How do you tell a parent her child will have to “power” through the next decade of life with a condition that will cause blepharospasm, discomfort, and mucous discharge upon awakening?1
It is a precarious position considering the desire to find the perfect remedy— yet with vernal keratoconjunctivitis (VKC), there is no magic bullet.
I was taught in my early years of training to research an enigmatic disease state and to pivot to where you can to succeed in treating the condition. I have learned that VKC can be treated effectively with a stepladder strategy by understanding the historical background and pathophysiology.
Previously from Dr. Cooper: How palynology and aldehydes affect allergy treatment
What history tells us
The first known description in the literature of VKC came from Arlt in 1846 where he reported three cases of perilimbal swelling in children.2 Almost a decade later, Desmarres depicted the limbal findings representative of VKC in slightly “lymphatic” children who were experiencing photophobia.2
After his death in 1870, von Graefe had his work published the following year delineating the “pavement-like granulations” of the conjunctiva which has become one of the hallmark signs of this inflammatory/immunological disease state.2
These doyens of ophthalmology, along with many others, classified at different times the condition as spring catarrh, phlyctenula pallida, circumcorneal hypertrophy, recurrent vegetative conjunctiva, verrucosa conjunctiva, and aestivale conjunctiva, calling attention to the various aspects of this disease.3 Even though these authors accepted VKC as an allergic entity, there were and still are many gaps in the knowledge of the etiology and pathophysiology.
The groundwork was laid to pursue more ambitious research in the immunological realm. This was done to discern whether this disease state had deeper implications than a mere Type 1 hypersensitivity reaction.