Efficacy of Epinastine Eyelid Cream in Pediatric Vernal Keratoconjunctivitis: A Case Report

Abstract

Allergic conjunctivitis (AC) is characterized by inflammatory responses in the conjunctiva and is often complicated by atopic dermatitis and mechanical irritation. Vernal keratoconjunctivitis (VKC), a severe subtype of AC, presents unique challenges in its diagnosis and management, particularly in pediatric patients. This case report describes an eight-year-old girl with VKC who exhibited poor adherence to a prescribed regimen of 0.05% epinastine ophthalmic solution and corticosteroid eye drops, resulting in persistent symptoms. Despite initial treatment, the patient's condition included giant papillae and thickened tarsal conjunctivae that were resistant to standard therapies. Upon transitioning to 0.5% epinastine eyelid cream, the patient showed improved adherence and partial symptom resolution. However, new limbal lesions, including Horner-Trantas dots, were observed following the cessation of steroid therapy. The reintroduction of steroids led to significant improvements in conjunctival lesions and complete resolution of limbal gelatinous hyperplasia. This case underscores the potential of epinastine eyelid cream in managing VKC, particularly in patients with adherence issues, and highlights the need for careful monitoring and combination therapy in severe cases. Further studies are needed to evaluate the long-term efficacy and safety of epinastine eyelid cream. However, once-daily application of eyelid cream may serve as a viable treatment and management option for pediatric patients with VKC.

Keywords: allergic conjunctivitis; epinastine; eyelid cream; treatment; vernal keratoconjunctivitis.

Figure 1. Anterior segment findings at the initial examination

(A, B) Mild conjunctival hyperemia with no corneal abnormalities. (C, D) Congestion and swelling of the palpebral conjunctiva with giant papillae. (E, F) Conjunctival hyperemia of the lower eyelid.

Figure 2. Conjunctival finding one month after the epinastine eyelid cream

In the right eye, the patient no longer experiences itching, and improvement in the giant papillae of the upper eyelid is observed (A, B). However, in the left eye, giant papillae increase with worsening conjunctival hyperemia (C, D). Limbal gelatinous infiltrates are observed in the left eye (B).

Figure 3. Progression of the upper eyelid

(A, B) Initial presentation showed congestion and swelling of the palpebral conjunctiva with giant papillae. (C, D) One month after starting epinastine eyelid cream, improvement in the giant papillae of the upper eyelid in the right eye was observed, while giant papillae enlargement and increased conjunctival hyperemia were noted in the left eye. (E, F) Following initiation of topical steroid therapy, remission was maintained at one-month post-treatment.

Figure 4. Progression of limbal findings

One month after the patient discontinues steroid eye drops, a limbal examination reveals Horner-Trantas dots and conjunctival hyperemia (A). Two weeks after restarting steroids, these findings improve (B), and remission is maintained one-month post-treatment (C).

Figure 5. Palpebral conjunctival findings three months after treatment

With the use of epinastine eyelid cream and fluorometholone eye drops, the patient experienced complete relief from itching, along with improvement in conjunctival proliferative changes (A, B) and a reduction in hyperemia (C, D).