Vernal keratoconjunctivitis & Maxwell-Lyons Sign

Vernal Keratoconjunctivitis (VKC) is a chronic and debilitating external ocular disease. In general, children are involved in a large percentage of the cases. The peak age of onset is 8 to 12 years, although 10% of VKC patients are older than 20 at age of onset.
Symptoms exacerbate in the summer and spring, possibly due to the increase in the pollen count.

Patients with VKC may be divided into two groups based on clinical presentation: palpebral vernal and limbal vernal

Palpebral vernal involves the upper tarsal conjunctiva and is characterized by cobblestone papillae (i.e., papillae that have enlarged, often having flattened tops. Papillae can be distinguished from follicles by their red centers; these centers consist of the dilated blood vessel at the core of the papilla surrounded by inflammatory cells. A sequela that may occur in VKC is conjunctival scarring that has a lacy appearance at the base of the old papillae. Although rare, there may be lacy scarring that extends superiorly into the fornix. On rare occasions there may be conjunctival cysts and enough scarring to cause symblepharon formation. Fibrin that is enhanced by heat may accumulate on the giant papillae and is known as the Maxwell-Lyons sign.

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