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Allergic conjunctivitis: symptoms, treatment
Last reviewed: 23.04.2024
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Allergic conjunctivitis is an acute recurrent or chronic inflammation of the conjunctiva caused by allergens. Symptoms include itching, lacrimation, discharge and conjunctival hyperemia. The diagnosis is established clinically. Treatment is carried out by local antihistamines and stabilizers of mast cell membranes.
Allergic conjunctivitis has the following synonyms: atopic conjunctivitis; atopic keratoconjunctivitis; hay fever; long-term allergic conjunctivitis; seasonal allergic conjunctivitis; spring keratoconjunctivitis.
[What causes allergic conjunctivitis?
Allergic conjunctivitis develops as a type I hypersensitivity reaction to a specific antigen.
Seasonal allergic conjunctivitis (conjunctivitis of hay fever) is associated with the pollen of trees, grasses or tobacco in the air. Has a tendency to reach a peak during spring and late summer. Disappears during the winter months, corresponding to the life cycle of plants that cause allergic conjunctivitis.
Chronic allergic conjunctivitis (atopic conjunctivitis, atonic keratoconjunctivitis) is associated with dust particles, animal dander and other off-season allergens. These allergens, especially domestic ones, tend to cause symptoms all year round.
Spring keratoconjunctivitis is the most severe type of conjunctivitis, probably of an allergic nature. It occurs most often in males aged 5 to 20 years, who also have eczema, asthma, or seasonal allergies. Spring conjunctivitis usually appears every spring and comes to a decline in winter. Often passes with the child's growing up.
Symptoms of allergic conjunctivitis
Patients complain of intense itching of both eyes, redness of the conjunctiva, photophobia, eyelid edema and a watery or viscous discharge. Often occurs concomitant rhinitis. Many patients have other atopic diseases, such as eczema, allergic rhinitis or asthma.
Symptoms of allergic conjunctivitis include edema, conjunctival hyperemia and often a viscous mucosal discharge, containing numerous eosinophils. The conjunctiva of the eyeball may appear transparent, bluish and thickened. Often marked chemosis and characteristic flabby edema of the lower eyelid. With seasonal and chronic allergic conjunctivitis small papillae on the conjunctiva of the upper eyelid have a velvety appearance. Chronic itching can lead to chronic rubbing of the eyelids, periocular hyperpigmentation and dermatitis.
In the most severe forms of chronic allergic conjunctivitis, large papillae can be seen on the tarsal conjunctiva, scarring of the conjunctiva, neovascularization of the cornea and its scarring with varying degrees of loss of visual acuity.
When spring keratoconjunctivitis is usually involved in the conjunctiva of the upper eyelid, but sometimes the conjunctiva of the eyeball is affected. Palpebral form on the conjunctiva of the superior cartilage is mainly rectangular, dense, flattened, closely located, from pale pink to grayish papillae in the form of a cobblestone pavement. The uninvolved tarsal conjunctiva is milky white. With the eye "limbal" form, the conjunctiva around the cornea becomes hypertrophic and grayish. Sometimes there is a defect of the corneal epithelium of a rounded shape, leading to pain and increased photophobia. Symptoms usually disappear in the colder months of the year and become less pronounced with age.
How to recognize allergic conjunctivitis?
The diagnosis is usually established clinically. In scrapings with conjunctiva, which can be taken from the upper or lower tarsal conjunctiva, there are eosinophils; However, such a study is rarely shown.
How is allergic conjunctivitis treated?
The elimination of allergens and the use of tear replacements can alleviate the symptoms; sometimes specific immunotherapy helps. Eye preparations containing a combination of antihistamine and vasoconstrictor components (for example, nafazoline / phenyramine) are useful in uncomplicated cases. If these drugs are not sufficient, antihistamines (eg, olopatadine, ketotifen), NSAIDs (eg ketorolac) or mast cell membrane stabilizers (eg, pemirolaste, nedocromil) can be used separately or in combination. In resistant cases, local glucocorticoids (for example, loteprednola drops, 0.1% fluorometholone, 0.12 to 1% prednisolone acetate, 2 times a day) can be useful. Because local glucocorticoids can contribute to the infection of the eye with the herpes simplex virus, possibly the leading cause of corneal ulceration and perforation, and with prolonged use lead to glaucoma and, possibly, cataracts, their use is prescribed and controlled by an ophthalmologist. Local topical administration of cyclosporine is indicated where glucocorticoids are needed, but can not be used.
Seasonal allergic conjunctivitis to a lesser degree requires the appointment of medications, possibly intermittent use of local glucocorticoids.