Background: The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC).
Methods: A total of 58 consecutive patients (52 boys and 6 girls aged 8 to 17 [mean 12.2] years) with severe active VKC were examined at two tertiary care facilities in Riyadh, Saudi Arabia, between 1995 and 1997. Patients were deemed to have severe VKC if they had had symptoms for at least 2 years, had diffuse palpebral conjunctival edema and thickening with papillary hypertrophy (P3) and giant papillary conjunctivitis, and had limbal infiltration of 180 degrees or more. Visual acuity was measured with the standard Snellen visual acuity chart. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Visual loss was defined as either blindness or visual impairment.
Results: Twelve patients (21%) had a best corrected visual acuity in one or both eyes of 20/200 or less, 20 (34%) had 20/50 to 20/200 vision, and 26 (45%) had 20/20 to 20/50 vision. The ocular complications that led to visual loss among 32 patients included steroid-induced cataract (8 patients), steroid-induced glaucoma (4), central corneal scars (7), irregular astigmatism (4), keratoconus (3) and limbal tissue hyperplasia (3). Of the 32 patients 12 had dry eye syndrome, which may have contributed to the visual loss.
Interpretation: Severe VKC in developing countries is a potentially blinding disease. Visual loss may be due to corneal complications, including corneal scars, astigmatism and keratoconus, as well as complications of the unsupervised use of topically administered corticosteroids.