Current best practice principles for the management of vernal keratoconjunctivitis in children

VKC is a rare form of ocular allergy underpinned by an immunologically mediated hypersensitivity reaction to environmental antigens, primarily affecting children. There is currently considerable variation in the management of VKC within the UK, risking misdiagnosis and delays to treatment.²

A recent review, based on the clinical expertise and experience of the current best practice across six large centres in the UK, describes the best practice recommendations for patients with VKC in UK settings, including principles for diagnosis, referral, initial treatment, long-term management and supportive care.²

Read and download the full review (PDF)

Symptoms and diagnosis

Taking a thorough patient history is an essential step in identifying VKC.² This includes:

Family/patient history of atopy

Family and/or patient history of atopy is present in at least 50% of patients with VKC²

Seasonality

Symptoms of VKC generally worsen in the spring and summer, but VKC can be perennial²

Previous treatments

Reviewing previous treatments may give an insight into effectiveness of specific approaches and prior patient adherence²

Characteristic symptoms experienced by children with VKC include:²

Itching/chronic eye rubbing

Photophobia*

Redness

Tarsal/limbal papillae

Watering

Pain/burning

Reduced vision*

Shield ulcer/ clouded cornea*

*Suggestive of severe eye disease; urgent referral recommended.²

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Severity and referral

VKC can be classified as mild, moderate or severe. The classification determines the urgency of referral of the patient:²

Initial treatment

Timely and effective care is critical in patients with VKC to increase the chances of a good outcome and reduce treatment burden. Treatment of VKC is escalated in steps depending on the severity and responses to previous therapy:²

Adapted from Ghauri A J et al, 2022²

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Long-term management

The focus of long-term management should be ensuring that symptoms are adequately controlled until puberty, when it is likely that the disease will end.

Follow-up should take place 2-4 weeks after the
initiation of treatment, and then:²

every 6 weeks if
on steroids

3 months after
initiating ciclosporin A

every 6-12 months for
stable patients

VKC has a relapsing and remitting nature.² To reduce the burden of this:

Children with severe VKC should be treated by a multidisciplinary team where possible²

Families should have rapid access to an eye clinic as flare-ups are common, even with effective treatment²

Quality of life should be assessed at the first appointment and then at least annually²

Although VKC is relapsing and remitting by nature, flare-ups do not mean that treatment has failed; the ultimate outcome for the child is likely to be positive.²

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Supportive care

Although prompt and effective treatment is critical for children with VKC, many patients have comorbidities and other complications that may cause distress, so may require supportive care. The key elements of supportive care include:²

Improving adherence

to treatment

Information, outreach
and communication

Emotional
support

Conclusion

Based on the clinical expertise and experience of experts, it may be possible to improve the experiences of patients with VKC and achieve high standards of care and good clinical outcomes in a variety of clinical settings. This could be achieved through the use of consistent and informed approaches, adequate information and local protocols.²

Read and download the full review (PDF)

References

1. Verkazia Summary of Product Characteristics. Available at: medicines.org.uk. Accessed May 2024

2. Ghauri A J, Biswas S et al. Management of vernal keratoconjunctivitis in children in the United Kingdom: a review of the literature and current best practice across six large United Kingdom centers. J Pediatr Ophthalmol Strabismus 2022:1-12

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