Vernal conjunctivitis is an allergic disease with a strong seasonal pattern, often affecting both eyes. It typically occurs when spring arrives and flowers bloom, with symptoms disappearing by late autumn when the weather turns cold. The condition recurs annually, with mild cases resolving after 3–4 years and severe cases persisting for over a decade. Its hallmark features include intense itching in both eyes, large flat papillae on the palpebral conjunctiva, gelatinous hyperplasia of the conjunctiva near the limbus, and secretions containing numerous eosinophils.

bubble_chart Etiology

The pathogenic cause may be an allergic reaction to airborne Mongolian snakegourd root or other substances. This disease is more common in children and young adults, with a higher incidence in males, and is non-pestilential.

bubble_chart Clinical Manifestations

The most prominent symptom of this disease is unbearable itching in both eyes, accompanied by a burning sensation that worsens in hot weather or after rubbing the eyes. It also includes grade I photophobia, tearing, and a small amount of discharge, which is characteristically sticky and stringy.

Vernal conjunctivitis is clinically classified into three types based on the affected area: palpebral conjunctival type, limbal type, and mixed type.

1. Palpebral conjunctival type: The lesions are confined to the palpebral conjunctiva and do not involve the fornix. The lower palpebral conjunctiva is usually unaffected or shows only grade I lesions. Initially, the palpebral conjunctiva exhibits severe congestion, followed by the development of numerous hard, flat papillae of varying sizes on the upper palpebral conjunctiva, resembling cobblestones (Figure 1). The fissures between the papillae appear light blue, and the surface of the papillae shows a milky opacity. The discharge is minimal, very sticky, and can be drawn into strings. A smear examination reveals an increase in eosinophils. If the lower palpebral conjunctiva is affected, the papillae are smaller and fewer, less prominent than those on the upper palpebral conjunctiva.

Figure 1: Vernal conjunctivitis (palpebral conjunctival type)

2. Limbal type: At the limbus corresponding to the palpebral fissure or the upper limbus, one or more yellowish-gray gelatinous elevated nodules can be seen, with congestion in the adjacent bulbar conjunctiva. These gelatinous masses may connect with each other, sometimes forming a complete ring around the limbus like a堤 (embankment). The bulbar conjunctiva often appears dirty brown. Both the palpebral conjunctival and limbal types commonly exhibit fine vascular nebula and superficial epithelial keratitis.

bubble_chart Treatment Measures

During the treatment season, wearing tinted protective glasses and avoiding exposure to Mongolian snakegourd root, strong sunlight, and dust is recommended. Topical application of 0.15% cortisone eye drops can rapidly alleviate symptoms, though it does not provide a permanent cure. Long-term use should be monitored for side effects. Solutions such as 2–4% sodium cromoglicate, 1:5000 adrenaline, 1% ephedrine, or 0.25% dilute acetic acid can help reduce symptoms. Beta-ray irradiation has shown positive results in some cases.