{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T23:28:52Z","timestamp":1783553332269,"version":"3.55.0"},"reference-count":75,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, and frequently severe allergic ocular condition predominantly impacting children and adolescents in tropical and subtropical areas. It profoundly affects patients\u2019 quality of life owing to its chronic symptoms and possible vision-threatening effects. Notwithstanding progress in comprehending VKC, its ocular symptoms and therapeutic approaches necessitate ongoing assessment. Aims: This review summarizes the main factors to consider when diagnosing, treating, and managing patients with VKC based on the current literature in this field. Methods: This comprehensive review examined peer-reviewed literature from 2010 to 2024 obtained from PubMed. The selection criteria encompassed research addressing the clinical presentation, diagnostic difficulties, and therapy of visual symptoms in pediatric patients with VKC. The publications chosen were those focusing on those that elucidate the pathophysiology, consequences, and innovations in treatment methodologies. Results: The ocular manifestations of VKC are varied and characterized by prominent symptoms such as severe itching, photophobia, lacrimation, and a viscous mucoid discharge. Clinical manifestations range from conjunctival hyperemia and limbal thickening to severe consequences that jeopardize vision, including shield ulcers and keratoconus. Improvements in imaging techniques such as anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy have enhanced diagnostic accuracy. The pharmacological approach has transitioned to steroid-sparing techniques, prioritizing mast cell stabilizers, antihistamines, and immunomodulators such as cyclosporine. Novel therapies, including biologics that target interleukin pathways, demonstrate potential in refractory instances. Nonetheless, access to modern medicines is restricted in resource-limited environments. Conclusions: VKC poses considerable diagnostic and treatment difficulties due to its chronic nature and possible consequences. This review emphasizes the necessity for prompt diagnosis and customized management approaches to avert vision impairment. Despite considerable advancements in comprehending VKC\u2019s etiology and therapy, inequalities in access to sophisticated care highlight the necessity for global activities to guarantee equitable treatment alternatives.<\/jats:p>","DOI":"10.3390\/children12050609","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T05:18:20Z","timestamp":1746595100000},"page":"609","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ocular Manifestations in Children with Vernal Keratoconjunctivitis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2969-8610","authenticated-orcid":false,"given":"Matteo","family":"Capobianco","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0999-5545","authenticated-orcid":false,"given":"Marco","family":"Zeppieri","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0059-5253","authenticated-orcid":false,"given":"Giuseppe","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6710-2460","authenticated-orcid":false,"given":"Federico","family":"Visalli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-876X","authenticated-orcid":false,"given":"Fabiana","family":"D\u2019Esposito","sequence":"additional","affiliation":[{"name":"Imperial College Ophthalmic Research Group [ICORG] Unit, Imperial College, London NW1 5QH, UK"},{"name":"Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3074-4508","authenticated-orcid":false,"given":"Roberta","family":"Foti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7556-6952","authenticated-orcid":false,"given":"Ludovica","family":"Cannizzaro","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Tognetto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-0068","authenticated-orcid":false,"given":"Caterina","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jtos.2024.12.007","article-title":"Epidemiological insights into Childhood vernal keratoconjunctivitis in India: Unravelling clinical presentation and environmental influences\u2014The EPIC VKC study\u2014Fourth report of the ICMR EYE SEE study group","volume":"36","author":"Gupta","year":"2024","journal-title":"Ocul. Surf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1167\/iovs.64.10.37","article-title":"Air Pollution and Meteorological Conditions Significantly Associated With Vernal Keratoconjunctivitis Exacerbations","volume":"64","author":"Levanon","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1136\/bjophthalmol-2011-301376","article-title":"Vernal keratoconjunctivitis: An update","volume":"97","author":"Wildner","year":"2013","journal-title":"Br. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3259","DOI":"10.1177\/1120672120978886","article-title":"Serum vitamin D levels in patients with vernal keratoconjunctivitis and its relationship with disease severity","volume":"31","author":"Sorkhabi","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jtos.2024.07.009","article-title":"Unraveling the complexity\u2014Insights and interventions of refractory vernal keratoconjunctivitis","volume":"4","author":"Agarwal","year":"2024","journal-title":"Ocul Surf."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mehrbod, P., Brun, P., Rosani, U., Leonardi, A., and Ghavami, S. (2024). Evaluation of Autophagy in Conjunctival Fibroblasts, Springer. Methods in Molecular Biology.","DOI":"10.1101\/2024.01.27.575831"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hehar, N.K., and Chigbu, D.I. (2024). Vernal Keratoconjunctivitis: Immunopathological Insights and Therapeutic Applications of Immunomodulators. Life, 14.","DOI":"10.3390\/life14030361"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109301","DOI":"10.1016\/j.exer.2022.109301","article-title":"Tissue remodeling in adult vernal keratoconjunctivitis","volume":"225","author":"Micera","year":"2022","journal-title":"Exp. Eye Res."},{"key":"ref_9","first-page":"1419","article-title":"Vernal keratoconjunctivitis: Atopy and autoimmunity","volume":"17","author":"Zicari","year":"2013","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sacchetti, M., Plateroti, R., Bruscolini, A., Giustolisi, R., and Marenco, M. (2021). Understanding Vernal Keratoconjunctivitis: Beyond Allergic Mechanisms. Life, 11.","DOI":"10.3390\/life11101012"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"340","DOI":"10.3109\/08820538.2013.874483","article-title":"Pathogenesis of Vernal Keratoconjunctivitis and Associated Factors","volume":"30","author":"Nebbioso","year":"2015","journal-title":"Semin. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5053","DOI":"10.1007\/s00431-024-05776-0","article-title":"Seeing eye to eye: A modified Delphi method-based multidisciplinary expert consensus on the diagnosis and treatment of vernal keratoconjunctivitis","volume":"183","author":"Ghiglioni","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Barcsay-Veres, A., Csorba, A., Kovacs, I., Tothfalusi, L., and Maneschg, O.A. (2025). Corticosteroid-sparing topical treatment with cyclosporin for juvenile keratoconjunctivitis. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-85256-z"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/ICO.0000000000003613","article-title":"Systemic Treatment with Cyclosporine A in Children With Severe Vernal Keratoconjunctivitis","volume":"44","author":"Gazit","year":"2025","journal-title":"Cornea"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3928\/01913913-20220328-01","article-title":"Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers","volume":"60","author":"Ghauri","year":"2023","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00347-024-01984-z","article-title":"Aktuelles zur Keratoconjunctivitis vernalis und atopica [Current aspects of vernal and atopic keratoconjunctivitis]","volume":"121","author":"Messmer","year":"2024","journal-title":"Ophthalmologie"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2828","DOI":"10.1177\/11206721211022153","article-title":"Vernal keratoconjunctivitis: An update","volume":"31","author":"Ghiglioni","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1136\/bjophthalmol-2017-311171","article-title":"Corneal staining patterns in vernal keratoconjunctivitis: The new VKC-CLEK scoring scale","volume":"102","author":"Leonardi","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/0301-4738.179727","article-title":"Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm","volume":"64","author":"Gokhale","year":"2016","journal-title":"Indian J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.33545\/26648547.2024.v6.i1a.28","article-title":"Efficacy of an isotonic seawater eye wash in patients with mild and moderate allergic vernal keratoconjunctivitis by measuring immunoglobulin E levels in tears: Report 1 clinical trial Gov\/USA NCT 04695795","volume":"6","author":"Manuel","year":"2024","journal-title":"Int. J. Ophthalmol. Optom."},{"key":"ref_21","unstructured":"Kaur, K., and Gurnani, B. (2023). Vernal Keratoconjunctivitis, StatPearls Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s12016-023-08970-4","article-title":"Vernal Keratoconjunctivitis: A Systematic Review","volume":"65","author":"Bruschi","year":"2023","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.ajo.2012.09.014","article-title":"Management, clinical outcomes, and complications of shield ulcers in vernal keratoconjunctivitis","volume":"155","author":"Reddy","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","first-page":"505","article-title":"A Case of Shield Ulcer Due to Vernal Keratoconjunctivitis","volume":"20","author":"Usta","year":"2021","journal-title":"Iran. J. Allergy Asthma Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s00417-019-04287-1","article-title":"Dermatologic tacrolimus ointment on the eyelids for steroid-refractory vernal keratoconjunctivitis","volume":"257","author":"Liu","year":"2019","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.4103\/ijo.IJO_2128_22","article-title":"An observational study on the presence of perilimbal conjunctival pigmentation in vernal keratoconjunctivitis","volume":"71","author":"Dubbaka","year":"2023","journal-title":"Indian J. Ophthalmol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13052-019-0656-4","article-title":"Vernal keratoconjunctivitis: An update focused on clinical grading system","volume":"45","author":"Zicari","year":"2019","journal-title":"Ital. J. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"820","DOI":"10.4103\/ijo.IJO_1897_21","article-title":"Long-term outcomes and risk factors for failure of glaucoma filtering surgery in eyes with vernal keratoconjunctivitis and steroid-induced glaucoma","volume":"70","author":"Senthil","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1136\/bjophthalmol-2019-313988","article-title":"Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis","volume":"104","author":"Senthil","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/ICO.0000000000002775","article-title":"Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis","volume":"41","author":"Donthineni","year":"2022","journal-title":"Cornea"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4103\/ijo.IJO_1179_21","article-title":"Clinical, histological and immunohistochemistry characteristics of cornea in the sequelae stage of chronic vernal keratoconjunctivitis","volume":"70","author":"Jaffet","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jtos.2020.10.005","article-title":"Management of corneal complications in vernal keratoconjunctivitis: A review","volume":"19","author":"Feizi","year":"2021","journal-title":"Ocul. Surf."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.sjopt.2011.02.001","article-title":"Ocular complications of severe vernal keratoconjunctivitis [VKC] in Yemen","volume":"25","author":"Bamashmus","year":"2011","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Mehta, J.S., Chen, W.L., Cheng, A.C.K., Cung, L.X., Dualan, I.J., Kekunnaya, R., Khaliddin, N., Kim, T.I., Lam, D.K., and Leo, S.W. (2022). Diagnosis, Management, and Treatment of Vernal Keratoconjunctivitis in Asia: Recommendations From the Management of Vernal Keratoconjunctivitis in Asia Expert Working Group. Front. Med., 9.","DOI":"10.3389\/fmed.2022.882240"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.4103\/IJO.IJO_2836_22","article-title":"Evaluation of dry eyes in children with vernal kerato-conjunctivitis using clinical tests and ocular surface analysis","volume":"71","author":"Gupta","year":"2023","journal-title":"Indian J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"110","DOI":"10.4103\/IJO.IJO_24_24","article-title":"Tear film parameters and meibography in eyes of children with vernal keratoconjunctivitis","volume":"73","author":"Gupta","year":"2025","journal-title":"Indian J. Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1080\/09273948.2024.2373375","article-title":"Evaluation of Meibomian Gland Structure and Function in Patients with Vernal Keratoconjunctivitis Using Non Contact Meibography and Lipid Layer Interferometry","volume":"32","author":"Singla","year":"2024","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1007\/s00417-021-05199-9","article-title":"Quantitative evaluation of lipid layer thickness and blinking in children with allergic conjunctivitis","volume":"259","author":"Yang","year":"2021","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1007\/s10792-022-02596-9","article-title":"Evaluation of corneal epithelial thickness mapping using anterior segment OCT in children with vernal keratoconjunctivitis","volume":"43","author":"Albadawi","year":"2023","journal-title":"Int. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"152","DOI":"10.51329\/mehdioptometry164","article-title":"Anterior-segment optical coherence tomography for tacrolimus therapy response monitoring of vernal keratoconjunctivitis","volume":"3","author":"Eltagoury","year":"2023","journal-title":"Med. Hypothesis Discov. Innov. Optom."},{"key":"ref_41","first-page":"344","article-title":"The Role of In Vivo Confocal Microscopy in Ocular Allergies","volume":"54","author":"Kojima","year":"2024","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Tajbakhsh, Z., Golebiowski, B., Stapleton, F., Salouti, R., Nowroozzadeh, M.H., Zamani, M., Briggs, N., and Jalbert, I. (2023). Dendritic Cell Density and Morphology Can Be Used to Differentiate Vernal Keratoconjunctivitis from Allergic Conjunctivitis. Biomolecules, 13.","DOI":"10.3390\/biom13101469"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104404","DOI":"10.1016\/j.jfo.2024.104404","article-title":"An evaluation of corneal topographic changes in a large series of patients with vernal keratoconjunctivitis","volume":"48","author":"Reyhan","year":"2024","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_44","first-page":"375","article-title":"Central corneal thickness and topographic indices in Malaysian children with vernal keratoconjunctivitis","volume":"79","author":"Shatriah","year":"2024","journal-title":"Med. J. Malays."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"103792","DOI":"10.1016\/j.jfo.2023.01.010","article-title":"Corneal topometric indices and proclivity toward corneal ectasia in vernal keratoconjunctivitis","volume":"47","author":"Yilmaz","year":"2024","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/aos.15212","article-title":"Prevalence of allergic sensitization with vernal keratoconjunctivitis: A systematic review with meta-analyses","volume":"101","author":"Rasmussen","year":"2023","journal-title":"Acta Ophthalmol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1824-7288-39-18","article-title":"Allergic conjunctivitis: A comprehensive review of the literature","volume":"39","author":"Lionetti","year":"2013","journal-title":"Ital. J. Pediatr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"240.e1","DOI":"10.1016\/j.jaapos.2022.05.015","article-title":"Ocular surface characteristics in pediatric vernal keratoconjunctivitis: A clinico-cytological study","volume":"26","author":"Sabu","year":"2022","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/pai.12450","article-title":"Microarray-based IgE detection in tears of patients with vernal keratoconjunctivitis","volume":"26","author":"Leonardi","year":"2015","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s00417-021-05109-z","article-title":"Comparative profile of ocular surface microbiome in vernal keratoconjunctivitis patients and healthy subjects","volume":"259","author":"Vishwakarma","year":"2021","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1177\/11206721211048814","article-title":"Vernal keratoconjunctivitis activity induces decrease of ocular surface CD14, TLR-4 and TLR-9 expression","volume":"32","author":"Sacchetti","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/02713683.2016.1242755","article-title":"Clinical Usefulness of Simultaneous Measurement of the Tear Levels of CCL17, CCL24, and IL-16 for the Biomarkers of Allergic Conjunctival Disorders","volume":"42","author":"Shoji","year":"2017","journal-title":"Curr. Eye Res."},{"key":"ref_53","first-page":"CC08","article-title":"Alpha-1 antitrypsin, a diagnostic and prognostic marker of vernal keratoconjunctivitis","volume":"8","author":"Ahsan","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.sjopt.2015.05.002","article-title":"Is there is an association between the presence of Staphylococcus species and occurrence of vernal keratoconjunctivitis?","volume":"29","author":"Abdulrahim","year":"2015","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1167\/iovs.65.4.23","article-title":"Endoplasmic Reticulum Stress and Unfolded Protein Response in Vernal Keratoconjunctivitis","volume":"65","author":"Leonardi","year":"2024","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1111\/all.15903","article-title":"Correlation between gene expression and clinical scores in vernal keratoconjunctivitis","volume":"79","author":"Leonardi","year":"2024","journal-title":"Allergy"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"100701","DOI":"10.1016\/j.mgene.2020.100701","article-title":"Mutation analysis of VSX1 gene in vernal keratoconjunctivitis patients","volume":"24","author":"Barjui","year":"2020","journal-title":"Meta Gene"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Syed, N.H., Shahidan, W.N.S., Shatriah, I., and Zunaina, E. (2022). MicroRNA Profiling of the Tears of Children With Vernal Keratoconjunctivitis. Front. Genet., 13.","DOI":"10.3389\/fgene.2022.847168"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.survophthal.2023.10.008","article-title":"Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape","volume":"69","author":"Ali","year":"2024","journal-title":"Surv. Ophthalmol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"100788","DOI":"10.1016\/j.waojou.2023.100788","article-title":"Vernal keratoconjunctivitis: Current immunological and clinical evidence and the potential role of omalizumab","volume":"16","author":"Doan","year":"2023","journal-title":"World Allergy Organ. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"106968","DOI":"10.1016\/j.ijscr.2022.106968","article-title":"Allogeneic simple limbal epithelial transplantation for bilateral limbal stem cell deficiency in chronic vernal keratoconjunctivitis: A case report","volume":"94","author":"Jain","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Yao, A., Singh, S., Bagga, B., Patel, B., and Malhotra, R. (2024). Oral mucous membrane tarsal patch grafting: Broadening indications and long-term outcomes. Orbit, 1\u20136.","DOI":"10.1080\/01676830.2024.2429570"},{"key":"ref_63","first-page":"9973441","article-title":"Combined Papillectomy and Autologous Conjunctival Membrane Graft as Management of Giant Papillae for Severe, Refractory Palpebral Vernal Keratoconjunctivitis-A Case Report","volume":"2024","author":"Annisa","year":"2024","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Azizi, S., Subhi, Y., and Rasmussen, M.L.R. (2023). Surgical Treatment of Corneal Shield Ulcer in Vernal Keratoconjunctivitis: A Systematic Review. J. Pers. Med., 13.","DOI":"10.3390\/jpm13071092"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2856","DOI":"10.4103\/ijo.IJO_1524_20","article-title":"Phototherapeutic keratectomy: Indications, methods and decision making","volume":"68","author":"Deshmukh","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1097\/ICO.0000000000003404","article-title":"Tear Tacrolimus Levels and Clinical Response After Adjunct Therapy with Cutaneous Application of Tacrolimus 0.1% over Upper Eyelid Skin in Chronic Vernal Keratoconjunctivitis","volume":"43","author":"Bardoloi","year":"2024","journal-title":"Cornea"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/ACI.0000000000000915","article-title":"Diagnostic criteria of chronic conjunctivitis: Atopic keratoconjunctivitis and vernal keratoconjunctivitis","volume":"23","author":"Leonardi","year":"2023","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.ajo.2012.11.018","article-title":"Vernal keratoconjunctivitis-like disease in adults","volume":"155","author":"Leonardi","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_69","unstructured":"Brindisi, G., Cinicola, B., Anania, C., De Castro, G., Nebbioso, M., Del Giudice, M.M., Licari, A., Caffarelli, C., De Filippo, M., and Cardinale, F. (2021). Vernal keratoconjunctivitis: State of art and update on treatment. Acta Biomed., 92."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Di Zazzo, A., Zhu, A.Y., Nischal, K., and Fung, S.S.M. (2024). Vernal keratoconjunctivitis in adults: A narrative review of prevalence, pathogenesis, and management. Front. Ophthalmol., 4.","DOI":"10.3389\/fopht.2024.1328953"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Chigbu, D.I., and Labib, B.A. (2021). Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives. Pharmaceuticals, 14.","DOI":"10.3390\/ph14070658"},{"key":"ref_72","first-page":"11","article-title":"Efectividad de la inmunoterapia con alergenos en pacientes con queratoconjuntivitis vernal [Effectiveness of allergen immunotherapy in patients with vernal keratoconjuctivitis]","volume":"60","year":"2013","journal-title":"Rev. Alerg. Mex."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/ACI.0000000000000765","article-title":"Vernal keratoconjunctivitis and keratoconus","volume":"21","author":"Wajnsztajn","year":"2021","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00417-021-05356-0","article-title":"A comparative study between ciclosporine A eye drop (2%) and tacrolimus eye ointment (0.03%) in management of children with refractory vernal keratoconjunctivitis","volume":"260","author":"Heikal","year":"2022","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.3928\/01913913-20210708-02","article-title":"Vernal Keratoconjunctivitis: Beyond the Classic Treatment","volume":"58","author":"Bernales","year":"2021","journal-title":"J. Pediatr. Ophthalmol. 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