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Allergic conjunctivitis

Updated August 17, 2024

Background

Overview

Definition

Allergic conjunctivitis is an inflammatory disease of the conjunctiva caused by an allergic reaction.

Pathophysiology

The pathophysiology of allergic conjunctivitis involves exposure to allergens triggering an IgE-mediated hypersensitivity reaction, leading to mucosal inflammation and associated ocular symptoms.

Epidemiology

Allergic conjunctivitis is estimated to affect 6-30% of the general population.

Risk factors

Risk factors for allergic conjunctivitis include a personal or familial predisposition to allergies, along with environmental elements that augment exposure to allergens. These allergens may include pollen, dust mites, animal dander, pollutants, and fungal allergens.

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.

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.

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 Family Physicians (AAFP 2024), 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 ...

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.

Use data of response to topical antihistamines and/or mastocyte stabilizers to support the diagnosis of allergic conjunctivitis.

Consider using the DECA criteria for clinical suspicion of allergic conjunctivitis.

DECA criteria for suspicion of allergic conjunctivitis

Calculator

When to use

Bilateral conjunctival hyperemia

Yes

Bilateral ocular pruritus

Yes

Ocular symptoms associated with exposure to suspicious allergens

Yes

Association with other allergic diseases rhinitis, asthma, atopic dermatitis)

Yes

Response to topical pharmacologic therapy antihistamines, mast cell stabilizers, dual action agents)

Yes

Absence of giant papillary conjunctivitis

Yes

Absence of corneal involvement

Yes

Calculation

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The DECA criteria is a clinical calculator used for the suspicion of allergic conjunctivitis. DECA stands for Discomfort, Eosinophils, Conjunctival hyperemia, and Antigen exposure. This scoring system applies to patients presenting with eye discomfort, particularly those with a history of allergies or exposure to potential allergens. The clinical utility of the DECA criteria is to aid in the diagnosis of allergic conjunctivitis, a common eye condition characterized by inflammation of the conjunctiva due to allergic reactions. It helps clinicians to differentiate allergic conjunctivitis from other types of conjunctivitis, such as bacterial or viral, based on the presence of specific signs and symptoms. Exclusion criteria for the use of the DECA criteria may include patients with other known eye conditions or infections, those with a history of eye surgery or trauma, and those who do not have a history of allergies or exposure to allergens. It's also important to note that the DECA criteria should be used in conjunction with a comprehensive clinical assessment and not as a standalone diagnostic tool.

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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.

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Nonpharmacologic interventions

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

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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

Consider advising to wear sunglasses to prevent contact with suspended allergens and for photophobia relief.

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