Treatment

The management of VKC lends itself to a stepwise sequence based on disease severity (Table
1). Symptoms of itching, burning, and irritation can be managed with cool compresses and
saline rinses. Preservative-free artificial tears can be used liberally. These simple measures
are reported by patients to provide significant symptomatic relief.

Table 1. Stepladder for treatment of VKC based on disease severity

Annex IModified Allen test

A modified Allen test measures arterial competency, and should be performed before taking
an arterial sample. The procedure for performing the test is as follows (see Figure I.1, below).

Figure I.1
Allen test. Source: http://fitsweb.uchc.edu/student/selectives/TimurGraham/Modified_Allen
%27s_Test.html

1. Instruct the patient to clench his or her fist; if the patient is unable to do
this, close the person's hand tightly.
 2. Using your fingers, apply occlusive pressure to both the ulnar and radial
arteries, to obstruct blood flow to the hand.

3. While applying occlusive pressure to both arteries, have the patient relax
his or her hand, and check whether the palm and fingers have blanched. If
this is not the case, you have not completely occluded the arteries with
your fingers.

Release the occlusive pressure on the ulnar artery only to determine whether the modified
Allen test is positive or negative.

Positive modified Allen test If the hand flushes within 5-15 seconds it
indicates that the ulnar artery has good blood flow; this normal flushing of
the hand is considered to be a positive test.

Negative modified Allen test If the hand does not flush within 5-15
seconds, it indicates that ulnar circulation is inadequate or nonexistent; in
this situation, the radial artery supplying arterial blood to that hand should
not be punctured.