Vernal keratoconjunctivitis (VKC) is an autoimmune allergic eye condition requiring long-term steroid treatment for symptom control. Although steroids work, unmonitored or prolonged use risks complications such as steroid-induced ocular hypertension (SIOHT) and steroid-induced glaucoma (SIG) leading to irreversible blindness.
Risk factors and clinical distinctions between patient groups must be understood for early detection, proper management, and prevention of blindness. The present multicentric research investigated steroid-related and non-steroid-related factors of glaucoma in patients with VKC, as well as urban–rural differences in presentation and outcomes.
This was a retrospective review of the charts over four centers from April 2019 to March 2020. There were 2,360 patients with VKC included, and their records were reviewed for the use of steroids, clinical features, family history, allergy, refractive errors, and treatment outcomes. Patients were also stratified between urban and rural locations to analyze demographic parameters.
Results
Among 2,360 VKC patients, SIOHT and/or SIG developed at 4.7%. Within them, the incidence of SIG was 53.5% and that of SIOHT was 46.5%, presenting at mean ages of 17.1 ± 5.9 years and 16.4 ± 6.0 years, respectively.
Topical dexamethasone was used most commonly (50%) among them.
Urban regions had greater prevalence of limbal VKC (23%) compared to rural regions (7.9%) (p = 0.01).
29 rural and 11 city patients were found to have a history of allergy, though the difference was not statistically significant (p = 0.1).
Steroid use patterns also differed, with more intense usage among urban populations.
Steroid withdrawal was adequate in 10.3% of the affected eyes,
62.9% needed anti-glaucoma drugs, and
24.9% needed surgery.
Refractive errors also presented, with myopia in 26.5% of SIG/SIOHT eyes and hyperopia in 2.8%.
This multicentric research demonstrates that glaucoma is a significant vision-threatening complication in VKC, and 25% of involved patients need surgery. Urban patients, especially with limbal VKC, seem to be more susceptible, perhaps as a result of environmental exposures. These observations necessitate greater precautions in VKC management, more strict monitoring of steroid treatment, and specialized strategies in urban vs rural populations.
Reference:
Dubey S, Shakya R, Pegu J, et al. (August 13, 2025) Risk Factors Associated With Steroid-Induced Ocular Hypertension and Glaucoma in Patients With Vernal Keratoconjunctivitis in a North Indian Population: A Multicenter Study. Cureus 17(8): e89972. doi:10.7759/cureus.89972
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