Management of refractory vernal keratoconjunctivitis with supra tarsal triamcinolone injection: our results

ABSTRACT

Vernal keratoconjunctivitis [VKC] cases are sometimes resistant to conventional treatments. We aimed to assess the efficacy, safety and longevity of the effect of supratarsal injection of intermediate acting steroid triamcinolone acetonide in the management of recalcitrant vernal keratoconjunctivitis. A prospective study comprising of Forty five patients [90 eyes] with severe VKC, and resistant to conventional method of treatments were selected and underwent injection of 0.6 ml triamcinolone acetonide in supratarsal area [in conjunctival side of upper lid] and were followed up for 12 months. Dramatic relief of symptoms [burning, itching, lacrimation and photophobia, tenacious discharge] was seen in all patients, in first few days after the supratarsal injection. Size of the cobble stone papillary hypertrophy in tarsal conjunctiva, gelatinous thickening of conjunctiva at limbus decreased significantly in the first month, but never disappeared completely. The mean period of recurrence of symptoms was 156.6 days [range 13-359 days]. No complication was noticed during the follow up period. All patients tolerated the treatment well. Supra tarsal injection of triamcinolone acetonide is a cheap, effective and safe modality for temporary suppression of clinical signs and symptoms of eyes with recalcitrant vernal keratoconjunctivitis. Rapid and dramatic symptomatic and clinical response and lack of complications suggest that supratarsal injection of triamcinolone acetonide could be a therapeutic approach for refractory vernal keratoconjunctivitis