Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Jan 24;17(1):e77901.
doi: 10.7759/cureus.77901. eCollection 2025 Jan.

Managing Bilateral Vernal Keratoconjunctivitis, Keratoconus, and Steroid-Induced Glaucoma: A Threefold Struggle

Nur Hafizah Maffar  1 , Yaakub Azhany  1 , Nur Ain Shafiyah Mohd Ghazali  1 , Julieana Muhammed  1
Affiliations
Case Reports

Managing Bilateral Vernal Keratoconjunctivitis, Keratoconus, and Steroid-Induced Glaucoma: A Threefold Struggle

Nur Hafizah Maffar et al. Cureus. .

Abstract

The coexistence of bilateral vernal keratoconjunctivitis (VKC), keratoconus, and steroid-induced glaucoma presents a complex ocular challenge, threatening visual acuity and long-term eye health. This combination poses significant risks, with VKC and keratoconus progressively affecting both eyes while glaucoma, induced by necessary steroid treatments, further complicates the clinical picture. We report a case of a young Malay girl who complained of bilateral eye itchiness with progressive blurring of vision, a history of frequent changes in prescribed glasses, and vigorous eye rubbing. Diagnosed with VKC at age 14, she defaulted on follow-up and began unsupervised use of topical steroids during flare-ups. This resulted in steroid-induced glaucoma, complicating the management of both VKC and coexisting keratoconus. This case underscores the importance of careful, supervised treatment, as improper management can significantly affect long-term outcomes.

Keywords: corticosteriod; flare-up; keratoconus (kc); steroid-induced glaucoma; vernal keratoconjunctivitis.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Macropapillae appearance on the upper tarsal conjunctiva (highlighted with the circle), with A representing the right eye and B representing the left eye
Figure 2
Figure 2. The anterior segment displays 360º chronic severe limbitis and Trantas dots in both eyes. The right eye is labeled as A, and the left eye as B, with red arrows indicating the findings
Figure 3
Figure 3. Corneal topography following corneal cross-linking reveals advanced keratoconus progression in the right eye (A and B) and minimal progression in the left eye (C and D)
Figure 4
Figure 4. Fundus photographs show an advanced cup-to-disc ratio of 0.95 with pallor in the right eye (A) and a ratio of 0.6 with a pink appearance in the left eye (B)
Figure 5
Figure 5. HVF test of the left eye (OS) is within normal limits. Unable to perform the HVF test of the right eye (OD) due to severely reduced vision, limited to hand movement perception
HVF: Humphrey visual field
Figure 6
Figure 6. OCT RNFL showed thinning of both nerve fiber layers, more pronounced in the right eye (OD)
OCT: Optical coherence tomography; RNFL: retinal nerve fiber layer
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India. Saboo US, Jain M, Reddy JC, Sangwan VS. Indian J Ophthalmol. 2013;61:486–489. - PMC - PubMed
    1. Vernal keratoconjunctivitis: a systematic review. Bruschi G, Ghiglioni DG, Cozzi L, Osnaghi S, Viola F, Marchisio P. Clin Rev Allergy Immunol. 2023;65:277–329. - PMC - PubMed
    1. A review of four hundred cases of vernal conjunctivitis. Neumann E, Gutmann MJ, Blumenkrantz N, Michaelson IC. Am J Ophthalmol. 1959;47:166–172. - PubMed
    1. Demographic and clinical characteristics of childhood and adult onset vernal keratoconjunctivitis in a tertiary care center during Covid pandemic: a prospective study. Singh A, Rana J, Kataria S, Bhan C, Priya P. Rom J Ophthalmol. 2022;66:344–351. - PMC - PubMed
    1. Steroid-induced ocular hypertension in Asian children with severe vernal keratoconjunctivitis. Ang M, Ti SE, Loh R, Farzavandi S, Zhang R, Tan D, Chan C. Clin Ophthalmol. 2012;6:1253–1258. - PMC - PubMed

Publication types

LinkOut - more resources