Rapid healing of vernal shield ulcer after surgical debridement - A case report

Purpose: This study was designed to report a patient with a vernal shield ulcer that did not respond to medical therapy but healed in 1 week after surgical debridement of the ulcer base. Methods: Case report and literature review. Results: A 12-year-old girl with a history of asthma and eczema was seen with a 5.7- x 5.7-mm corneal epithelial defect in the right eye. Her uncorrected visual acuity was 20/200 OD and 20/70 OS. Slit-lamp examination revealed giant papillae on the tarsal conjunctivae, diffuse punctate epitheliopathy, and a thick mucoid discharge in both eyes. A diagnosis of vernal keratoconjunctivitis both eyes (OU) with a shield ulcer OD was made and prednisolone 1% was started 4 times per day OD. Topical ofloxacin 0.3% 3 times per day and topical cyclosporine 0.05% every 2 hours were added OD 2 days later. On minimal improvement in the epithelial defect in 1 week, surgical debridement of the ulcer base was performed. The epithelial defect healed smoothly in 1 week with an underlying stromal scar and the uncorrected visual acuity improved to 20/70 OD at 1 month and 20/40 at 10 months. Conclusion: Corneal shield ulcers and plaques are rare but serious complications of vernal keratoconjunctivitis, which may be unresponsive to standard medical therapy. Surgical debridement is a fast and effective procedure yielding rapid healing of the ulcer and minimizing complications, such as infections.