Advances in the Pharmacotherapy of Vernal Keratoconjunctivitis: From Mast Cell Stabilizers to Biologics

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.