Ocular Surface Characteristics in Pediatric Vernal Keratoconjunctivitis
abstract
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Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To compare the ocular surface parameters of children with vernal keratoconjunctivitis (VKC) with those of healthy controls and to correlate cytological characteristics with clinical findings and disease severity.
METHODS
Newly diagnosed cases of VKC, not currently being treated, were recruited, along with age-matched controls with no ocular comorbidities. The Ocular Surface Disease Index questionnaire (OSDI) was administered to all children. Slit lamp biomicroscopy for meibomian gland dysfunction and ocular surface analysis was performed, including tear meniscus height, noninvasive tear film break-up time, lipid layer thickness, meibomian gland morphology, and meibomian gland duct distortion on meibography imaging. Conjunctival impression cytology was also performed.
RESULTS
A total of 68 VKC patients and 33 controls were included. Statistically significant difference was seen in the mean OSDI score (30 ± 13.7 vs 16.1 ± 3 [P ≤ 0.01]), lipid layer thickness (24.2 ± 7.9 nm vs 69.9 ± 15.1 nm [P <0.001]), and noninvasive tear film break-up time (6.8 ± 1.7 vs 12.5 ± 1.8 sec [P < 0.01]) between groups. Mean tear meniscus height was 0.22 ± 0.06 mm in the VKC and 0.24 ± 0.04 mm in the control group (P = 0.096). Significant association was seen between grade of squamous metaplasia and severity of VKC (P < 0.01). Severity of VKC was found to be positively correlated with OSDI score (r = 0.767), grade of squamous metaplasia (r = 0.64) and negatively correlated with noninvasive tear film break-up time (r = -0.468), and lipid layer thickness (r = -0.253).
CONCLUSIONS
This study highlights the poor ocular surface health of children with VKC, with severe disease being associated with worse forms of dry eye disease.
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Additional Info
Disclosure statements are available on the authors' profiles:
Ocular surface characteristics in pediatric vernal keratoconjunctivitis: a clinico-cytological study
J AAPOS 2022 Sep 16;[EPub Ahead of Print], S Sabu, N Gupta, N Raj, A Panigrahi, N Lomi, M Vanathi, P Vashist, S Sen, R TandonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Why was this study conducted?
Vernal keratoconjunctivitis (VKC) typically occurs in children and can have long-term effects on the ocular health of those affected. It is an allergic eye disease that is generally recurrent and can be severe due to its impact on vision and long-term effects, such as corneal scarring. In adults with seasonal allergic conjunctivitis, detrimental impacts on the ocular surface have been discovered. Yet little is known of the ocular surface status of patients suffering from this condition.
How was the study performed?
This prospective study, conducted in New Delhi, North India, compared 68 pediatric patients with VKC with 33 healthy controls. The diagnosis was based on patient history and a grading system for the ocular signs of allergic conjunctivitis. Patients with acute complications, such as shield ulcer, infection, keratoconus, and use of other medications or with other diseases, were excluded. Impression cytology was performed to diagnose and grade squamous metaplasia along with an ocular surface analyzer.
What did the study find?
Overall, children with VKC were found to have poor ocular surface health, particularly a high incidence of dry eyes; 74% of these children had dry eyes. The patient group had a mean age of 9.8 years ± 4.4 years (range, 4–16 years), which was similar to that in the control group. The mean age of onset of symptoms was 5.7 ± 2.2 years, and the mean duration of the disease was 4.1 ± 2.8 years. The majority (77%) of the patients were male. Almost all patients (96%) reported a foreign body sensation. Significant findings in the group with VKC versus the control group included a higher average OSDI score (30.7 ± 13.7 vs 16.1 ± 3; P < .001), thinner lipid layer (24.2 ± 7.9 nm vs 69.9 ± 15.1 nm; P < .001), and shorter noninvasive tear film break-up time (6.8 ± 1.6 sec vs 12.5 ± 0.8 sec; P < .001). There was also a significant association between the grade of squamous metaplasia on the ocular surface and VKC severity (P < .01). Patients with more severe VKC were more likely to have a higher grade of squamous metaplasia and a lower goblet cell density, noninvasive tear break-up time, and lipid layer thickness. It was hypothesized that the inflammation might result in damage to the meibomian glands along with frequent eye rubbing.
What do we do now?
In a patient with VKC, the ocular surface should be assessed, and any associated ocular surface disease managed, as earlier diagnosis and appropriate management of VKC, particularly controlling the inflammation and associated ocular surface disease, will likely prevent long-term adverse events from these conditions.