Comparative study of limbal and palpebral vernal keratoconjunctivitis: clinical features, treatment response and outcome
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent inflammatory disorder of the ocular surface that predominantly affects children and adolescents. It is characterized by intense itching, photophobia, mucous discharge, conjunctival hyperemia, papillary hypertrophy and, in more severe cases, corneal involvement. Clinically, VKC is commonly categorized into palpebral, limbal and mixed forms according to the predominant site of inflammation. The limbal and palpebral phenotypes may differ in their demographic characteristics, severity of symptoms, corneal involvement and response to treatment. Recognition of these differences may assist clinicians in selecting appropriate therapy and predicting outcome. Objective: To compare the clinical features, severity, treatment response, complications and short-term outcomes of patients with limbal and palpebral forms of vernal keratoconjunctivitis attending a tertiary-level ophthalmology service. Methods: This prospective comparative observational study was conducted in the Department of Ophthalmology, Sher-e-Bangla Medical College Hospital, Barishal, Bangladesh from January 2026 to June 2026. A total of 100 patients diagnosed with VKC were included, comprising 50 patients with limbal VKC and 50 with palpebral VKC. Patients with mixed VKC were excluded from the comparative analysis. Baseline demographic characteristics, symptom profile, slit-lamp findings, visual acuity, corneal involvement, disease severity, associated atopy, treatment received, adverse effects and treatment response were recorded. Patients were followed for 12 weeks. Treatment response was assessed using clinical improvement in symptoms and signs, reduction in corneal involvement and need for rescue corticosteroid therapy. Statistical analysis was performed using SPSS. Categorical variables were analyzed using Chi-square or Fisher's exact test, while continuous variables were analyzed using independent-samples t-test or Mann–Whitney U test where appropriate. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 10.1 ± 3.1 years. The mean age was higher among patients with limbal VKC than those with palpebral VKC (10.8 ± 3.2 vs. 9.4 ± 2.9 years, p=0.024). Males predominated in both groups. Intense itching was reported by 96% of limbal and 98% of palpebral cases. Photophobia was significantly more frequent in the limbal group (86% vs. 68%, p=0.035), whereas giant upper tarsal papillae were present in 100% of palpebral cases compared with 18% of limbal cases (p<0.001). Horner–Trantas dots were observed in 88% of limbal cases and 12% of palpebral cases (p<0.001). Corneal involvement was more common in palpebral VKC (44%) than limbal VKC (26%), although the difference was not statistically significant (p=0.059). After 12 weeks of treatment, marked or complete clinical response was observed in 84% of limbal patients and 72% of palpebral patients. Recurrence during follow-up was less frequent in limbal VKC than in palpebral VKC (16% vs. 28%). Conclusion: Limbal and palpebral VKC demonstrated distinct clinical patterns. Limbal VKC was characterized by greater photophobia and a high frequency of Horner–Trantas dots, while palpebral VKC showed more pronounced giant tarsal papillary hypertrophy and a tendency toward greater corneal involvement. Both phenotypes responded to appropriate topical therapy, although palpebral disease required more intensive and prolonged treatment in a proportion of patients. Phenotype-based recognition and regular follow-up may help minimize corneal complications and improve clinical outcomes.
Institution: Mugda Medical College
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7204642929