Clinical Case
NEW CLUE — Nº 1
A young boy is brought in with severe itching and watering of both eyes that has been recurring every spring for the past couple of years.
2The symptoms are markedly worse in warm weather and seem to improve somewhat in the winter months; the family lives in a warm, dry climate.
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3Visual acuity is mildly reduced in both eyes during flare-ups; there is significant thickening and gelatinous appearance of the tissue at the junction of the cornea and the white of the eye.
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4Eversion of the upper eyelids reveals large, flattened, cobblestone-like papillae covering the tarsal conjunctiva in both eyes.
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5Fluorescein staining reveals a well-demarcated, oval epithelial defect in the upper cornea in one eye, corresponding to an area of contact with the enlarged papillae.
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6Given the severity of the papillary reaction and the development of a corneal shield ulcer, topical corticosteroids are used for the acute flare alongside long-term mast cell stabilisers, with close monitoring given the risk to vision from the corneal involvement.
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