Corneal disease is the primary cause of visual loss in allergic eye disease. It occurs almost exclusively in vernal keratoconjunctivitis and atopic keratoconjunctivitis. It is characterized by punctate and then confluent corneal ulceration, plaque formation, increased risk of corneal infection and abnormalities of corneal shape. It is related to the degree of conjunctival inflammation and largely controlled by inflammatory mediators in the tear film. Other contributing causes are changes in corneal sensation, tear film, and the immune response of resident corneal cells. Corneal disease in vernal keratoconjunctivitis and atopic keratoconjunctivitis currently requires aggressive treatment with topical steroids. In the future, better identification of the undesirable immune response in individual patients will allow targeting of anti-inflammatory treatment with fewer side effects.
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