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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

First described in 1974 by an Australian ophthalmologist Dr. Spring, Giant Papillary Conjunctivitis (GPC) is one of the external ocular allergic conditions. It is most often associated with contact lens wear, but has also been described in patients with ocular prostheses and corneal sutures following surgery. Diagnosis is usually straightforward. Patients complain of decreasing lens tolerance, mucus production, often severe enough to cause blurred vision, and some itch. Inspection will reveal conjunctival hyperaemia and enlarged tarsal papillae. Management centres around patient education regarding careful lens hygiene but in severe cases may require a change to disposable lenses or a cessation of lens wear. In some cases, pharmacological agents may be required. The histopathology of GPC is very similar to Vernal Keratoconjunctivitis (VKC). It is caused by a complex immunological reaction and is not solely IgE-mediated. Trauma and foreign body reactions also play a role. The incidence of GPC has decreased with the advent of disposable lenses.
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PMID:Giant papillary conjunctivitis--a review. 1033 25

Vernal keratoconjunctivitis was the most common conjunctival disease seen over a 2 year period (January 1997-December 1998) at the University of Benin Teaching Hospital, Benin City, Nigeria. One hundred and nine consecutive patients were seen with vernal keratoconjunctivitis. There was a male to female ratio of 1:1.3. The age range of the patients was 5 months to 38 years with a mean age of 15.5 +/- 8.3 years (SD). Of the patients 54.1% were children. Itching was the most common symptom, followed by redness, tearing, aching eye and photophobia. Ninety patients (82.6%) had predominantly tarsal papillae, while the others had mixed and limbal papillae. A history of atopic diseases such as asthma and rhinitis was present in only five patients (4.5%). There was no patient with corneal ulcer or scarring. Although the complications were few, health education of the patients about the dangers of self medication with steroids should be emphasized.
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PMID:Vernal keratoconjunctivitis in Nigerians: 109 consecutive cases. 1462 Apr 34

Vernal keratoconjunctivitis (VKC) is an allergic eye disease that especially affects young boys. The most common symptoms are itching, photophobia, burning, and tearing. The most common signs are giant papillae, superficial keratitis, and conjunctival hyperaemia. Patients with VKC frequently have a family or medical history of atopic diseases, such as asthma, rhinitis, and eczema. However, VKC is not associated with a positive skin test or RAST in 42-47% of patients, confirming that it is not solely an IgE-mediated disease. On the basis of challenge studies as well as immunohistochemical and mediator studies, a Th2-driven mechanism with the involvement of mast cells, eosinophils, and lymphocytes has been suggested. Th2 lymphocytes are responsible for both hyperproduction of IgE (interleukin 4, IL-4) and for differentiation and activation of mast cells (IL-3) and eosinophils (IL-5). Other studies have demonstrated the involvement of neural factors such as substance P and NGF in the pathogenesis of VKC, and the overexpression of oestrogen and progesterone receptors in the conjunctiva of VKC patients has introduced the possible involvement of sex hormones. Thus, the pathogenesis of VKC is probably multifactorial, with the interaction of the immune, nervous, and endocrine systems. The clinical management of VKC requires a swift diagnosis, correct therapy, and evaluation of the prognosis. The diagnosis is generally based on the signs and symptoms of the disease, but in difficult cases can be aided by conjunctival scraping, demonstrating the presence of infiltrating eosinophils. Therapeutic options are many, in most cases topical, and should be chosen on the basis of the severity of the disease. The most effective drugs, steroids, should however be carefully administered, and only for brief periods, to avoid secondary development of glaucoma.A 2% solution of cyclosporine in olive oil or in castor oil should be considered as an alternative. The long-term prognosis of patients is generally good; however 6% of patients develop corneal damage, cataract, or glaucoma.
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PMID:Vernal keratoconjunctivitis. 1506 27

Allergic conjunctivitis is a group of diseases that are frequent in childhood, associated to several allergic diseases affecting the ocular surface. It is related to type 1 hypersensitivity reactions. Two acute disorders: seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do three chronic diseases: vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. The ocular surface inflammation causes itching, tearing, lid and conjunctival edema-redness, and photophobia during the acute phase and can lead to a classic late-phase response (associated to eosinophilia and neutrophilia) in a subset of individuals. As in the case of several chronic allergic diseases, it can remodel the ocular surface tissue. This allergic disease is very frequent. Vernal keratoconjunctivitis could produce corneal lesions and visual illness; however, atopic keratoconjunctivitis does not permanently affect the vision. The aim of this review is to provide a current overview for a better understanding of the symptoms associated to this disease, to describe its classification, recent advances in its physiopathology and its treatment.
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PMID:[Allergic conjunctivitis in children]. 1754 45

Vernal keratoconjunctivitis / spring catarrh is a variety of exogenous allergic conjunctivitis, which is a very troublesome ocular disease of childhood and in the adolescent age group. The child suffers from intense itching, grittiness, discharge, redness, lacrimation, photophobia, and so on, thereby, decreasing his learning hours. The troublesome features are aggravated in the spring season / hot climate that lasts for years together and rarely persists after adolescence. Mast cell stabilizers, topical Nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids are the available treatment options that too with symptomatic relief and potential side effects, which limits the long-term use of these medicines. The clinical picture of vernal keratoconjunctivitis / spring catarrh is very similar to Kaphaja Abhishyanda, and Triyushnadi Anjana Bhaishajya Ratnavali (B.R.), and its treatment was clinically tried on the patients attending the Netra Roga OPD of the R.G. Government P.G. Ayurveda College Hospital at Paprola (H.P.). A proper protocol and performa was adopted with strict inclusion and exclusion criteria. In the first phase, a pilot study was conducted on 38 clinically diagnosed patients with vernal keratoconjunctivitis, and it gave 100% relief in photophobia, foreign body (FB) sensation, and lacrimation, with marked relief in other features. Encouraged by this pilot work, Triyushnadi Anjana (TA) and 2% sodium cromoglycate (mast cell stabilizer) eye drops in the second-phase clinical trial on 32 patients were tried clinically to evaluate the comparative efficacy. In the second clinical trial, the patients were randomly divided into two groups and Group I was given sodium cromoglycate 2% eye drops and Group II was given TA. The outcome of this study verified the results of the first phase pilot study, and on comparison of the results of the two groups in the second clinical study it was observed that the TA-treated group showed better results. Transient irritation in the eyes was reported by all patients after application of TA, which was relieved by keeping the eyes closed for a few minutes. None of the patients reported any adverse action of the trial drug. Thus, it can be concluded that TA is a safe, cost-effective, and potent Ayurvedic alternative in the treatment of vernal keratoconjunctivitis / spring catarrh.
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PMID:A clinical study to assess the efficacy of Triyushnadi Anjana in Kaphaja Abhishyanda with special reference to vernal keratoconjunctivitis. 2204 41

Vernal keratoconjunctivitis (VKC) is an allergic ocular disease in children and young adults. It is linked to atopy but it is characterized by typical inflammatory changes of ocular tissues. The conjunctiva often shows hyperplasia, with infiltration of lymphocytes and eosinophils; also mast cells, confined to the substantia propria in normal subjects, invade the epithelium in VKC. Both mucosal (MC(T)) and connective tissue (MC(TC)) types of mast cell can be found in the conjunctival tissues of VKC patients, whereas MC(TC) predominate in the normal eye. Much of the damage caused to the surface of the eye in VKC appears to be due to cytotoxic factors released from the invading eosinophils. Ongoing studies of cell/mediator interactions involved in the inflammatory process are contributing to the understanding of VKC and other allergic eye diseases also providing the rationale for effective treatment which may be found by blocking the immunological inflammatory network at specific points. Therapeutic studies with nedocromil sodium have shown encouraging results. For example, a six-week placebo comparison in Italy found nedocromil sodium eye drops to be efficacious in reducing hyperaemia, eye itching and inflammatory cells present in tears. Similarly, a four-week trial in Egypt showed this drug superior to sodium cromoglycate using the same q.i.d. regimen.
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PMID:Vernal Keratoconjunctivitis (VKC). 2282 85

Vernal keratoconjunctivitis (VKC) is an unusually severe sight-threatening allergic eye disease, occurring mainly in children. Conventional therapy for allergic conjunctivitis is generally not adequate for VKC. Pediatricians and allergists are often not familiar with the severe clinical symptoms and signs of VKC. As untreated VKC can lead to permanent visual loss, pediatric allergists should be aware of the management and therapeutic options for this disease to allow patients to enter clinical remission with the least side effects and sequelae. Children with VKC present with severe ocular symptoms, that is, severe eye itching and irritation, constant tearing, red eye, eye discharge, and photophobia. On examination, giant papillae are frequently observed on the upper tarsal conjunctiva (cobblestoning appearance), with some developing gelatinous infiltrations around the limbus surrounding the cornea (Horner-Trantas dot). Conjunctival injections are mostly severe with thick mucus ropy discharge. Eosinophils are the predominant cells found in the tears and eye discharge. Common therapies include topical antihistamines and dual-acting agents, such as lodoxamide and olopatadine. These are infrequently sufficient and topical corticosteroids are often required for the treatment of flare ups. Ocular surface remodeling leads to severe suffering and complications, such as corneal ulcers/scars. Other complications include side effects from chronic topical steroids use, such as increased intraocular pressure, glaucoma, cataract and infections. Alternative therapies for VKC include immunomodulators, such as cyclosporine A and tacrolimus. Surgery is reserved for those with complications and should be handled by ophthalmologists with special expertise. Newer research on the pathogenesis of VKC is reviewed in this article. Vernal keratoconjunctivitis is a very important allergic eye disease in children. Complications and remodeling changes are unique and can lead to blindness. Understanding of pathogenesis of VKC may lead to better therapy for these unfortunate patients.
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PMID:Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. 2443 33

Vernal keratoconjunctivitis (VKC) is an inflammatory disease of the ocular surface. It commonly occurs in the first decade of life, has a wide geographical distribution, and usually occurs in warm, dry areas. The pathogenesis of VKC seems to have an immune, nervous, and endocrine basis. The most common eye symptoms are itching, discharge, tearing, eye irritation, redness of the eyes, and photophobia. Although VKC generally has a good prognosis, the lack of clarity regarding the origin of the disease makes treatment a challenge for pediatricians and ophthalmologists. The purpose of this review is to discuss the pathogenesis, clinical features, and diagnostic criteria in VKC, with a focus on its therapeutic management. The selection of a therapeutic scheme from the many available options is based on clinical features and the personal preferences of both physicians and patients. Due to the lack of uniform grading of disease severity, there is no worldwide consensus on first-line and second-line therapeutic approaches. The choice of treatment for long-term moderate to severe VKC includes topical cyclosporine or tacrolimus. Further data are needed to define the minimal effective concentration and the safety of these drugs in eye drops and to clarify the diagnosis of VKC in patients who require these drugs. Finally, while promising newly discovered drugs are expected to enter into clinical practice, further studies on their efficacy and safety are required.
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PMID:An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis. 2746 27