Shield Ulcer in VKC
Severe forms of Vernal Keratoconjunctivitis can present with corneal manifestations which start as punctate epithelial erosions which can coalesce into macro-erosions of the epithelium.
Plaques containing fibrin and mucous can accumulate into macro-erosions forming Shield ulcers.
Characteristically present in the superior cornea (suggestive of a mechanical cause due to the large papillae) and can be sight threatening.
PATHOGENESIS:
Mechanical irritation to the corneal epithelium by giant papillae and toxic epitheliopathy from inflammatory mediators secreted by the eosinophils and mast cells.
ETIOLOGY:
Age predominantly affected: 5-20 years.
Young males twice commonly affected.
Inflammation more in the hot, dry climate.
SYMPTOMS:
Intense itching.
Sensitivity to light.
Ropy discharge from the eyes.
MANAGEMENT OF SHIELD ULCER:
Simple scraping of base and margins of the ulcer with removal of the inflammatory plaque like material will promote re-epithelialisation.
Topical steroid 4-6 times a day.
Topical antibiotics and cycloplegics.
Cool compress.
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Image from Rajan Eye Care Hospital
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