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Allergic conjunctivitis

Background

Overview

Definition
Allergic conjunctivitis is an inflammatory disease of the conjunctiva caused by an allergic reaction.
1
Pathophysiology
The pathophysiology of allergic conjunctivitis involves exposure to allergens triggering an IgE-mediated hypersensitivity reaction, leading to mucosal inflammation and associated ocular symptoms.
1
Epidemiology
Allergic conjunctivitis is estimated to affect 6-30% of the general population.
2
Disease course
Clinically, allergic conjunctivitis presents with symptoms such as redness, itching, eye discharge, foreign body sensation, and swollen eyelids. Some patients may also experience burning and stinging, which can be attributed to chronic neuropathic pain.
3
Prognosis and risk of recurrence
The prognosis of allergic conjunctivitis is generally good. While it is a chronic condition, it can be effectively managed with treatment, including allergen avoidance, the use of antihistamines, and in some cases, specific immunotherapy.
4

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of allergic conjunctivitis are prepared by our editorial team based on guidelines from the American Academy of Ophthalmology (AAO 2022,2019), the Japanese Society of Allergology (JSA/JSOA 2022), the Brazilian Pediatric Ophthalmology Society (SBOP 2021), and the Spanish Ocular Surface and Cornea Group (GESOC/SEAIC 2015). ...
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Screening and diagnosis

Diagnostic criteria
As per GESOC/SEAIC 2015 guidelines:
Diagnose allergic conjunctivitis based on family and personal history of atopy, characteristic clinical signs and symptoms, and results of appropriate additional tests.
B
Use data of response to topical antihistamines and/or mastocyte stabilizers to support the diagnosis of allergic conjunctivitis.
A
Consider using the DECA criteria for clinical suspicion of allergic conjunctivitis.
C
DECA criteria for suspicion of allergic conjunctivitis
Bilateral conjunctival hyperemia
Bilateral ocular pruritus
Ocular symptoms associated with exposure to suspicious allergens
Association with other allergic diseases (rhinitis, asthma, atopic dermatitis)
Response to topical pharmacologic therapy (antihistamines, mast cell stabilizers, dual action agents)
Absence of giant papillary conjunctivitis
Absence of corneal involvement
Criteria are not met
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Medical management

Topical corticosteroids: as per AAO 2022 guidelines, consider offering topical corticosteroids in patients with acute exacerbations of vernal/atopic conjunctivitis.
B

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  • Topical antihistamines

  • Topical vasoconstrictors

  • Topical cyclosporine

  • Topical tacrolimus

  • Topical NSAIDs

  • Intranasal corticosteroids

  • Oral antihistamines

  • Oral leukotriene receptor antagonists

  • Systemic immunosuppressants

  • Specific immunotherapy

Nonpharmacologic interventions

Avoidance of allergens: as per AAO 2022 guidelines, advise environment modifications in patients with vernal/atopic conjunctivitis.
B

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  • Eye hygiene

Specific circumstances

Pediatric patients, nonpharmacological measures
As per SBOP 2021 guidelines:
Advise the following nonpharmacological measures:
general environmental measures to reduce exposure to allergens (such as elimination of domestic dust, fungi, and pollen)
specific actions such as the use of cold-water compresses, preservative-free artificial tears, and local cleansing with saline solution to wash the allergens from the conjunctiva and to contract the conjunctival vessels to relieve edema and hyperemia
A
Consider advising to wear sunglasses to prevent contact with suspended allergens and for photophobia relief.
B

More topics in this section

  • Pediatric patients (pharmacotherapy)

  • Pediatric patients (immunotherapy)