Season – More common in summer. Hence, the name Spring catarrh is a misnomer. Recently it is being labelled as Warm weather conjunctivitis. Climate – More prevalent in the tropics. VKC cases are mostly seen in hot months of summer, therefore, more suitable term for this condition is "summer catarrh" Ref. Pathology
Conjunctival epithelium undergoes hyperplasia and sends downward projection into sub-epithelial tissue. Adenoid layer shows marked cellular infiltration by eosinophils, lymphocytes, plasma cells and histiocytes. Fibrous layer show proliferation which later undergoes hyaline changes. Conjunctival vessels also show proliferation, increased permeability and vasodilation. Diagnosis
Classification
Based on severity, authors have classified VKC into clinical grades:Grade 0 - Absence of symptoms
Grade 1 MILD - Symptoms but no corneal involvement
Grade 2 MODERATE - Symptoms with photophobia but no corneal involvement
Grade 3 SEVERE - Symptoms, photophobia, mild to moderate SPKs OR with Diffuse SPK or corneal ulcer

Treatment
Local therapy- Topical steroids are effective. Commonly used solutions are of fluorometholone, medrysone, betamethasone or dexamethasone. Mast cell stabilizers such as sodium cromoglycate (2%) drops 4–5 times a day are quite effective in controlling VKC, especially atopic ones. Azelastine eyedrops are also effective. Topical antihistamines can be used. Acetyl cysteine (0.5%) used topically has mucolytic properties and is useful in the treatment of early plaque formation. Topical Cyclosporine is reserved for unresponsive cases. Systemic therapy- Oral antihistamines and oral steroids for severe cases. Treatment of large papillae- Cryo application, surgical excision or supratarsal application of long-acting steroids.
Physicians in the Beard school of thought associated neurasthenia with the stresses of urbanization and with stress suffered as a result of the increasingly competitive business environment. Typically, it was associated with upper class people and with professionals working in sedentary occupations, but really can apply to anyone who lives within the monetary system. Freud included a variety of physical symptoms into this category, including fatigue, dyspepsia with flatulence, and indications of intra-cranial pressure and spinal irritation. In common with some other people of the time, he believed this condition to be due to "non-completed coitus" or the non-completion of the higher cultural correlate thereof, or to  "infrequency of emissions" or the infrequent practice of the higher cultural correlate thereof. Later, Freud formulated that in cases of coitus interruptus as well as in cases of masturbation, there was "an insufficient libidinal discharge" that had a poisoning effect on the organism, in other words, neurasthenia was the result of (auto‑)intoxication. Eventually he separated it from anxiety neurosis, though he believed that a combination of the two conditions existed in many cases.In 19th-century Britain and, by extension, across the British Empire, neurasthenia was also used to describe mental exhaustion or fatigue in “brain workers” or in the context of “overstudy”. This use was often synonymous with the term “brain fag”. Diagnosis
From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as weakness, dizziness and fainting. A common treatment promoted by neurologist S. Weir Mitchell was the rest cure, especially for women.