.50 nm and 12.02 ± 2.73 sec respectively) (both p’s = 0.001). Both groups had comparable Schirmer I scores. Conclusion Children with VKC have significant MG dropouts, deterioration in meibum quality and a thinner and less stable tear film. VKC patients are thus prone to a vicious cycle of inflammation attributable both to the allergic component and to deterioration in MG structure and function. Co-management of MG dysfunction warrants as much attention as the allergic component itself.