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Thread: Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision

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    Arrow Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision

    Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision

    Chief Complaint:
    Decreased distance visual acuity for four months.

    History of Present Illness:
    The patient is an eight year-old white male who suffers from seasonal allergic rhinitis. He presents for an eye examination complaining of a four month history of decreased distance visual acuity. Of note, he has a history of phlyctenulosis superiorly in the right eye during the previous summer that resolved with lotepredonol 0.5% topical therapy.

    Past Ocular History:
    Unremarkable for surgery or trauma. He is mildly myopic with a current optical prescription of -1.75 spherical in both eyes (OU). Phlyctenulosis as noted above.

    Past Medical History:
    History of asthma and seasonal allergies throughout his childhood.

    His allergic rhinitis is treated with beclomethasone dipropionate nasal spray (Vanceril) and combined oral therapy of chlorpheniramine and pseudoephedrine (Kronofed, antihistamine and decongestant).

    Family History:
    Maternal grandparent with cataract, glaucoma and macular degeneration. Multiple myopic family members.

    Social History:
    The patient is a well-adjusted 2nd-grader who lives at home with his parents. He has had no known exposure to anyone with infectious eye disease.

    Ocular Examination:
    Moderate photophobia noted during the exam.
    Neurologic status: Alert and oriented x3, non-focal
    Visual Acuity, with correction (-1.75 sphere, OU): Right eye (OD)-- 20/40; Left eye (OS)20/40 (pinhole correction to 20/25 OD and OS)
    Extraocular motility: Full, both eyes (OU)
    Pupils: Normal with no relative afferent pupillary defect (RAPD)
    Confrontation Visual Fields: Full, OU
    Intra-ocular pressure: OD--17 mmHg; OS--18 mmHg
    Slit lamp examination: Limbal papillary reaction superiorly and bulbar conjunctival injection superiorly, OU (see Figure 1). Palbebral papillae are evident on the superior tarsal conjunctiva, OS, other-wise normal.
    Dilated Fundal Exam (DFE): No pallor or edema of disc, OU. Normal macula vessels and periphery, OU.
    The patient's course and presentation is classic for vernal keratoconjunctivitis. The day of presentation, the patient was started on the topical steroid Lotomax (loteprednol etabonate 0.5%) BID and the topical antihistamine Optivar (azelastine 0.05%) BID. At his 1 week follow-up visit, the limbal and palpebral signs were resolving. The Lotamax was tapered off. At his 6 week follow-up, there was no sign of limbal involvement of disease and only mild papillae of the tarsal conjunctiva. The patient was continued on Optivar until symptoms resolved.


    Discussion & Treatment:

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    Last edited by trimurtulu; 01-11-2009 at 10:36 PM.

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