Clinical presentation of vernal keratoconjunctivitis in an immunocompromised patient: a case report


  • Shailender Minhas Eye Mobile Unit, Zonal Hospital, Dharamshala, Himachal Pradesh, India
  • Rajeev Tuli Department of Ophthalmology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
  • Gaurav Sharma Department of Ophthalmology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India



VKC, Immune-compromised state, Shield ulcer, CD4 counts


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.


Metrics Loading ...


Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zeccaro O, Magrini L, et al. Vernal keratoconjunctivitis revisited: A case series of 195 patients with long term follow up. Ophthalmology. 2000;107:1157–63.

De Smedt S, Wildner G, Kestelyn P. VKC: an update. Br J Ophthalmol. 2013;97:9–14.

Kosrirukvongs P, Vichyanand P, Wongsawad W. Vernal Keratoconjunctivitis in Thailand. Asia Pac J Allergy Immunol. 2003;21:25–30.

Neumann E, Gutmann MJ, Blumen Kranz N, Michaelson IC. A review of four hundred cases of vernal conjunctivitis. Am J Ophthalmol. 1959;47:166-72.

Saleh. A. Al-Akily, Mahfouth. A. Bamashmus. Ocular complications of severe VKC in Yemen. Saudi. J Ophthalmol. 2011;25(3):291-4.

Barreto J Jr, Netto MV, Santo RM, Jose NK, Bechara SJ. Slit-Scanning topography in VKC. Am J Ophthalmol. 2007;143(2):250–4.

Wright DN. (HIV) infection. J Allergy Clin Immunol. 1990;85:445-52.

Abu El-Asrar AM, Al-Mansouri S, Tabbara KF, Missotten L, Geboes K. Immunopathogenesis of conjunctival remodeling in vernal keratoconjunctivitis. Eye. 2006;20:71.

Linhar et al. Allergy, Asthma Clin Immunol. 2014;10:35

Mossman TR, Coffman R. Two types of mouse helper T cells clone: Implications from immune regulation. Immunol Today. 1987;8:233.






Case Reports