Abstract
Limbal and palpebral vernal keratoconjunctivitis (VKC) are usually considered to be different expressions of the same disease. This single centre population of 120 patients with VKC had 32 patients with limbal VKC, 54 with palpebral VKC and 34 with mixed palpebral and limbal VKC. There were higher proportions of females (p = 0.015) blacks, Indians and Asians (p = 0.0001) in the limbal group and fewer limbal patients had other atopic diseases (p = 0.03). The age of presentation was similar for all groups; 87/112 (78 per cent) presenting before the age of 16. The follow-up period was shorter in the limbal VKC patients (p = 0.004) suggesting a shorter disease course. Only one limbal VKC patient developed corneal opacities compared to fifty (47 per cent) with palpebral or mixed VKC, 24 (27 per cent) of whom lost vision. Tear and serum levels of total IgE and specific IgE to the major inhalent allergens cat, house dust mite and grass pollen were compared in 17 patients with palpebral or mixed VKC and ten with limbal VKC; no statistically significant differences were shown. However the significant variations in sex, racial distribution and associated atopic disease suggest that limbal VKC may be a different disease from palpebral VKC although this is not expressed in terms of IgE production.
Similar content being viewed by others
Article PDF
References
Beigelman MN : Vernal conjunctivitis. Los Angeles. University of Southern California Press, 1950.
Duke-Elder S : Vol VIII. Diseases of the outer eye. Part 1. London. Henry Kimpton, 1965, 475–93.
Allansmith MR : Vernal conjunctivitis. In Duane TD ed. Vol 4. Chap 9. Clinical Ophthalmology. New York. Harper and Row, 1980, 6.
Allansmith MR and Abelson MB : Ocular allergies. In Smolin G, Thoft RA Eds. Chap 6. The Cornea; scientific foundations and clinical practice. Boston, Little Brown and Co. 1983, 26.
Smolin G and O'Connor R : Ocular Immunology. Philadelphia, Lea and Febiger 1981, 137.
Easty DL : External ocular disease in atopic patients. In Easty DL, Smolin G. eds. Chap 9. External eye disease. London, Butterworth and Co., 1985, 247.
Buckley RJ : Vernal keratoconjunctivitis. Int Ophthalmol Clin 1989, 29: 303–8.
Dart JKG, Buckley RJ, Monnickendan M, Prasad J : Perennial allergic conjunctivitis: definition, clinical characteristics and prevalence. A comparison with seasonal allergic conjunctivitis. Trans Ophthalmol Soc UK 1986, 105: 513–20.
Kemeny DM and Richards D : Increased speed and sensitivity of a micro radioallergosorbent test (MRAST). J Immun Methods 1988, 108: 105–13.
Aalders-Deenstra V, Kok PTM, Bruynzeel PLB : Measurement of total IgE antibody levels in lacri-mal fluid of patients suffering from atopic and non-atopic eye disorders. Evidence for local IgE production in atopic eye disorders. Br J Ophthalmol 1985, 69: 385–8.
Insler MS, Lim JM, Queng JT, Wanissorn C, McGovern JP : Tear and serum IgE concentrations by Tandem-R IgE immunoradiometric assay in allergic patients. Ophthalmology 1987, 94: 945–8.
Platts-Mills TAE : Local production of IgG, IgA and IgE antibodies in grass pollen hay fever. J Immunol 1979, 122: 2218–24.
Aoki H : Relations of eye diseases with thymus and endocrine glands—especially with regard to experimental allergic conjunctivitis and vernal conjunctivitis. Acta Soc Ophthalmol Jap 1968, 72: 1949–65.
Buckley RJ : Vernal keratopathy and its management. Trans Ophthalmol Soc UK 1981, 101: 234–8.
Udell IJ, Gleich GJ, Allansmith MA, Ackerman SJ, Abelson MB : Eosinophil granule major basic protein and Charcot-Leyden crystal protein in human tears. Am J Ophthalmol 1981, 92: 824–8.
Gleich JG, Frigas E, Loegering DA, Wassom DL, Steinmuller D : Communication. Cytotoxic properties of the eosinophil major basic protein. J Immunol 1979, 123: 2925–7.
Morgan G : The pathology of vernal conjunctivitis. Trans Ophthalmol Soc UK 1971, 91: 467–78.
Collin HB and Allansmith MR : Basophils in vernal conjunctivitis in humans: an electron microscopic study. Invest Ophthalmol Vis Sci 1977, 16: 858–64.
Allansmith MR, Baird RS, Greiner JV : Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis compared and contrasted. Am J Ophthalmol 1979, 87: 544–55.
Takakusaki I : Fine structure of the human palpebral conjunctiva with special reference to the pathological changes in vernal conjunctivitis. Arch Histol Jap 1969, 30: 247–82.
Hogan MJ, Alvarado JA, Weddell JE : Histology of the human eye. Philadelphia. WB Saunders 1971, 119.
Samra Z, Zavaro A, Barishak Y, Sompolinsky D : Vernal keratoconjunctivitis: the significance of immunoglobulin E levels in tears and serum. Int Archs Allergy Appl Immunol 1984, 74: 158–64.
Sompolinsky D, Samra Z, Zavaro A, Barishak Y : Allergen-specific immunoglobulin E antibodies in tears and serum of vernal conjunctivitis patients. Int Archs Allergy Appl Immunol 1984, 75: 317–21.
Ballow M and Mendelson L : Specific immunoglobulin E antibodies in tear secretions of patients with vernal conjunctivitis. J Allergy Clin Immunol 1980, 66: 112–8.
Allansmith MR, Hahn GS, Simon MA : Tissue, tear and serum IgE concentrations in vernal conjunctivitis. Am J Ophthalmol 1976, 81: 506–11.
Frankland AW and Easty D : Vernal kerato-conjunctivitis: an atopic disease. Trans Ophthalmol Soc UK 1971, 91: 479–82.
Zavaro A, Baryishak YR, Samra Z, Sompolinsky D : Extrinsic and idiopathic vernal keratoconjunctivitis? two cases with a dissimilar immu-nopathology. Br J Ophthalmol 1983, 67: 742–5.
Baryishak YR, Zavaro A, Monselise M, Samra Z, Sompolinsky D : Vernal keratoconjunctivitis in an Israeli group of patients and its treatment with sodium cromoglycate. Br J Ophthalmol 1982, 66: 118–22.
Easty DL, Birkinshaw M, Merrett T, Merrett J, Madden P : Immunology of vernal disease. In Pepys J, Edwards AM. The mast cell; its role in health and disease. London. Pitman Medical Publishing Co. 1979, 493–502.
Foster CS : The cromolyn sodium collaborative study group. Evaluation of topical cromolyn sodium in the treatment of vernal keratoconjunctivitis. Ophthalmology 1988, 95: 194–201.
Ballow M, Mendelson L, Donshik P, Rooklin A, Rapacz P : Pollen-specific IgG antibodies in the tears of patients with allergic-like conjunctivitis. J Allergy Clin Immunol 1984, 73: 376–80.
Mann LE, Cornell-Bell AH, Marten-Ellis C, Allansmith MR : Conjunctival basophil hypersen-sitivity lesions in guinea pigs. Analysis of upper tarsal epithelium. Invest Ophthalmol Vis Sci 1986, 27: 1255–60.
Khatami M, Donnelly JJ, John T, Rockey JH : Vernal conjunctivitis. Model studies in guinea pigs immunised topically with fluoresceinyl ovalbumin. Arch Ophthalmol 1984, 102: 1683–88.
Darougar S and St C Dwyer R : Models of immediate and delayed hypersensitivity in the guinea pig conjunctiva. Trans Ophthalmol Soc UK 1971, 91: 451–61.
Asrar AM, Geboes K, Missotten L, Emarah MH, Maudgal PC, Desmet V : Cytological and immu-nohistochemical study of the limbal form of vernal keratoconjunctivitis by the replica technique. Br J Ophthalmol 1987, 71: 867–72.
Befus D, Goodacre R, Dyck N, Bienenstock J : Mast cell heterogeneity in man. I. Histologie studies of the intestine. Int Archs Allergy Appl Immunol 1985, 76: 232–6.
Irani AA, Schechter NM, Craig SS, DeBlois G, Schwartz LB : Two types of human mast cells that have distinct neutral protease compositions (tryp-tase/chymotryptic protease). Proc Natl Acad Sci USA 1986, 83: 4464–8.
Pearce FL : Functional differences between mast cells from various locations. In Befus AD, Bienenstock J, Denburg JA, eds. Mast cell differentiation and heterogeneity. New York: Raven Press, 1986, 215–22.
Butrus SI, Leung DYM, Gellis S, Baum J, Kenyon KR, Abelson MB : Vernal conjunctivitis in the hyperimmunoglobulinemia E syndrome. Ophthalmology 1984, 91: 1213–6.
Rothenberg ME, Owen WF, Stevens RL : Mast cells and eosinophils. Int Ophthalmol Clin 1989, 29: 267–74.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tuft, S., Dart, J. & Kemeny, M. Limbal vernal keratoconjunctivitis: Clinical characteristics and immunoglobulin E expression compared with palpebral vernal. Eye 3, 420–427 (1989). https://doi.org/10.1038/eye.1989.63
Issue Date:
DOI: https://doi.org/10.1038/eye.1989.63
This article is cited by
-
Vernal Keratoconjunctivitis: an update focused on clinical grading system
Italian Journal of Pediatrics (2019)
-
Individualize treatment for vernal keratoconjunctivitis based on clinical features and personal preferences
Drugs & Therapy Perspectives (2017)
-
An Update on the Therapeutic Approach to Vernal Keratoconjunctivitis
Pediatric Drugs (2016)
-
Keratoconjunctivitis vernalis
Der Ophthalmologe (2015)
-
The role of the T follicular helper cells in allergic disease
Cellular & Molecular Immunology (2012)