Perilimbal conjunctival pigmentation and its association with vernal keratoconjunctivitis in children from the West Rand

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Van Vuuren, Chandre
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University of the Free State
Vernal keratoconjunctivitis (VKC) is a recurrent inflammatory disorder which affects the anterior ocular structures of pre-pubertal children resulting in preventable vision loss. Certain risk factors such as gender, warm and dry climates as well as systemic allergies, have been identified to increase the onset of VKC. Recently, perilimbal conjunctival pigmentation has been found to be a consistent and early indication of the development of VKC. Aim: The study aimed to evaluate the presence of perilimbal conjunctival pigmentation and its association with VKC in children from the West Rand, South Africa. Not only is there limited information regarding VKC in South Africa, but a gap has been identified in the literature concerning perilimbal conjunctival pigmentation in VKC and its association with ocular allergic responses and racial factors such as varying skin tones. This study was designed to provide a better understanding of these features and highlight the clinical relevance of the presenting pigmentation. With this knowledge, the appropriate ocular treatment of VKC can be provided, which may promote childhood eye care, especially in the West Rand. Methods: This study consisted of an observational quantitative study design employing cross sectional sampling. The sampling method consisted of non-probability convenience sampling. The data was collected through structured interviews and clinical examinations, which were performed to measure selected variables during a given period. The presence of VKC and perilimbal conjunctival pigmentation was determined through the symptoms reported by the participants during structured interviews. Furthermore, anterior and posterior ocular health examinations were performed with a slit lamp to identify VKC and perilimbal conjunctival pigmentation, based on a diagnostic criterion. The findings of the participants were divided into groups for the purpose of analytical non-parametric comparison to determine significant associations. Results: This study consisted of 125 participants between the age group of 6 and 12 years. The sample predominantly consisted of 68 female participants. The larger part of the sample population, being 75 participants, were of Black African race. Furthermore, most of the sample, 80 participants, resided in Krugersdorp. The findings of this study determined a VKC prevalence of 28% as well as a perilimbal conjunctival pigmentation prevalence of 28% in the sample population. Ocular pigmentation in the absence of VKC was found in 6.40% of the sample. More female participants displayed VKC (62.50%) while more male participants displayed both VKC and the perilimbal pigmentation (55.56%). Both VKC and perilimbal conjunctival pigmentation was identified more frequently in participants of 8 to 11 years of age. Furthermore, it was recognised that all the participants who displayed VKC and perilimbal conjunctival pigmentation were of the Black African ethnicity. The data also indicated that 62.96% of these affected participants resided in Kagiso, a local township settlement in the West Rand. Moreover, most of the participants displaying both VKC and the perilimbal pigmentation experienced ocular allergic responses in the form of symptoms such as ocular itching (96.30%) and clinical signs such as conjunctival hyperaemia (88.89%) and tarsal conjunctival papillae (88.89%). Conclusion: The results of this study has identified that age, gender, ethnicity and residential distribution affects the prevalence of VKC and perilimbal conjunctival pigmentation. Considering that all the affected participants were of the Black African race, a conclusion was made that a darker skin tone may increase the presence of perilimbal conjunctival pigmentation found in VKC. Most of the participants displaying both VKC and perilimbal conjunctival pigmentation experienced ocular inflammatory reactions in the form of ocular symptoms and signs. This identification signifies that the presence of allergic responses may intensify perilimbal conjunctival pigmentation. The study has determined that the presence of perilimbal pigmentation, which is found in VKC, is not only produced by the darker skin tones of an individual. The pigmentation is also induced by ocular allergic responses linked to this ocular disorder. Therefore, eye care practitioners may use this clinical sign to identify the early development of VKC to provide prompt treatment and encourage the promotion of ocular health amongst children
Dissertation (M. Optometry (Optometry))--University of the Free State, 2021, Vernal keratoconjunctivitis, Perilimbal conjunctival pigmentation, Quantitative research, Ocular disorders, West Rand, Skin complexion, Allergic responses