Allergic Conjunctivitis

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Allergic conjunctivitis is common, especially during the allergy season. Consultation with the allergist to perform skin tests or in vitro tests may be useful and confirmatory in the diagnosis of ocular allergy. If treatment is necessary, antihistamines, mast cell stabilizers, and nonsteroidal anti-inflammatory drugs are safe and reasonably effective. Corticosteroids are an order of magnitude more potent than noncorticosteroids; however, they have attendant side effects that are best monitored by the ophthalmologist. The development of “modified” corticosteroids has been a boon to the treatment of ocular allergy because these drugs may reduce potential side effects without sacrificing potency.

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History

A detailed history may reveal recent exposure to individuals who have conjunctivitis or upper respiratory tract infection within the family, school, or workplace. Such a history may help confirm an adenovirus infection in an endemic area. Knowledge of the patient's sexual activities and any associated discharge may suggest chlamydial disease or Neisseria infection. Frequently, the patient does not mention the use of over-the-counter topical medications such as vasoconstrictors or artificial

Examination

The eye should be carefully examined for evidence of eyelid involvement (ie, blepharitis, dermatitis, swelling, discoloration, ptosis, blepharospasm), conjunctival involvement (ie, chemosis), hyperemia, palpebral and bulbar papillae, cicatrization, and presence of increased or abnormal-appearing secretions. In addition, a funduscopic examination should be performed for uveitis associated with autoimmune disorders and chronic steroid use.

The bulbar conjunctiva is examined by looking directly at

Seasonal and perennial allergic conjunctivitis

Because SAC and PAC are linked to allergic rhinitis (more commonly known as allergic rhinoconjunctivitis), they are the most prevalent forms of ocular allergy [7], [23], [24], [25]. Of the two, SAC is more common. The importance of this condition is due more to its frequency than its severity [21].

Procedures

Scraping the conjunctival surface to look for eosinophils is a helpful diagnostic test. The procedure is done by placing a drop of topical anesthetic such as tetracaine hydrochloride 0.5% in the lower conjunctival sac. The anesthetic takes effect within 10 seconds. Using a platinum spatula, the inner surface of the lower lid is gently scraped several times. The material is then spread on a microscope slide. The slide is stained with Hansel stain, Giemsa stain, or another common reagent. Slides

Late-phase reaction

A conjunctival late-phase reaction (LPR) has been described [38], [39], [40], [41]. In the guinea pig model used by Leonardi and colleagues [42], the LPR manifested in several forms, including a classic biphasic response (33%), a multiphasic response (25%), and a single prolonged response (41%). The histologic evaluation of the conjunctiva revealed the typical influx of nonspecific cells of the inflammatory response, including neutrophils, basophils, and eosinophils. Tears collected from timed

Antihistamines

Antihistamines may be given systemically to relieve allergic symptoms. These drugs may only partially relieve ocular symptoms, and patients often complain of side effects such as drowsiness and dryness of the eyes, nose, and mouth. Antihistamines such as antazoline and pheniramine are available as eye drops and are usually combined with a topical vasoconstrictor such as naphazoline hydrochloride. These antihistamine-vasoconstrictor eye drops are now available over-the-counter and are useful in

Summary

Allergic conjunctivitis is common, especially during the allergy season. Ocular symptoms are usually accompanied by nasal symptoms, and there may be other allergic events in the patient's history that support the diagnosis of ocular allergy. Diagnostic tests can be helpful, especially conjunctival scrapings, to look for eosinophils. Consultation with the allergist to perform skin tests or in vitro tests may be useful and confirmatory in the diagnosis of ocular allergy. Symptoms may be mild, and

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      While first-generation oral antihistamines may partially relieve ocular and nasal symptoms, they may also cause or exacerbate ocular surface dryness, which may impair the protective barrier provided by the ocular tear film (Bielory & Friedlaender, 2008). Combining topical antihistamines and vasoconstrictor may also be useful in the short-term treatment of mild allergic conjunctivitis (Bielory & Friedlaender, 2008). However, adverse effects include burning and stinging on instillation, mydriasis, and rebound hyperaemia or conjunctivitis medicamentosa with chronic use (Sánchez et al., 2011).

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