SHIELD ULCERS AND PLAQUES OF THE CORNEA IN VERNAL KERATOCONJUNCTIVITIS

Background: Shield-shaped corneal ulcers and plaques are serious sight-threatening corneal manifestations of vernal keratoconjunctivitis. There are few reports describing the management of these patients and their outcomes. Methods: The clinical presentation, treatment, and outcome of 66 shield ulcers and/or plaques in 55 eyes of 41 patients with vernal keratoconjunctivitis were studied in this retrospective study of patients treated at King Khaled Eye Specialist Hospital during an 11-year period. Results: Patients with shield ulcers where the base of the ulcer was transparent usually had rapid re-epithelialization and an excellent visual outcome with medical treatment alone. Patients with shield ulcers and visible plaque formation had delayed reepithelialization when receiving only medical treatment. Complications of delayed reepithelialization consisted of bacterial keratitis in five eyes, amblyopia in one eye, and strabismus in one patient. Conclusions: Patients with shield ulcers and/or plaques that do not re-epithelialize once active vernal keratoconjunctivitis has been controlled should have surgical intervention. In this series, a simple scraping of the base and margins of the ulcer with removal of the inflammatory material (i,e., the plaque) resulted in rapid re-epithelialization in 20 of 23 ulcers and plaques. An algorithm for treating shield ulcers and/or plaques is presented based on the experience at this institution.