Dr.Shridhar Kulkarni, K21451
A 23 year old male; known case of VKC since 10 years; presented with OU blurring of vision associated with photophobia, itching and redness. BCVA was OD 6/12 (N12) and OS 6/9 (N8). Slit lamp examination showed OU giant papillae in tarsal conjunctivae, hazy cornea with bilateral shield ulcer; grade 2 in OD and grade 3 in OS. Debridement done followed by vigamox, FML, sodium chromoglycate and carboxymethyl cellulose eye drops. Patient improved and ulcer healed with superficial scar in OS but ulcer persisted in OD. After 2 failed topical steroid pulse therapy; supra-tarsal Triamcinolone steroid injection (0.5ml of 10 mg/ml) were given after physician clearance. On 2 week follow-up; patient improved significantly with VA 6/6 with pin-hole (N6) in OU. IOP was normal. Bilateral shield corneal ulcer is uncommon and may be refractory to topical steroid therapy. Supra-tarsal injections of Triamcinolone produced dramatic response. Close monitoring of IOP is necessary.
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