Definition: Chronic allergic condition of the conjunctiva, affecting mainly children & young adults. Characterized by seasonal variation & may be associated with keratoconus. It is caused by hypersensitivity to airborne allergens. It is common in patients with asthma, hay fever or atopy.
Types of spring catarrh
1. Palpebral type:
• Large flat-topped papillae, giving a cobblestone appearance on the tarsus & absent from the fornix, affecting mainly the upper tarsus.
• Papillae: Bluish-white or red, formed of central core of fibrous tissue, rich in eosinophils & covered by thick epithelium. The centre & edges show tiny twigs of Bl. vessels.
• On lid eversion: The papillae are covered by sticky, milky white film of discharge rich in eosinophils.
2. Bulbar type: (More severe)
• Gelatinous limbal masses formed of hypertrophied
epithelium with CT core & hyaline degeneration.
• Usually starting at the upper limbus, then later all around.
• White spot secretions of eosinophils & necrotic epithelium
may be seen (Tranta spots).
3. Mixed type: Mixture of palpebral & bulbar type.
Symptoms
1. Itching & lacrimation.
2. Scanty, whitish, thready mucoid discharge.
3. Hyperemia.
4. Phtophobia & blepharospasm.
5. Seasonal variation (It Symptoms in spring & summer).
Signs
1. Types of spring catarrh:
2. Other manifestations:
• Fine punctate epithelial keratitis.
• 360 degree corneal pannus may occur.
• Rarely vernal corneal ulcers.
Differential diagnosis
1. Palpebral type should be differentiated from papillary trachoma.
2. Bulbar type should be differentiated from limbal phlycten.
Treatment
1. Mast cell stabilizers:
• Disodium chromoglycate: Preventing histamine release.
• Lodoxamide.
2. Topical steroids:
• Only in severe unresponsive cases (During acute attacks).
• Should never be used for a long period, as it causes cataract & steroid- induced glaucoma.
3. Symptomatic ttt:
• Dark glasses.
• Cold compresses.
• Vasoconstrictor & antihistaminic eye drops.
• Systemic antihistaminics may help.
• Avoid exposure to allergens if known.
4. Resistant cases: Beta irradiation to the conjunctiva, cryotherapy or
even surgery.