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A Teenager with Vernal Keratoconjunctivitis and Pellucid Marginal Degeneration, Presenting with Exotropia

International medical case reports journal, 2020-09, Vol.13, p.399 [Peer Reviewed Journal]

COPYRIGHT 2020 Dove Medical Press Limited ;ISSN: 1179-142X ;EISSN: 1179-142X ;DOI: 10.2l47/IMCRJ.S262999

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  • Title:
    A Teenager with Vernal Keratoconjunctivitis and Pellucid Marginal Degeneration, Presenting with Exotropia
  • Author: Bajracharya, Leena ; Agrawal, Nisha ; Dhungel, Shashwat ; Parajuli, Rojeeta ; Adhikari, Srijana
  • Subjects: Physiological aspects ; Strabismus ; Youth
  • Is Part Of: International medical case reports journal, 2020-09, Vol.13, p.399
  • Description: Background: Vernal keratoconjunctivitis (VKC), an allergic disease, has a known association with ectatic disorders of the cornea. Pellucid marginal degeneration (PMD) is a bilateral, asymmetrical, ectatic disorder of the cornea characterized by inferior corneal thinning. We report a case of sensory exotropia due to PMD in association with VKC. Case Details: A 19-year old boy with a history of VKC presented with exotropia of the right eye of 3 years' duration. His unaided vision in his right eye was 1/60 and in his left eye it was 6/36. On examination, both eyes had high against the rule astigmatism, which was more in the right eye. There was exotropia of 15[degrees] (40 prism diopter base in) in the right eye with suppression (Worth four dot test). Corneal examination in both eyes showed inferior band thinning, 2 mm above the inferior limbus, extending from 4 to 8 clock hours, with bulging of the cornea just above the thinning. The clinical features were suggestive of PMD, which was supported by his corneal scans - Atlas, Pentacam, and Optovue. Although he was undergoing treatment for VKC, the onset of PMD and decrease in vision went unnoticed. The asymmetric error which was not corrected during the sensitive period of visual development led to sensory exotropia. Conclusion: A child with VKC should undergo regular refraction so as not to miss any ectatic changes occurring in the cornea. A delay in diagnosing corneal ectasia may negate the possibility of collagen cross-linking which prevents progression of ectasia. If visual rehabilitation is delayed beyond the age of visual maturation, it can lead to strabismus, suppression, and loss of binocular function. Keywords: vernal keratoconjunctivitis, pellucid marginal degeneration, exotropia, suppression
  • Publisher: Dove Medical Press Limited
  • Language: English
  • Identifier: ISSN: 1179-142X
    EISSN: 1179-142X
    DOI: 10.2l47/IMCRJ.S262999
  • Source: Open Access: DOAJ Directory of Open Access Journals
    Open Access: PubMed Central
    Geneva Foundation Free Medical Journals at publisher websites
    AUTh Library subscriptions: ProQuest Central
    ROAD: Directory of Open Access Scholarly Resources
    Dove Press Free
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