Association of Dry Eye with Vernal Keratoconjunctivitis: A Hospital-based Cross-sectional Study

Abstract

Introduction: Vernal Keratoconjunctivitis (VKC) is a common allergic disease seen in children. The allergic component is caused by Immunoglobulin E (IgE) and mast cell-mediated pathway. It is proposed to be a combination of immune system, genetic, and environmental factors. Secondary dry eye develops secondary to inflammatory disease namely vascular, allergic, environmental conditions like allergens, cigarette smoke, hormonal changes, systemic disorders, such as diabetes mellitus, eye surgeries such as refractive surgery and systemic medications, such as diuretics and antihistamines. Co-existence of dry eye and VKC can worsen the symptoms of the patient and may also lead to prolonged and unnecessary treatment of the disease. Aim: To study the association of dry eye with VKC by Schirmer’s test and Tear Film Breakup Time (TBUT). Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Opthalmology, Sri Siddhartha Medical College and Research Centre, Tumkur, Karnataka, India, from December 2020 to June 2022. Thirtythree patients of age group between 5-20 years with symptoms of VKC were evaluated for dry eye using Schirmer’s test and TBUT, respectively. Each patient was subjected to detailed history taking, followed by ocular examination as per the predesigned proforma. The patients were subjected to the tear film analysis using Schirmer’s test and TBUT. A total of 33 patients were evaluated and the data was compiled. The association between categorical variables were analysed by using Chi-square test. The data was analysed by using Statistical Package fot the Social Sciences (SPSS) software version 21.0. The parameters compared were the type of dry eye with the type of VKC. Results: The mean±Standard Deviation (SD) age of the study group was found to be 11±1.5 years. Out of 33 patients, 69.69% of all the cases were seen in the 5-12 years age group. There was male preponderance in the present study with 63.63% of patients being male child. VKC was most commonly seen as mixed accounting for 57.57% of cases. In the current study, it was discovered that 60.6% of cases showed no sign of dry eye, whereas 39.82% of cases had dry eye. The dry eye was more commonly seen in mixed type of VKC. The p-value was statistically significant (p-value<0.001) for association of dry eye with mixed type of VKC. Conclusion: The present study highlighted the co-existence of dry eye with VKC. There was a significant association of dry eye with VKC and type of VKC as well, which might have long-term effects on the ocular surface. These ocular surface alterations exist during active and the quiet phase of VKC. The patients of VKC may need a long-term follow-up and treatment for this ocular surface alteration.