WordNet

of or characteristic of or occurring in spring; "the vernal equinox"
inflammation of the conjunctiva of the eye (同)pinkeye

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春の,春に起こる / 青春の,生き生きとした

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/04 03:54:05」(JST)

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Vernal keratoconjunctivitis (VKC) or Spring catarrh is a recurrent, bilateral, and self-limiting inflammation of conjunctiva, having a periodic seasonal incidence.

Etiology

VKC is thought to be an allergic disorder in which IgE mediated mechanism play a role. Such patients often give family history of other atopic diseases such as hay fever, asthma or eczema, and their peripheral blood shows eosinophilia and increased serum IgE levels.

Predisposing factors

Age and sex – 4–20 years; more common in boys than girls.
Season – More common in summer. Hence, the name Spring catarrh is a misnomer. Recently it is being labelled as Warm weather conjunctivitis.
Climate – More prevalent in the tropics. VKC cases are mostly seen in hot months of summer, therefore, more suitable term for this condition is "summer catarrh" Ref.^[1]

Pathology

Conjunctival epithelium undergoes hyperplasia and sends downward projection into sub-epithelial tissue.
Adenoid layer shows marked cellular infiltration by eosinophils, lymphocytes, plasma cells and histiocytes.
Fibrous layer show proliferation which later undergoes hyaline changes.
Conjunctival vessels also show proliferation, increased permeability and vasodilation.

Clinical picture

Symptoms- VKC is characterised by marked burning and itchy sensations which may be intolerable and accentuates when patient comes in a warm humid atmosphere. Associated symptoms include mild photophobia, lacrimation, stringy discharge and heaviness of eyelids.^{[citation needed]}

Signs of VKC can be described in three clinical forms.

Palpebral form- Usually upper tarsal conjunctiva of both the eyes is involved. Typical lesion is characterized by the presence of hard, flat-topped papillae arranged in cobblestone or pavement stone fashion. In severe cases papillae undergo hypertrophy to produce cauliflower-like excrescences of 'giant papillae'.
Bulbar form- It is characterised by dusky red triangular congestion of bulbar conjunctiva in palpebral area, gelatinous thickened accumulation of tissue around limbus and presence of discrete whitish raised dots along the limbus (Tranta's spots).
Mixed form- Shows the features of both palpebral and bulbar types.

Vernal keratopathy

Corneal involvement in VKC may be primary or secondary due to extension of limbal lesions. Vernal keratopathy includes 5 types of lesions.^{[citation needed]}

Punctuate epithelial keratitis.
Ulcerative vernal keratitis.
Vernal corneal plaques.
Subepithelial scarring.
Pseudogerontoxon.

Treatment

Local therapy- Topical steroids are effective. Commonly used solutions are of fluorometholone, medrysone, betamethasone or dexamethasone. Mast cell stabilizers such as sodium cromoglycate (2%) drops 4–5 times a day are quite effective in controlling VKC, especially atopic ones. Azelastine eyedrops are also effective. Topical antihistamines can be used. Acetyl cysteine (.0.5%) used topically has mucolytic properties and is useful in the treatment of early plaque formation. Topical Cyclosporine is reserved for unresponsive cases.^{[citation needed]}
Systemic therapy- Oral antihistamines and oral steroids for severe cases.
Treatment of large papillae- Cryo application, surgical excision or supratarsal application of long-acting steroids.
General measures include use of dark goggles to prevent photophobia, cold compresses and ice pack for soothing effects, change of place from hot to cold areas.
Desensitization has also been tried without much rewarding results.
Treatment of vernal keratopathy- Punctuate epithelial keratitis require no extra treatment except that instillation of steroids should be increased. Large vernal plaque requires surgical excision. Ulcerative vernal keratitis require surgical treatment in the form of debridement, superficial keratectomy, excimer laser therapeutic keratectomy, as well as amniotic membrane transplantation to enhance re-epithelialisation.
PROSE (prosthetic replacement of the ocular surface ecosystem) treatment, an iterative medical process that uses custom designed and fabricated prosthetic devices, maintains ocular surface health and improves vision in individuals with VKC.^[2]

References

^ Shah, Syed Imtiaz Ali (2014). Concise Ophthalmology (4th ed.). Paramount. p. 31. ISBN 978-969-637-001-7.
^ Rathi VM, Sudharman Mandathara P, Vaddavalli PK, Dumpati S, Chakrabarti T, Sangwan VS (May 2012). "Fluid-filled scleral contact lenses in vernal keratoconjunctivitis". Eye & Contact Lens 38 (3): 203–6. doi:10.1097/ICL.0b013e3182482eb5. PMID 22367220.

UpToDate Contents

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1. 春季カタル vernal keratoconjunctivitis
2. アレルギー性結膜炎：臨床症状および診断 allergic conjunctivitis clinical manifestations and diagnosis
3. アトピー性角結膜炎 atopic keratoconjunctivitis
4. 巨大乳頭結膜炎 giant papillary conjunctivitis
5. 中毒性結膜炎 toxic conjunctivitis

English Journal

Relation Between Total Tear IgE and Severity of Acute Seasonal Allergic Conjunctivitis.

Mimura T, Usui T, Yamagami S, Miyai T, Amano S.SourceDepartment of Ophthalmology, University of Tokyo Graduate School of Medicine , Tokyo , Japan.
Current eye research.Curr Eye Res.2012 Oct;37(10):864-70. Epub 2012 May 17.
Purpose: Measurement of total tear immunoglobulin E (IgE) is useful for the diagnosis of allergic conjunctivitis, but it is still unknown whether measurement of total tear IgE is useful for assessment of the severity of allergic conjunctivitis. We evaluated the relation between the total IgE level i
PMID 22595024

Japanese Journal

アレルギー性結膜疾患における涙液中IgE抗体の病因・診断・治療的意義 (特集アレルギー疾患におけるIgEの病因病態的意義の新たな検討)

臨床免疫・アレルギー科 63(1), 52-54, 2015-01
NAID 40020330384

カラー臨床報告シクロスポリン全身治療が奏効した春季カタルの1例

臨床眼科 68(10), 1491-1495, 2014-10
NAID 40020219840

アレルギー性結膜疾患診療ガイドライン(第二版) : 点眼治療のポイント(ガイドラインのワンポイント解説)

アレルギー 63(8), 1103-1109, 2014-09-01
NAID 110009841106

Related Pictures

★リンクテーブル★

リンク元	「結膜炎」「春季カタル」「atopic conjunctivitis」「giant papillary conjunctivitis」

「結膜炎」

　　[★]

英: conjunctivitis
関: 結膜

see. マイナーエマージェンシー第1版 p.65 SOP.174

概念

結膜に起こる炎症疾患の総称。

病原体と特徴

ウイルス性結膜炎

病原体：アデノウイルス、エンテロウイルス、単純ヘルペスウイルス、インフルエンザウイルス、水痘・帯状疱疹ウイルス、風疹ウイルス、麻疹ウイルス、EBウイルス。
治療法：対症療法。単純ヘルペスに対してはアシクロビル眼軟膏。
症状：透明な滲出液、耳介前リンパ節腫脹、結膜濾胞

細菌性結膜炎

症状：黄白色の眼脂、軽度疼痛

結膜炎をきたす疾患

SOP.175

	疾患名			病原体	潜伏期	病型	症状、経過
感染性結膜炎	流行性角結膜炎	epidemic keratoconjunctivitis	はやりめ	アデノウイルス8,19,37型(ときに4型)	7-14日	急性濾胞性結膜炎	眼脂、流涙、羞明。眼瞼腫瘤、結膜充血、浮腫、結膜の小出血斑。耳前リンパ節の腫脹と圧痛。2-4週間で消退。発症後10日後に角膜に点状上皮化混濁。
	咽頭結膜熱	pharyngoconjunctival fever	プール熱	アデノウイルス3型(ときに4,7型)	5-6日	急性結膜炎	急性結膜炎、咽頭炎、発熱。点状上皮化混濁は少ない。
	急性出血性結膜炎	acute hemorrhagic conjunctivitis		エンテロウイルス70型	1日	球結膜下出血。眼球は浮腫状、結膜充血、濾胞形成は軽度。耳前リンパ節腫脹軽度。発症より3-4日にびまん性の多発性びらん。眼痛、異物感、羞明。約1週間で治癒。罹患後2,3週間後に四肢の弛緩性の運動麻痺や脳神経麻痺があり得る。
	トラコーマ	trachoma
	封入体結膜炎	inclusion conjunctivitis
	新生児封入体結膜炎	neonatal inclusion conjunctivitis
	細菌性結膜炎	bacterial conjunctivitis
	淋菌性結膜炎	gonococcal conjunctivitis
	新生児膿漏眼	blennorrhea of the newborn
アレルギー性結膜疾患	アレルギー性結膜炎	allergic conjunctivitis
アレルギー性結膜疾患	春季カタル	vernal conjunctivitis
その他の結膜炎	フリクテン性結膜炎	phlyctenular conjunctivitis	束状結膜炎
	慢性濾胞性結膜炎	chronic follicular conjunctivitis
	Stevens-Johnson症候群	Stevens-Johnson syndrome
	眼類天疱瘡	ocular pemphigoid
	結膜弛緩症	conjunctivochalasis