European Journal of Biomedical and Pharmaceutical Sciences

MONTELUKAST – CAN WE USE IT IN VERNAL KERATOCONJUNCTIVITIS

Rajiv Gupta*

ABSTRACT

Vernal Keratoconjunctivitis (VKC) is a chronic, bilateral allergic inflammation of the conjunctiva. The disease is seasonal, recurrent & commonly seen among young boys. Common symptoms of the disease are redness, itching, lacrimation, photophobia, foreign body sensation & a characteristic ropy discharge. Signs found in VKC are conjunctival congestion, giant papillae involving upper palpebral conjunctiva & the limbus, Tranta’s dots & superficial keratitis.[1,2] Patients with VKC frequently have a positive family history or history of allergic diseases like asthma, rhinitis, atopic dermatitis etc.[3] It is a multifactorial disease with involvement of environmental conditions, immune mechanism & endocrinal system. T2 lymphocytes are thought to be responsible for the pathogenesis of the disease.[4] It leads to hyper production of IgE (IL-4) & enhance differentiation and activation of mast cells (IL-3) & eosinophils (IL-5). These cells cause increased production of leukotrienes, which can be detected in tear fluid of VKC patients. If leukotrienes are administered on the surface of the conjunctiva (i.e. LTB4, LTC4 & LTD4), they cause vasodilatation, edema, hyperemia & infiltration of eosinophils & other leucocytes.[5,6,7] The management of VKC includes correct diagnosis, prognostic evaluation and proper therapy. There are many therapeutic options& the selection of the drug depends on the severity of the disease. However at present no drug is able to achieve the ultimate goal of therapy meaning the complete resolution of the disease & prevention of recurrence. Most commonly used drug is topical steroid which controls effectively the acute phase of the disease but may lead to complications of glaucoma & cataract on prolong use.[8, 9] Second line drugs are topical antihistamines, mast cell stabilizers & non steroidal anti-inflammatory drugs (NSAID). Topical cyclosporine 2% is effective in chronic cases but about 6% of patients develop complications of cataract, corneal damage or glaucoma. Montelukast which is a leukotriene receptor 1 antagonist has the potential to reduce the symptoms of VKC as it has been found that biological activity of leukotriene on conjunctiva produces a similar picture as that of VKC. [10]

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