Vernal Keratoconjunctivitis with Atypical Localization of Shield Ulcer

Aims: To present an atypical case of vernal keratoconjunctivitis associated with unusual inferior location of shield ulcer.

Presentation of Case: We are presenting an unusual case of vernal disease in a 7-year-old male associated with 2 corneal ulcers in the same eye, one of which was located inferiorly. The patient was prescribed topical steroids, antihistamine and lubricating eye drops. Three weeks later the symptoms got resolved and ulcers were healed, leaving mild subepithelial fibrosis. The patient was advised to continue antihistamine eye drops for the whole year with prophylactic dosage regimen.

Discussion: Vernal keratoconjunctivitis is a bilateral, seasonally recurring inflammation of conjunctiva and cornea. It affects mostly children with male preponderance. In several cases vernal disease can be complicated with development of a shield ulcer, which usually has superior location under upper eyelid. Despite the fact that literature review has revealed two atypical cases with inferior localization reported in India, it is a very rare finding. Our case also was unusual with two shield ulcers, one of which was located inferiorly.

Conclusion: This case demonstrates a very rare presentation of an atypical inferiorly located shield ulcer. Literature review revealed only two similar cases in India. Our case demonstrates the usage of topical steroids to be successful and advisable in the treatment of shield ulcer, as it controls the inflammation. Topical antihistamine medications should be added and given for a long period for preventing possible recurrences.