Vernal keratoconjunctivitis and immune-mediated diseases: one unique way to symptom control?

We report the case of a 15-year old boy affected by Vernal keratoconjunctivitis (VKC), asthma and atopic dermatitis (AD) treated with omalizumab with the control not only of respiratory and cutaneous symptoms but also of ocular manifestation. A 15-year old adolescent suffering from persistent allergic asthma with a seven years history of severe ocular itching, discharge, irritation and mild photophobia increasing during the summer, not responding to topical antihistamines, came to our attention at the Pediatric Department of the “Policlinico Umberto I” hospital in Rome. A severe atopic dermatitis since the second month of age, firstly presenting as a diaper dermatitis, then involving the folds of the limbs, and finally the face and the neck, especially the perioral and the periocular areas, was also referred. On ophtalmological evaluation he showed intense conjunctival hyperemia and the upper palpebral conjunctiva presented giant palpillae in both eyes (Fig. 2a). A corneal center ulcer involving the left eye with intense pain, photophobia, and scarce visual acuity was found. In fact, best corrected visual acuity (BCVA) was 20/40 in left eye and 20/20 in right eye with Snellen chart. The adolescent underwent a topic therapy with vancomycin, fusidic acid and atropine 1% for 2 months followed by the topical administration of artificial tears with 1% cyclosporine We report the case of a young male affected by VKC associated with severe atopic dermatitis and uncontrolled asthma, two immunological diseases mediated by Immunoglobulin E. 1 VKC is a rare and chronic relapsing condition involving conjunctiva and/or corneal tissue, occurring mainly in children and adolescents, in dry and hot climates which can lead to visual loss.