A red-eye presentation concerning for vernal keratoconjunctivitis: a case report.

Area of Science:

• Ophthalmology
• Allergology
• Pediatrics

Background:

• Vernal keratoconjunctivitis (VKC) is a chronic allergic eye condition impacting children's quality of life.
• While rare in Canada, VKC diagnosis can be challenging due to atypical seasonality or inconclusive allergy testing.
• Persistent conjunctivitis unresponsive to standard treatments warrants consideration for VKC.

Purpose of the Study:

• To present a case of Vernal keratoconjunctivitis (VKC) in a Canadian child with atypical presentation.
• To highlight diagnostic challenges and effective management strategies for VKC.
• To emphasize the importance of ophthalmologist consultation for VKC.

Main Methods:

• A case study of an 11-year-old male with a six-month history of bilateral conjunctival inflammation, photophobia, and vision changes.
• Clinical assessment included photographic documentation of Horner-Trantas dots, conjunctival inflammation, ecchymosis, and chemosis.
• Diagnostic workup involved epicutaneous testing and serum IgE, alongside response to olopatadine, loteprednol, and rupatadine therapy.

Main Results:

• The patient presented with atypical symptoms and initial allergy testing showed mild sensitization.
• VKC diagnosis was confirmed based on clinical features and photographic evidence.
• A combination of topical and oral antihistamines, with topical steroids for flares, effectively managed symptoms, leading to stability and medication discontinuation.

Conclusions:

• Vernal keratoconjunctivitis (VKC) requires ophthalmologist evaluation to prevent vision-threatening complications, even in regions where it's uncommon.
• VKC should be suspected in persistent conjunctivitis unresponsive to antihistamines, irrespective of clear seasonal patterns or allergen sensitization.
• Combined topical/oral antihistamine therapy, supplemented by topical steroids for exacerbations, is effective for VKC symptom stabilization, often requiring extended treatment duration.