Recalcitrant bilateral shield ulcer in vernal keratoconjunctivitis

Recalcitrant bilateral shield ulcer in vernal keratoconjunctivitis

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Allergic conjunctivitis is frequently encountered in general practice and in the specialist pediatric clinics.Though these cases are well managed in specialty allergy clinics yet a rare and severe manifestation in the form of bilateral shield ulcer can be potentially blinding Apparel Fabric by the Yard and comes with management challenges.The pathobiology is driven by multiple inflammatory mediators which contribute to the recalcitrant nature of these noninfectious indolent ulcers.A seven-year-old boy presented with a recent onset photophobia with other characteristic ocular manifestations of vernal keratoconjunctivitis.Grade three shield ulcer in both the eyes was managed with both medical and surgical arms.

Medical immunomodulation was achieved with topical Me Fall Top steroids, topical immunomodulators along-with copious lubrication of the ulcer.Surgical intervention included a permanent tarsorraphy in the left eye and debridement of the plaques over the ulcer base in both the eyes.Aggressive follow-up and step wise management approach resulted in promising results without any recurrence.