Published: 2018-02-22

A clinicopathological study of vernal conjunctivitis in urban and rural areas of Eastern India: A hospital based study

Suman Adhikari, Asok Kumar Naskar, Samarendra Kabasi, Sujata Deb, R. K. Deb, Sukanta Sen


Background: Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications.

Methods: The present study was carried out amongst the patients suffering from vernal conjunctivitis and attending the Outpatient Department of Ophthalmology of Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital, Kishanganj (Bihar). The conjunctiva and cornea were examined for any complication of the disease. The patients were categorized into two treatment groups, each group treated with one topical drug. As the total number of patients in the study was 100, each treatment group consisted of 50 patients, one group of patients was treated with 0.05% azelastine eye drop and the other group treated with 2% sodium cromoglycate eye drop.

Results: Greater incidence during the period from March to June (59%) and the highest number in the month of May (18%). Of the 100 patients in the study group, the largest group of 89 patients presented with limbal vernal conjunctivitis; 7 patients presented with palpebral vernal conjunctivitis and 4 patients suffered from a mixed type (both limbal and palpebral) type of the disease.

Conclusions: Examination of the conjunctival biopsy specimens of the patients showed chronic nonspecific inflammatory reaction, mostly confined to the subepithelial region. Patients in both groups showed dramatic results of the treatment proving the efficacy of steroids. 


Azelastine eye drop, Prognosis, Sodium cromoglycate eye drop, Vernal keratoconjunctivitis

Full Text:



Tabbara KF. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol. 1999;34:88-92.

Cameron JA. Shield ulcers and plaques of the cornea in vernal keratoconjunctivitis. Ophthalmol. 1995;102:985-993.

Dahan E, Appel R. Vernal keratoconjunctivitis in the black child and its response to therapy. Br J Ophthalmol. 1983;67:688-692.

BenEzra D, Pe'er J, Brodsky M, Cohen E. Cyclosporine eye drops for the treatment of severe vernal keratoconjunctivitis. Am J Ophthalmol. 1986;101:278-282.

De Smedt S, Nkurikiye J, Fonteyne Y, Hogewoning A, Van Esbroeck M, De Bacquer D, Tuft S, Gilbert C, Delanghe J, Kestelyn P. Vernal keratoconjunctivitis in school children in Rwanda and its association with socio-economic status: a population-based survey. American J Trop Med Hyg. 2011;85(4):711-7.

Khan MD, Kundi N, Saeed N, Gulab A, Nazeer AF. A study of 530 cases of vernal conjunctivitis from the North West Frontier Province of Pakistan. Pak J Ophthalmol. 1986;2:111-114.

Resnikoff S, Cornand G, Filliard G, Hugard L. Limbal vernal conjunctivitis in the tropics. Rev Int Trach. 1988;3-4:53-71.

Sethi M, Nanda R, Bali AS, Sadhotra P. Hospital based study of demography and clinical picture of vernal keratoconjunctivitis. Int J Res Med Sci. 2018;6:65-8.

Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, et al. Vernal keratoconjunctivitis revisited. A case series of 195 patients with long-term followup. Ophthalmol. 2000;107:1157-1163.

Yemaneberhan H, Bekele Z, Venn A, Lewis S, Parry E, Britton J. Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia. Lancet. 1997;350:85-90.

Viinanen A, Munhbayarlah S, Zevgee T, Narantsetseg L, Naidansuren T, Koskenvuo M, et al. The protective effect of rural living against atopy in Mongolia. Allergy. 2007;62:272-280.

Williams PB, Crandall E, Sheppard JD. Azelastine hydrochloride, a dual-acting anti-inflammatory ophthalmic solution, for treatment of allergic conjunctivitis. Clin Ophthalmol. 2010;4:993-1001.

La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ita J pediatrics. 2013;39(1):18.

Bonini S, Coassin M, Aronni S, Lambiase A. Vernal keratoconjunctivitis. Eye (Lond). 2004;18(4):345-51.

Pleyer U, Leonardi A. Vernal keratoconjunctivitis. Ophthalmol. 2015;112(2):177-89.

Vichyanond P, Pacharn P, Pleyer U, Leonardi A. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. Pediatr Allergy Immunol. 2014;25(4):314-22.

Saboo US, Jain M, Reddy JC, Sangwan VS. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India. Ind J Ophthalmol. 2013;61(9):486-9.

Leonardi A, Secchi AG. Vernal keratoconjunctivitis. Int Ophthalmol Clin. 2003;43(1):41-58.

Bielory L, Frohman L. Allergic and immunologic disorders of the eye. J Allergy Clin Immunol. 1992;86:1-20.

Ballow, Mark et al. Complement proteins and C3 anaphylatoxin in the tears of patients with conjunctivitis. J Allergy Clinical Immunol. 1985;76(3):473-6.

Srinivasan M, Srinivasan S. Vernal ulcer. Ind J Ophthalmol. 1990;38:33-4.

Bleik JH, Tabbara KF. Topical cyclosporine in vernal keratoconjunctivitis. Ophthalmol. 1991;98(11):1679-84.

Friedlaender M, Harris J, Lavallee N, Russell H, Shilstone J. Evaluation of the onset and duration of effect of azelastine eye drops [0.05%] versus placebo in patients with allergic conjunctivitis using an allergen challenge model. Ophthalmol. 2000;107:2152-7.

Friedlaender MH, Okumoto M, Kelley J. Diagnosis of allergic conjunctivitis. Arch Ophthalmol. 1984;102(8):1198-9.

McGILL J, Holgate S, Church M, Anderson D, Bacon A. Allergic eye disease mechanisms. The Brit J Ophthalmol. 1998;82(10):1203-14.

Akpek EK, Hasiripi H, Christen WG, Kalayci D. A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis. Ophthalmol. 2000;107:263-9.

Foster CS. Evaluation of cromolyn sodium in the treatment of vernal keratoconjunctivitis. Ophthalmol. 1988;95:194-201.

EL-Asrar AM, Tabbara KF, Geboes K, Missotten L, Desmet V. An immunohistochemical study of topical cyclosporine in vernal keratoconjunctivitis. Ame J Ophthalmol. 1996;121(2):156-61.

Posey WC. Vernal Conjunctivitis. Atlantic Med J. 1924;27:215-9.

Lehrfeld L. Vernal conjunctivitis observations on eighty-seven cases at the Wills Hospital (1929-1931). Arch Ophthalmol. 1932;8(3):380-404.

Tobgy R. Folia Ophthal. Orient, 1933;1:168.

Ciprandi G, Buscaglia S, Catrullo A, Pesce G, Fiorino N, Montagna P, et al. Azelastine eye drops reduce and prevent allergic conjunctival reaction and exert anti-allergic activity. Clin Exp Allergy. 1997;27(2):182-91.