Vernal conjunctivitis

  • Definition
    • Vernal conjunctivitis is long-term (chronic) swelling (inflammation) of the outer lining of the eyes. It is due to an allergic reaction.

  • Causes
    • Vernal conjunctivitis often occurs in people with a strong family history of allergies. These may include allergic rhinitis, asthma, and eczema. It is most common in young males, and most often occurs during the spring and summer.

  • Symptoms
    • Symptoms include:

      • Burning eyes
      • Discomfort in bright light (photophobia)
      • Itching eyes
      • The area around the cornea where the white of the eye and the cornea meet (limbus) may become rough and swollen
      • The inside of the eyelids (most often the upper ones) may become rough and covered with bumps and a white mucus
      • Watering eyes
  • Exams and Tests
    • The health care provider will perform an eye exam.

  • Treatment
    • Avoid rubbing the eyes because this can irritate them more.

      Cold compresses (a clean cloth soaked in cold water and then placed over the closed eyes) may be soothing.

      Lubricating drops may also help soothe the eye.

      If home-care measures do not help, you may need to be treated by your health care provider. Treatment may include:

      • Antihistamine or anti-inflammatory drops that are placed into the eye
      • Eye drops that prevent a type of white blood cell called mast cells from releasing histamine (may help prevent future attacks)
      • Mild steroids that are applied directly to the surface of the eye (for severe reactions)

      Recent research suggests that a mild form of cyclosporine, which is an anti-cancer drug, may be helpful for acute episodes. It may also help prevent recurrences.

  • Outlook (Prognosis)
    • The condition continues over time (is chronic). It gets worse during certain seasons of the year, most often in the spring and summer. Treatment may provide relief.

  • Possible Complications
    • Complications may include:

      • Continuing discomfort
      • Reduced vision
      • Scarring of cornea
  • When to Contact a Medical Professional
    • Call your provider if your symptoms continue or get worse.

  • Prevention
    • Using air conditioning or moving to a cooler climate may help prevent the problem from getting worse in the future.

  • References
    • Barney NP, Graziano FM, Cook EB, Stahl JL. Allergic and immunologic diseases of the eye. In: Adkinson NF, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 39.

      Boguniewicz M, Cho CB, Sicherer SH. Occular allergies. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 1477.

      Hernandez-Trujillo V, Riley E, Rudnick C. Allergy. In: Rakel RE, Rakel D, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 19.

      Lambiase A, Leonardi A, Sacchetti M, et al. Topical cyclosporine prevents seasonal recurrences of vernal keratoconjunctivitis in a randomized, double-masked, controlled 2-year study. J Allergy Clin Immunol 2011;128(4):896-897. PMID: 21868078

      Rubenstein JB, Tannan A. Allergic conjunctivitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 4.7.

      Stock EL. Vernal keratoconjunctivitis. In: Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2013:vol 4, chap 9.