International Journal of Scientific Reports | September 2019 | Vol 5 | Issue 9 Page 254 International Journal of Scientific Reports Minhas S et al. Int J Sci Rep. 2019 Sep;5(9):254-256 http://www.sci-rep.com pISSN 2454-2156 | eISSN 2454-2164 Case Report Clinical presentation of vernal keratoconjunctivitis in an immunocompromised patient: a case report Shailender Minhas 1 *, Rajeev Tuli 2 , Gaurav Sharma 2 INTRODUCTION Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, recurrent, conjunctival inflammatory condition found in young individuals predisposed by their atopic background. 1 The disease shows marked seasonal (spring/summer) influence, probably secondary to vernal allergens, but perennial forms also exist. The onset of disease is generally before the age of 10 years. The mean age group of the disease is 4-20 years and resolves during late puberty. In the younger age group males predominate but in older age group male to female ratio is nearly equal. 2,3 VKC is both type I (IgE dependent) hypersensitivity reaction to exogenous antigens and Type IV (Th2 lymphocyte mediated) hypersensitivity reaction. B lymphocytes from the lymphoid follicles of the conjunctiva locally produce IgE. Chronic allergic inflammation of the ocular surface is mainly mediated by Th2 derived cytokines, IL4, IL5 and IL13 along with over expression of mast cells, eosinophils, neutrophils, chemokines, adhesion molecules, growth factors and fibroblasts. Once activated, Th2 lymphocytes play role in recruitment and activation of mast cells and eosinophils. Degranulation of mast cells leads to histamine release, causing classical allergic reactions of vasodilatation, edema, hyperaemia and recruitment of inflammatory cells. 8,10 Clinical features The main symptoms of VKC are itching, photophobia, foreign body sensation, redness, mucous production and burning sensation. Blepharospasm may also occur in severe cases. Conjunctiva develops papillae over upper tarsus and limbus shows gelatinous opacifications. The Giant papillae may increase the mass of upper lid markedly and hence pseudoptosis may be typical. Horner-Trantas dots are another important feature of ABSTRACT Vernal keratoconjunctivitis (VKC) is a chronic bilateral inflammation of the conjunctiva, commonly associated with a personal or family history of atopy. It is characterized by severe itching, foreign body sensation, thick ropy discharge, photophobia and conjunctival injection. VKC has palpebral, limbal and mixed forms. The classical conjunctival sign in palpebral VKC is the presence of giant papillae, which are predominantly seen on the superior tarsal conjunctiva. The limbal form occurs in dark skinned individuals and the papillae tend to occur at the limbus and have a thick gelatinous appearance. Clinical findings and laboratory investigations support the presence of IgE mediated type 1 hypersensitivity reaction. Involvement of CD4 T helper (Th2) driven type IV hypersensitivity has also been confirmed. There has been an increase in the prevalence of allergic disorders in recent years and exaggerated manifestations of these diseases have been recognized in patients living with Human immunodeficiency virus. Keywords: VKC, Immune-compromised state, Shield ulcer, CD4 counts 1 Eye Mobile Unit, Zonal Hospital, Dharamshala, Himachal Pradesh, India 2 Department of Ophthalmology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India Received: 01 August 2019 Accepted: 17 August 2019 *Correspondence: Dr. Shailender Minhas, E-mail: shailendraminhas@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20193764