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Shield Ulcer.


-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.


www.ophthalmobytes.com⁣

Image from Rajan Eye Care Hospital⁣

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