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Allergic conjunctivitis

Definition
Allergic conjunctivitis is an inflammatory disease of the conjunctiva caused by an allergic reaction.
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Pathophysiology
The pathophysiology of allergic conjunctivitis involves exposure to allergens triggering an IgE-mediated hypersensitivity reaction, leading to mucosal inflammation and associated ocular symptoms.
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Epidemiology
Allergic conjunctivitis is estimated to affect 6-30% of the general population.
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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.
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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.
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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 Japanese Society of Allergology (JSA/JSOA 2022), the American Academy of Ophthalmology (AAO 2022; 2019), the Brazilian Pediatric Ophthalmology Society (SBOP 2021), and the Spanish Ocular Surface and Cornea Group (GESOC/SEAIC 2015).
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Guidelines

1.Screening and diagnosis

Diagnostic criteria
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
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2.Medical management

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

More topics in this section

  • Topical antihistamines

  • Topical vasoconstrictors

  • Topical cyclosporine

  • Topical tacrolimus

  • Topical NSAIDs

  • Intranasal corticosteroids

  • Oral antihistamines

  • Oral leukotriene receptor antagonists

  • Systemic immunosuppressants

  • Specific immunotherapy

3.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

4.Specific circumstances

Pediatric patients, nonpharmacological measures
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)