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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 796-797

Supratarsal triamcinolone injection aids in the alleviation of concurrent bilateral shield ulcers


1 Department of Cornea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
3 Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission11-Sep-2020
Date of Acceptance15-Mar-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Meena Lakshmipathy
Sankara Nethralaya, 18 College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2913_20

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  Abstract 


Keywords: Bilateral, recurrence, shield ulcer, supratarsal triamcinolone, vernal keratoconjunctivitis


How to cite this article:
Paul RS, Kulkarni S, Lakshmipathy M. Supratarsal triamcinolone injection aids in the alleviation of concurrent bilateral shield ulcers. Indian J Ophthalmol Case Rep 2021;1:796-7

How to cite this URL:
Paul RS, Kulkarni S, Lakshmipathy M. Supratarsal triamcinolone injection aids in the alleviation of concurrent bilateral shield ulcers. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:796-7. Available from: https://www.ijoreports.in/text.asp?2021/1/4/796/327656



A 23-year-old male presented with complaints of redness, itching, watering both eyes (BE) for the past 2 months. He was a diagnosed case of BE vernal keratoconjunctivitis (VKC) since the age of 10 years with periodic symptomatic fluctuations. He had no systemic history suggestive of any atopic preponderance. On examination, uncorrected visual acuity was 20/80 in the right eye (RE) and 20/30 in the left eye (LE). Slit-lamp examination revealed BE upper tarsus cobblestone papillae with corneal shield ulcer grade 2 in the RE and grade 3 in the LE, respectively.[1] [Figure 1] After scraping the ulcers' base, margin, and removal of inflammatory debris, he was initiated on topical tapering 0.1% fluorometholone and 4% sodium chromoglycate in BE. [Figure 2] His symptoms recurred within 4 days of cessation of month-long steroid course. He was restarted on slow taper topical 0.1% fluorometholone resulting in resolution of his ulcers and his symptoms. He had a second recurrence of BE cobblestone papillae, conjunctival congestion, and RE shield ulcer after 2 months of asymptomatic period. [Figure 3]a and [Figure 3]b In view of waxing-waning disease course with maximum medical therapy (topical steroids and mast cell stabilizer) and second recurrent episode within 3 months of initial presentation, decision in favor of RE supratarsal injection of triamcinolone acetonide (20 mg) was taken. Medical management was continued for LE. There was a subsequent resolution of cobblestone papillae and shield ulcer within 2 weeks post supratarsal injection, with recurrence-free period in 18 months follow-up. [Figure 3]c and [Figure 3]d. In all outpatient visits, his BE intraocular pressure and retinal evaluation were within normal limits.
Figure 1: Digital photograph of the anterior segment on the day of presentation (a) the right and left eyes, (b) upper tarsal cobblestone papillae, (c) the right eye grade 2 shield ulcer, and (d) the left eye grade 3 shield ulcer with a plaque

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Figure 2: Digital photograph of the anterior segment of (a) the right eye and (b) the left eye 2 weeks postsurgical debridement and initiation of the first topical steroid pulse therapy

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Figure 3: Digital photograph of the anterior segment of (a) the right and (b) left eyes after the second recurrent episode and (c) the right and (d) left eyes at 4 months follow-up period following supratarsal triamcinolone injection

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Chronic recurrent VKC can result in corneal complications like shield ulcer in 3–11% of patients.[2] Shield ulcers of grade 2 and above are generally refractive to medical treatment warranting surgical management.[3] Supratarsal triamcinolone injection can be improvized as a stand-in method prior to any surgical intervention even in noncompliant patients.[4] This case highlights an uncommon bilateral, similar looking, concurrent shield ulcers and use of supratarsal triamcinolone injection to dramatically resolve signs and satisfactorily alleviate symptoms for a prolonged duration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cameron JA. Shield ulcers and plaques of cornea in vernal keratoconjunctivitis. Ophthalmology 1995;102:985-93.  Back to cited text no. 1
    
2.
Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, et al. Vernal keratoconjunctivitis revisited: A case series of 195 patients with long term followup. Ophthalmology 2000;107:1157-63.  Back to cited text no. 2
    
3.
Lin HY, Yeh PT, Shiao CS, Hu FR. Surgical management and immunohistochemical study of corneal plaques in vernal keratoconjunctivitis. J Formos Med Assoc 2013;112:569-73.  Back to cited text no. 3
    
4.
Xavier da CA, Pereira GJÁ, Candido MLG, Lucia LV, Pereira BT, Serapião dos SM. Supratarsal injection of triamcinolone for severe vernal keratoconjunctivitis in children. Arq Bras Oftalmol 2017;80:186-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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