Cytological Modification of Conjunctiva in Vernal Kerato Conjunctivitis and Its Clinical and Hematological Correlation

Abstract

To evaluate the cytological epithelial modification of conjunctiva in VKC and correlate with its various clinical features, hematological. Investigations and response to treatment. MATERIALS AND METHOD: This was a prospective study of 50 consecutive patients of VKC presenting to M.S Ramaiah Hospital, who were willing to undergo laboratory Investigations. A detailed preliminary eye examination, including Best Corrected Visual Acuity (BCVA), Tear film examination including Schirmer's test, Tear Break Up Time, Mucin ferning patterns, Tears pH, Conjunctival Impression Cytology (CIC), Skin Prick Test and Blood Investigations like Hemoglobin, Complete Blood Count, ESR, Absolute Eosinophil Count(AEC), Serum IgE Levels (S.IgE) were done. RESULT: Patients belonged to the age group of 4 to 25 years and M:F ratio was 4:1.Total number of patients with Palpebral VKC & mixed VKC were 13 And 37 respectively and none had limbal VKC. Total number of patients with VKC was 50 out of which Patients with normal AEC and normal S.IgE were 4(8%), with raised AEC & normal S.IgE Were 4(8%) and with raised or normal AEC & raised IgE were 42 (84%). All patients had alkaline tear film, abnormal ferning patterns were observed in 49 (98%), and abnormal TBUT in 37(74%) patients. 28(56%) had abnormal CIC grading.89.28 % (25/28) patients of abnormal CIC had Raised S.IgE levels. Only 37.5% (3/8) of VKC cases with normal S.IgE levels showed abnormal CIC. Only in 52.38% of patients with severe VKC could the allergen (skin prick test) be identified. 80. 95 b% of severe VKC cases had raised S.IgE. 59.95% (N: 25) cases had positive skin prick test out of 42 cases with raised S.IgE. VKC patients with Normal AEC &IgE levels were easily cured with mast cell stabilizers, antihistaminics and artificial tears VKC patients with raised AEC levels & Normal IgE levels were treated with topical steroids during the attacks and mast cell stabilizers and artificial tears, VKC patients with raised AEC &IgE were resistant to treatment with steroids and immunomodulators. CONCLUSION: VKC seems to be a strongly IgE mediated. There is need for a more robust skin prick test to identify the allergens/atopy. Immunotherapy should probably be considered early in the disease status reduce ocular morbidity due to VKC.