Author(s):
Kajal Pansare, Ganesh Sonawane, Chandrashekhar Patil, Deepak Sonawane, Sunil Mahajan
Email(s):
kajalgsonawane@gmail.com
DOI:
10.52711/2321-5836.2025.00047 
Address:
Kajal Pansare1*, Ganesh Sonawane2, Chandrashekhar Patil3, Deepak Sonawane4, Sunil Mahajan5
1Assistant Professor, Department of Pharmacology, Divine College of Pharmacy, Satana, Nashik - 423301 (India)
2Assistant Professor, Department of Pharmaceutical Chemistry, Divine College of Pharmacy, Satana, Nashik - 423301 (India)
3Associate Professor, Department of Pharmacology, Divine College of Pharmacy, Satana, Nashik - 423301 (India)
4Professor, Department of Pharmaceutics, Divine College of Pharmacy, Satana, Nashik - 423301 (India)
5Professor, Department of Pharmaceutical Chemistry, Divine College of Pharmacy, Satana, Nashik - 423301 (India)
*Corresponding Author
Published In:
Volume - 17,
Issue - 4,
Year - 2025
ABSTRACT:
Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, and severe allergic inflammatory disorder of the ocular surface that predominantly affects children and adolescents in warm, dry climates. Its pathogenesis involves complex immune responses, primarily mediated by IgE, mast cells, eosinophils, and Th2 cytokines. VKC can lead to significant ocular discomfort and, in severe cases, visual impairment due to corneal complications. This review aims to provide a comprehensive update on the pharmacotherapeutic advancements in VKC, ranging from conventional treatments like mast cell stabilizers and corticosteroids to emerging options such as immunomodulators and biologic agents. A structured review of the literature was conducted, analyzing current and evolving therapeutic approaches based on their mechanisms of action, clinical efficacy, safety profiles, and limitations. While conventional therapy remains effective for mild to moderate cases, the advent of immunomodulators (cyclosporine, tacrolimus) and biologics (e.g., omalizumab) offers hope for managing refractory and severe forms of VKC with better disease control and fewer side effects. Additionally, advancements in ocular drug delivery systems enhance the therapeutic potential of existing drugs. The therapeutic landscape of VKC is evolving rapidly, with immunologically targeted therapies emerging as promising alternatives. Individualized treatment strategies based on disease severity and immune profile may become the future standard of care.
Cite this article:
Kajal Pansare, Ganesh Sonawane, Chandrashekhar Patil, Deepak Sonawane, Sunil Mahajan. Advances in the Pharmacotherapy of Vernal Keratoconjunctivitis: From Mast Cell Stabilizers to Biologics. Research Journal of Pharmacology and Pharmacodynamics. 2025;17(4):304-0. doi: 10.52711/2321-5836.2025.00047
Cite(Electronic):
Kajal Pansare, Ganesh Sonawane, Chandrashekhar Patil, Deepak Sonawane, Sunil Mahajan. Advances in the Pharmacotherapy of Vernal Keratoconjunctivitis: From Mast Cell Stabilizers to Biologics. Research Journal of Pharmacology and Pharmacodynamics. 2025;17(4):304-0. doi: 10.52711/2321-5836.2025.00047 Available on: https://rjppd.org/AbstractView.aspx?PID=2025-17-4-9
11. REFERENCES:
1. Leonardi A. Vernal keratoconjunctivitis: pathogenesis and treatment. Prog Retin Eye Res. 2002; 21(3): 319–339. doi:10.1016/S1350-9462(01)00024-6
2. Bonini S, Sacchetti M. Vernal keratoconjunctivitis. Eye (Lond). 2000; 14(Pt 3B): 360–363. doi:10.1038/eye.2000.101
3. La Rosa M, Lionetti E, Reibaldi M, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013; 39: 18. doi:10.1186/1824-7288-39-18
4. Kumar S. Vernal keratoconjunctivitis: a major review. Acta Medica (Hradec Kralove). 2009; 52(2): 73–78. doi:10.14712/18059694.2019.48
5. Abu El-Asrar AM, Al-Amro SA, Khan NM. Clinical manifestations and epidemiology of vernal keratoconjunctivitis in Saudi Arabia. Int Ophthalmol. 1991; 15(5): 367–372. doi:10.1007/BF00163991
6. Scuderi G, Contestabile MT, Iacoviello L, et al. Epidemiology and clinical features of vernal keratoconjunctivitis in Italy. Ophthalmologica. 1998; 212(6): 404–409. doi:10.1159/000027357
7. Leonardi A, Piliego F, Castegnaro A, et al. Allergic conjunctivitis: a cross-sectional study. Clin Exp Allergy. 2015; 45(6): 1118–1125. doi:10.1111/cea.12538
8. Singhal D, Sahay P, Maharana PK, et al. Vernal keratoconjunctivitis. Surv Ophthalmol. 2019; 64(3): 289–311. doi:10.1016/j.survophthal.2018.11.003
9. Leonardi A, Curnow SJ, Zhan H, et al. Cytokine modulation in vernal keratoconjunctivitis and potential therapeutic targets. Curr Eye Res. 2006; 31(10): 803–815.
10. Bielory L. Allergic and immunologic disorders of the eye. J Allergy Clin Immunol. 2000; 106(6): 1019–1032.
11. Zicari AM, Nebbioso M, Celani C, et al. Immunopathogenesis and clinical findings in vernal keratoconjunctivitis: current perspectives. Clin Ophthalmol. 2021; 15: 3063–3073.
12. La Rosa M, Lionetti E, Reibaldi M, et al. Allergic conjunctivitis: a comprehensive review of the literature. Ital J Pediatr. 2013;39:18.
13. Abu El-Asrar AM, Al-Amro SA, Khan NM. Clinical manifestations and epidemiology of vernal keratoconjunctivitis in Saudi Arabia. Int Ophthalmol. 1991;15(5):367–372.
14. McGill JI, Holgate ST, Church MK, et al. The role of histamine and antihistamines in allergic conjunctivitis. Clin Allergy. 1985; 15(2): 125–136.
15. Abelson MB, Butrus SI. Pharmacology of ketorolac in the treatment of ocular inflammation. J Ocul Pharmacol Ther. 1994; 10(2): 155–164.
16. Bielory L, Friedlaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am. 2008; 28(1): 43–58.
17. Leonardi A, Bogacka E, Fauquert JL, et al. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy. 2012; 67(11): 1327–1337.
18. Pucci N, Caputo R, Mori F, et al. Long-term follow-up of cyclosporine A 1% eye drops for severe vernal keratoconjunctivitis in children. J Allergy Clin Immunol. 2007; 119(6): 1497–1498.
19. Takamura E. Overview of tacrolimus ophthalmic suspension for the treatment of allergic conjunctival diseases. Allergol Int. 2020; 69(2): 197–203.
20. Fukushima A, Ohashi Y. Topical immunomodulatory therapy with tacrolimus for ocular allergic diseases. Ocul Immunol Inflamm. 2013; 21(6): 420–429.
21. Doan S, Gabison EE, Weber M, et al. Omalizumab in severe vernal keratoconjunctivitis: efficacy after 3-year treatment. J Fr Ophtalmol. 2019; 42(4): e153–e156.
22. Ayuso V, Ten Berge JC, van Dijk K, et al. Omalizumab in the treatment of severe allergic conjunctivitis: A retrospective multicenter study. Allergy. 2020; 75(9): 2535–2538.
23. Le M, Thai A, Thong B, et al. Dupilumab: a novel treatment for severe atopic and vernal keratoconjunctivitis. Case Rep Ophthalmol. 2022; 13(1): 230–236.
24. Sharma A, Gupta A, Arora T, et al. Advances in ocular drug delivery systems for inflammatory eye disease: focus on vernal keratoconjunctivitis. Expert Opin Drug Deliv. 2020; 17(4): 543–558.
25. Souto EB, Dias-Ferreira J, Lopez-Machado A, et al. Advanced formulation approaches for ocular drug delivery: challenges and promises. Drug Discov Today. 2019; 24(8): 1679–1686.
26. Leonardi A, Silva D, Perez Formigo D, et al. Management of vernal keratoconjunctivitis: an evidence-based approach for primary care. Pediatr Allergy Immunol. 2023; 34(1): e13934.
27. Doan S, Gabison EE. Current management of severe vernal keratoconjunctivitis. Clin Ophthalmol. 2019; 13: 1199–1206.
28. Qureshi R, Conway M, Acharya N. Challenges in the use of biologics for ocular inflammatory diseases in pediatric patients. Pediatr Drugs. 2021; 23(5): 457–470.
29. Leonardi A. Emerging therapies in vernal keratoconjunctivitis. Curr Opin Allergy Clin Immunol. 2021; 21(5): 457–464.
30. Montan PG. Ocular allergies: a clinical review and current treatment strategies. Acta Ophthalmol. 2022; 100(3): e668–e675.