Vernal keratoconjunctivitis (spring catarrh): symptoms and treatment

Vernal keratoconjunctivitis (VKC) is a chronic allergic condition that inflames the front surface of the eye and the inside of the eyelids. The College of Optometrists describes it as a rare but serious allergic disease affecting the eyes of young children. It explains that VKC is not a simple allergic condition like seasonal allergic conjunctivitis, because it involves various different types of immune reaction.

Allergy UK notes that when someone with VKC is exposed to airborne allergens such as dust and pollen, symptoms can worsen, and that the connection with eczema may contribute to the severe inflammatory response. Many people do not recognise when they need to seek help and treat VKC as ordinary allergic conjunctivitis, which is the most common allergic reaction affecting the eyes.

Allergy UK says symptoms usually affect both eyes. In milder cases they commonly include itchy, red eyes, a burning sensation, and watery eyes with a small amount of discharge. The College of Optometrists adds that children complain of itching, watering and a stringy discharge, that vision may be blurred and eyes abnormally sensitive to light, and that a typical symptom is great difficulty in opening the eyes after waking.

In more severe cases Allergy UK lists sensitivity to light, blurred vision, eye pain and a sensation like grit in the eye, difficulty opening the eyes, stringy or mucus-like discharge especially after sleeping, swollen cobblestone-like bumps (papillae) on the inside of the eyelid, and droopy eyelids.

The College of Optometrists explains that substances released from the inflamed tissue can damage the cornea, and that a whitish deposit known as plaque may accumulate on the cornea, which may also become scarred. Because the condition can be very distracting, it may cause children to miss school.

• Intense itching of both eyes.

• Burning, grittiness or pain.

• Stringy, mucus-like discharge, particularly after sleeping.

• Light sensitivity and blurred vision.

• Cobblestone-like bumps under the upper eyelids.

Allergy UK advises that if you suspect you or your child has VKC, you should visit your GP for referral to an eye specialist (ophthalmologist). It stresses that VKC is rare and serious and requires specialist care. It also says VKC can be mistaken for infectious conjunctivitis that needs prompt treatment.

For any red eye with pain, sensitivity to light or changes in vision, the NHS conjunctivitis page advises asking for an urgent GP appointment or getting help from NHS 111, because these can be signs of a more serious eye problem. Because VKC can scar the cornea, new pain, worsening vision or a child who cannot open their eyes should not wait.

Allergy UK lists the typical routes of treatment once diagnosed: avoiding triggers, lubricant eye drops to soothe the eyes, anti-allergy eye drops (mast cell stabilisers) to reduce the allergic reaction, steroid eye drops to reduce inflammation (although this is not a long-term solution), immunosuppressant eye drops to keep inflammation under control and reduce flare-ups, and immunotherapy where VKC is caused by a single allergen.

The College of Optometrists says many cases need to be referred to an ophthalmologist, who may in turn refer to allergy specialists, and that surgery is sometimes needed when plaque has accumulated on the cornea. Long-term treatment plans are therefore individual and are usually supervised by the eye team.

The College of Optometrists says VKC often disappears at puberty, though it may change into another allergic eye disease known as atopic keratoconjunctivitis. Allergy UK says VKC tends to be outgrown by puberty, whereas atopic keratoconjunctivitis is most common between the ages of 30 and 50 years and is often considered the adult equivalent.

Allergy UK also points families to practical support, including a VKC and ME app that helps people keep track of appointments, medication reminders and how to apply eye drops, and to tips shared by other parents. Because the condition can be debilitating, it is reasonable to tell school staff about the diagnosis and the treatment plan.