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Allergic Conjunctivitis Overview ·
Signs and symptoms of
inflammatory disease s of the eye overlap various conditions ·
Ocular complaints are
uncommonly the only complaint in allergic disease o
Perhaps 10% of the
cases, eye problems are the only manifestation of allergies ·
The sensitivity of the
eye to allergen-induced problems results in the frequent manifestations o
Itch, watering,
swelling, soreness o
These can often be the
most prominent features but not usually the only symptom Allergic Diseases of the Eye
·
Conjunctivitis:
Inflammation of the Conjunctiva ·
Broad spectrum of
problems can cause conjunctivitis o
Allergy – IgE-mediated
or cellular-mediated reactions o
Infection – Viral and
bacterial are most common o
Autoimmune – Uveitis,
episcleritis, vasculitis (RA, SLE, PAN, Wegner’s) o
Miscellaneous- Dry eye,
irritants, foreign body ·
Acute Allergic
Conjunctivitis (IgE-mediated) o
Seasonal (cedar, oak,
ragweed) o
Perennial (cat, dust
mite) ·
Vernal
Keratoconjunctivitis (VKC) o
Chronic mast
cell-epithelial-lymphocyte disorder o
Begins often in
grade-school boys and often resolves by 3rd decade o
Usually have year round
symptoms o
Tense pruritus
aggravated by non-specific triggers (wind, hot weather, etc) o
Papillary response on
the upper lid similar to that seen in giant papillary conjunctivitis o
Corneal symptoms include
photophobia, foreign body sensation, and giant papillae (7-8 mm) on the tarsal
conjunctiva o
Can lead to blindness o
While 50-60% have
positive skin tests, immunotherapy does not help ·
Atopic
Keratoconjunctivitis (AKC) o
More common than VKC and
seen in patients with eczema and asthma o
May begin in 20’s but
becomes more common as one gets older o
25% of elderly
eczematous patients have some AKC o
Intense pruritus,
thickened eyelids, and 40% of patients over 30 contract ocular herpes o
Symptoms are present on
year round basis with seasonal exacerbations o
In cases with severe
Atopic Dermatitis, cataracts occur in 10% of patients which involve the
anterior portion of the lens ·
Drug-Induced
Conjunctivitis/Contact Dermatitis of the Eyelids o
Usually delayed-type
hypersensitivity caused by cosmetics (e.g. hair dyes, nail polish), thimerosol,
neosporin, and agents used to treat glaucoma o
Stinging and burning are
the commonest complaints ·
Giant Papillary
Conjunctivitis o
Most often seen in
extended-wear soft contact lens o
Papillary hypertrophy of
the tarsal conjunctiva is seen in 5-10% of soft lens wearers ·
Tear Film Dysfunction o
Often seen in RA,
Sjogren’s syndrome, HIV disease o
Perimenopausal and
post-menopausal women, computer users, lens wearers o
Initially complain mild
injection and excessive mucus that is confused with SAC or PAC o
Gritty, sandy feeling
which usually worsens later in the day o
Anticholinergic
properties of antihistamines, TCAs, B-blockers, retinoids, etc. |
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