Delhi Journal of Ophthalmology

Recalcitrant bilateral shield ulcer in vernal keratoconjunctivitis

Siddharth Madan, Sarita Beri, Prachi Virmani, Sarah Khan
Department of Ophthalmology, Lady Hardinge Medical college and Associated Hospitals, University of Delhi, New Delhi, India

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.


Corresponding Author:

Siddharth Madan  
M.S, D.N.B, F.I.C.O Assistant Professor,
Department of Ophthalmology, Lady Hardinge Medical college and Associated Hospitals, University of Delhi, New Delhi
Email: drsiddharthmadan@gmail.com


Received: 02-JUL-2020 Accepted: 24-JUL-2020 Published Online: 12-MAR-2021
DOI: https://dx.doi.org/10.7869/djo.633

Abstract
Allergic conjunctivitis is frequently encountered in general practice and in the specialist pediatric clinics. Though these cases are well managed in specialty allergy clinics yet a rare and severe manifestation in the form of bilateral shield ulcer can be potentially blinding and comes with management challenges. The pathobiology is driven by multiple inflammatory mediators which contribute to the recalcitrant nature of these noninfectious indolent ulcers. A seven-year-old boy presented with a recent onset photophobia with other characteristic ocular manifestations of vernal keratoconjunctivitis. Grade three shield ulcer in both the eyes was managed with both medical and surgical arms. Medical immunomodulation was achieved with topical steroids, topical immunomodulators along-with copious lubrication of the ulcer. Surgical intervention included a permanent tarsorraphy in the left eye and debridement of the plaques over the ulcer base in both the eyes. Aggressive follow-up and step wise management approach resulted in promising results without any recurrence.

Keywords :Acute angle closure, Salbutamol, Ipratropium, Glaucoma