Types of spring catarrh
1. Palpebral type:
• Large flat-topped papillae, giving a cobblestone appearance on the tarsus & absent from the fornix, affecting mainly the upper tarsus.
• Papillae: Bluish-white or red, formed of central core of fibrous tissue, rich in eosinophils & covered by thick epithelium. The centre & edges show tiny twigs of Bl. vessels.
• On lid eversion: The papillae are covered by sticky, milky white film of discharge rich in eosinophils.
2. Bulbar type: (More severe)
• Gelatinous limbal masses formed of hypertrophied
epithelium with CT core & hyaline degeneration.
• Usually starting at the upper limbus, then later all around.
• White spot secretions of eosinophils & necrotic epithelium
may be seen (Tranta spots).
3. Mixed type: Mixture of palpebral & bulbar type.
Symptoms
1. Itching & lacrimation.
2. Scanty, whitish, thready mucoid discharge.
3. Hyperemia.
4. Phtophobia & blepharospasm.
5. Seasonal variation (It Symptoms in spring & summer).
Signs
1. Types of spring catarrh:
2. Other manifestations:
• Fine punctate epithelial keratitis.
• 360 degree corneal pannus may occur.
• Rarely vernal corneal ulcers.
Differential diagnosis
1. Palpebral type should be differentiated from papillary trachoma.
2. Bulbar type should be differentiated from limbal phlycten.
Treatment
1. Mast cell stabilizers:
• Disodium chromoglycate: Preventing histamine release.
• Lodoxamide.
2. Topical steroids:
• Only in severe unresponsive cases (During acute attacks).
• Should never be used for a long period, as it causes cataract & steroid- induced glaucoma.
3. Symptomatic ttt:
• Dark glasses.
• Cold compresses.
• Vasoconstrictor & antihistaminic eye drops.
• Systemic antihistaminics may help.
• Avoid exposure to allergens if known.
4. Resistant cases: Beta irradiation to the conjunctiva, cryotherapy or
even surgery.