Managing Bilateral Vernal Keratoconjunctivitis, Keratoconus, and Steroid-Induced Glaucoma: A Threefold Struggle

The coexistence of bilateral vernal keratoconjunctivitis (VKC), keratoconus, and steroid-induced glaucoma presents a complex ocular challenge, threatening visual acuity and long-term eye health. This combination poses significant risks, with VKC and keratoconus progressively affecting both eyes while glaucoma, induced by necessary steroid treatments, further complicates the clinical picture. We report a case of a young Malay girl who complained of bilateral eye itchiness with progressive blurring of vision, a history of frequent changes in prescribed glasses, and vigorous eye rubbing. Diagnosed with VKC at age 14, she defaulted on follow-up and began unsupervised use of topical steroids during flare-ups. This resulted in steroid-induced glaucoma, complicating the management of both VKC and coexisting keratoconus. This case underscores the importance of careful, supervised treatment, as improper management can significantly affect long-term outcomes.