Allergic Conjunctivitis

Aka: Allergic Conjunctivitis, Hay fever Conjunctivitis, Irritant Conjunctivitis

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II. Epidemiology

  1. High Prevalence (up to 40% of the U.S. population)

III. Pathophysiology

  1. Mast Cell and IgE mediated Allergic Reaction

IV. Causes

  1. See Vernal Conjunctivitis
  2. Related to seasons or environmental change (esp. spring, summer, fall)
    1. Recent outdoor exposure to pollen, grass
    2. Perennial, indoor allergens (e.g. animal dander, Dust mites) may also cause Allergic Conjunctivitis
  3. Irritants
    1. Smog
    2. Chlorine
    3. Dust
    4. Cigarette smoke
  4. Iatrogenic: Topical Antibiotics
    1. May also cause chemical Conjunctivitis
    2. Gentamicin and other Aminoglycoside eye preparations
    3. Sulfonamide eye preparations
    4. Neomycin eye preparations

V. Symptoms

  1. Typically bilateral involvement
  2. Eye itching
    1. Pathognomonic for Allergic Conjunctivitis
  3. Eye tearing with stringy discharge
  4. Eye Fullness Sensation

VI. Signs

  1. Marked Conjunctival Hyperemia
  2. Marked Chemosis
  3. Red hypertrophic papillae on lid Conjunctival lining
    1. Best seen with Fluorescein
    2. Appears as cobblestoning
  4. Conjunctival edema
    1. Eye may appear to sink into Conjunctiva

VII. Management: Approach

  1. General Measures
    1. Discontinue offending agents or medications
    2. Avoid allergan exposures
    3. Consider Allergic Rhinitis management (oral Antihistamines, Intranasal Corticosteroids)
    4. Avoid Topical Decongestants
  2. Mild Symptoms
    1. Cold compress to eyes
    2. Artificial tears (preservative-free agents)
  3. Moderate Symptoms
    1. Ocular Antihistamines AND
    2. Ocular NSAIDs OR Ocular Mast Cell Stabilizers
  4. Severe Symptoms
    1. Continue agents used for mild and moderate symptoms as above AND
    2. Consider Topical Corticosteroid (e.g. loteprednol 0.2% or fluorometholone 0.1%)
      1. Exercise caution (exclude infection first) and refer to ophthalmology
    3. Other agents
      1. Topical NSAIDs (see below)
      2. Systemic Corticosteroids (short course)
      3. Immunomodulators (by ophthlamology or allergist)
        1. Omalizumab (Xolair)
        2. Cyclosporin A
        3. Tacrolimus

VIII. Management: Medications

  1. Ocular Mast Cell Stabilizers (preferred)
    1. Cromolyn Sodium (Crolom) 1 drop 4-6x/day
    2. Lodoxamide 0.1% (Alomide) 1-2 drops each eye four times daily
    3. Olopatadine 0.1% (Patanol, OTC in 2020) 1-2 drops each eye twice daily
    4. Ketotifen 0.025% (Alaway OTC, Zaditor) 1-2 drops each eye twice daily
      1. Less expensive and over-the-counter
  2. Ocular Antihistamines
    1. Naphazoline (Vasocon, Naphcon) 1 drop twice to four times daily prn
    2. Epinastine (Elestat) 0.05% 1 drop each eye twice daily
    3. Bepotastine (Bepreve) 1.5% 1 drop each eye twice daily
    4. Alcaftadine (Lastacraft, OTC as of 2022) 0.25% (2.5 mg/mL) one drop in each eye daily
  3. Ocular NSAIDs
    1. Ketorolac 0.5% (Acular) 1 drop four times daily for 7 days
    2. Diclofenac 0.1% (Voltaren) 1 drop four times daily
  4. Oral Antihistamine
    1. Mild to moderate: Non-Sedating Antihistamine (e.g. Cetirizine)
    2. Severe: Diphenhydramine (Benadryl)
  5. Consider Intranasal Steroid
  6. Consider short course of oral Corticosteroids (3-5 days)
    1. Indicated for severe, refractory cases

IX. Resources: Patient Education

  1. Information from your Family Doctor
    1. http://www.familydoctor.org/handouts/678.html

X. References

  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Bielory (2020) Ann Allergy Asthma Immunol 124(2):118-34 +PMID: 31759180 [PubMed]
  3. Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]
  4. Winters (2024) Am Fam Physician 110(2):134-44 [PubMed]

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Related Studies

Ontology: Allergic Conjunctivitis (C0009766)

Definition (MSHCZE) Zánět spojivek (konjunktivitida) způsobená alergickou reakcí. Existuje forma atopická (spojená s dalšími projevy atopie), sezónní (obv. reakce na pyl) a vernální. K. a. se projevuje pálením, řezáním a svěděním, někdy bývají otoky víček. Mohou být přítomny další projevy alergického onemocnění. Léčí se protialergickými léky (antihistaminika, inhibitory degranulace mastocytů, lokální kortikoidy). Srov. flykténa. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Conjunctivitis due to hypersensitivity to various allergens.
Concepts Disease or Syndrome (T047)
MSH D003233
SnomedCT 473460002, 231854006, 155168003, 193868008, 283401000009105, 20212001
English Allergic Conjunctivitides, Atopic Conjunctivitides, Conjunctivitides, Allergic, Conjunctivitides, Atopic, Conjunctivitis, Allergic, Conjunctivitis, Atopic, ALLERGIC CONJUNCTIVITIS, Conjunctivitis allergic, Conjunctivitis, Allergic [Disease/Finding], Conjunctivitis;allergic, allergic conjunctivitis, atopic conjunctivitis, Allergic conjunctivitis, Allergic conjunctivitis (disorder), Atopic conjunctivitis, Atopic conjunctivitis (disorder), atopic; conjunctivitis, conjunctivitis; allergic, conjunctivitis; atopic, allergic; conjunctivitis, Allergic Conjunctivitis, Atopic Conjunctivitis
French CONJONCTIVITE ALLERGIQUE, Conjonctivite allergique
German allergische Konjunktivitis, ALLERGISCHE KONJUNKTIVITIS, Konjunktivitis allergisch, Allergische Konjunktivitis, Konjunktivitis, allergische, Konjunktivitis, atopische, Allergische Bindehautentzündung, Bindehautentzündung, allergische
Swedish Bindhinneinflammation, allergisk
Japanese ｱﾚﾙｷﾞｰｾｲｹﾂﾏｸｴﾝ, 巨大乳頭状結膜炎, 結膜炎-アトピー性, 春季結膜炎, アトピー性結膜炎, 結膜炎-巨大乳頭状, 角結膜炎-春季, アレルギー性結膜炎, 結膜炎-春季, 春期結膜炎, アレルギー結膜炎, 春季角結膜炎, 結膜炎-アレルギー性, アトピー結膜炎
Czech konjunktivitida alergická, Alergická konjunktivitida
Finnish Allerginen sidekalvotulehdus
Russian KON"IUNKTIVIT VESENNII SO SVETOBOIAZN'IU I ZUDOM, KON"IUNKTIVIT ALLERGICHESKII, ALLERGICHESKII KON"IUNKTIVIT, KERATOKON"IUNKTIVIT VESENNII, KON"IUNKTIVIT ATOPICHESKII, KON"IUNKTIVIT VESENNII, АЛЛЕРГИЧЕСКИЙ КОНЪЮНКТИВИТ, КЕРАТОКОНЪЮНКТИВИТ ВЕСЕННИЙ, КОНЪЮНКТИВИТ АЛЛЕРГИЧЕСКИЙ, КОНЪЮНКТИВИТ АТОПИЧЕСКИЙ, КОНЪЮНКТИВИТ ВЕСЕННИЙ, КОНЪЮНКТИВИТ ВЕСЕННИЙ СО СВЕТОБОЯЗНЬЮ И ЗУДОМ
Portuguese CONJUTIVITE ALERGICA, Conjuntivite alérgica, Conjuntivite Alérgica, Conjuntivite Atópica
Italian Congiuntivite atopica, Congiuntivite allergica
Croatian KONJUNKTIVITIS, ALERGIJSKI
Polish Zapalenie spojówek alergiczne
Hungarian Allergiás conjunctivitis
Norwegian Allergisk konjunktivitt, Øyekatarr, allergisk, Konjunktivitt, allergisk, Allergisk bindehinnebetennelse, Allergisk øyekatarr, Akutt atopisk konjunktivitt, Allergisk øyebetennelse
Spanish conjuntivitis alérgica (trastorno), conjuntivitis alérgica, conjuntivitis atópica (trastorno), conjuntivitis atópica, Conjuntivitis alérgica, Conjuntivitis Alérgica, Conjuntivitis Atópica
Dutch allergisch; conjunctivitis, atopisch; conjunctivitis, conjunctivitis; allergisch, conjunctivitis; atopisch, conjunctivitis allergisch, Allergische conjunctivitis, Conjunctivitis, allergische, Conjunctivitis, atopische, Voorjaarsconjunctivitis, allergische conjunctivitis
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Conjunctival Disorders

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