Treatment of refractory shield ulcer and update on its management

Vernal Shield ulcer is a rare sight threatening corneal manifestation of vernal keratoconjunctivitis. This study is designed to report management of a refractory shield ulcer that did not respond to variety of medications but healed in 1 week after surgical debridement of ulcer base. A 12-year old Omani boy with H/O vernal conjunctivitis since 5 years on ketotifen eye drops presented with a shield ulcer in right eye. Slit lamp examination revealed a shield ulcer covered with mucus plaque in superior part of cornea in right eye and giant papillae in tarsal conjunctiva in both eyes. A bandage contact lens was inserted and he was put on topical fluromethalone, cyclosporine 0.5% along with lomefloxacin eye drops. Patient improved well symptomatically but ulcer did not heal completely even after 2 weeks. Removal of mucus plaque and surgical debridement of ulcer base was performed. Ulcer healed dramatically in 1 week with underlying stromal scar. Vernal shield ulcers and plaques are rare but serious and sight threatening complications of vernal keratoconjunctivitis. Ulcers unresponsive to standard medical therapy should have surgical intervention. A simple scraping of ulcer base and removal of plaque is an effective procedure resulting in rapid healing of ulcer.