Allergic Conjunctivitis

Aka: Allergic Conjunctivitis, Hay fever Conjunctivitis, Irritant Conjunctivitis

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II. Causes

  1. Related to seasons or environmental change
    1. Recent exposure to pollen, grass
  2. Irritants
    1. Smog
    2. Chlorine
    3. Dust
    4. Cigarette smoke
  3. Iatrogenic: Topical Antibiotics
    1. Gentamicin and other Aminoglycoside eye preparations
    2. Sulfonamide eye preparations
    3. Neomycin eye preparations

III. Symptoms

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

IV. 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

V. Management: Approach

  1. General Measures
    1. Discontinue offending agents or medications
    2. Avoid allergans
    3. Consider Allergic Rhinitis management (oral Antihistamines, Intranasal Corticosteroids)
  2. Mild Symptoms
    1. Cold compress to eyes
    2. Artificial tears
  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)

VI. Management: Preparations

  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) 1-2 drops each eye twice daily
      1. Over the counter in U.S. as of 2020
    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
  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
    2. Severe: Diphenhydramine (Benadryl)
  5. Consider Intranasal Steroid
  6. Consider short course of oral Corticosteroids (3-5 days)
    1. Indicated for severe, refractory cases

VII. Resources: Patient Education

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

VIII. References

  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Cronau (2010) Am Fam Physician 81(2): 137-44 [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)

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