Allergic Conjunctivitis
Purpose of review: The focus of this review is to provide a logical paradigm for the diagnosis and treatment of ocular allergies, with a focus on seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC).
Recent findings: Several classes of topical medications are currently available for the management of ocular allergies, including: lubricating agents, vasoconstrictors, antihistamines, mast cell stabilizers, and topical corticosteroids.
Summary: SAC and PAC make up the vast majority of ocular allergy cases. A proactive approach to these diseases, anticipating the regional spring and fall allergen spikes, is needed for optimally managing these disorders. A multifaceted treatment regimen comprising patient education, lifestyle modification, and topical medications (such as antihistamines and/or mast cell stabilizers and corticosteroids) may be required in order to manage ocular allergies effectively. The appropriate treatment paradigm is based on the severity of the patients' signs and symptoms. For moderate-to-severe cases, especially chronic vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis, comanagement with an ophthalmologist is recommended.
Allergic conjunctivitis is a group of ocular surface diseases that are typically associated with type 1 hypersensitivity reactions. Allergic conjunctivitis is often underdiagnosed, as it is a comorbid condition of rhinitis and asthma. It can also be difficult to differentiate allergic conjunctivitis from other ocular surface disorders, as these may share some of the same signs and symptoms. Studies have estimated the prevalence of allergic conjunctivitis to range between 15 and 40% of the population. The onset of seasonal allergic conjunctivitis (SAC, also called hay fever conjunctivitis), the most common form of allergic conjunctivitis, coincides with regional seasonal increases in circulating allergens, such as grass pollens. SAC is not generally considered to be serious or sight-threatening but causes much discomfort and loss of productivity during the spring and fall allergy seasons. Individuals with perennial allergic conjunctivitis (PAC) experience symptoms throughout the year; however, seasonal spikes can occur. SAC and PAC comprise most of the allergic conjunctivitis cases (about 95% in the United States) and will be the focus of this review.
Both SAC and PAC are IgE-mediated events for which the mast cell response leads to the release of histamine, leukotrienes, prostaglandins, and other mediators. The acute response is rapid, usually taking place within 30 min. An upregulation of adhesion molecules follows, with an increased infiltration of inflammatory cells (i.e. mast cells and eosinophils) into the conjunctival epithelium. During the delayed phase, additional mast cell activation occurs within the conjunctiva, which increases the severity of the response.
The other types of allergic conjunctivitis (other than SAC and PAC) are considered more serious, and referral to an ophthalmologist is generally warranted. Chronic vernal keratoconjunctivitis (VKC) is associated with conjunctival scarring, eyelid thickening, ptosis, corneal neovascularization, ulceration, thinning, infection, keratoconus, and vision loss. Individuals suffering from atopic keratoconjunctivitis (AKC) can experience eyelid tightening, loss of eyelashes, and cataracts in addition to the sequelae mentioned for VKC. Giant papillary conjunctivitis (GPC) is associated with eyelid inflammation, which can cause ptosis or a drooping of the eyelid.
Abstract and Introduction
Abstract
Purpose of review: The focus of this review is to provide a logical paradigm for the diagnosis and treatment of ocular allergies, with a focus on seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC).
Recent findings: Several classes of topical medications are currently available for the management of ocular allergies, including: lubricating agents, vasoconstrictors, antihistamines, mast cell stabilizers, and topical corticosteroids.
Summary: SAC and PAC make up the vast majority of ocular allergy cases. A proactive approach to these diseases, anticipating the regional spring and fall allergen spikes, is needed for optimally managing these disorders. A multifaceted treatment regimen comprising patient education, lifestyle modification, and topical medications (such as antihistamines and/or mast cell stabilizers and corticosteroids) may be required in order to manage ocular allergies effectively. The appropriate treatment paradigm is based on the severity of the patients' signs and symptoms. For moderate-to-severe cases, especially chronic vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis, comanagement with an ophthalmologist is recommended.
Introduction
Allergic conjunctivitis is a group of ocular surface diseases that are typically associated with type 1 hypersensitivity reactions. Allergic conjunctivitis is often underdiagnosed, as it is a comorbid condition of rhinitis and asthma. It can also be difficult to differentiate allergic conjunctivitis from other ocular surface disorders, as these may share some of the same signs and symptoms. Studies have estimated the prevalence of allergic conjunctivitis to range between 15 and 40% of the population. The onset of seasonal allergic conjunctivitis (SAC, also called hay fever conjunctivitis), the most common form of allergic conjunctivitis, coincides with regional seasonal increases in circulating allergens, such as grass pollens. SAC is not generally considered to be serious or sight-threatening but causes much discomfort and loss of productivity during the spring and fall allergy seasons. Individuals with perennial allergic conjunctivitis (PAC) experience symptoms throughout the year; however, seasonal spikes can occur. SAC and PAC comprise most of the allergic conjunctivitis cases (about 95% in the United States) and will be the focus of this review.
Both SAC and PAC are IgE-mediated events for which the mast cell response leads to the release of histamine, leukotrienes, prostaglandins, and other mediators. The acute response is rapid, usually taking place within 30 min. An upregulation of adhesion molecules follows, with an increased infiltration of inflammatory cells (i.e. mast cells and eosinophils) into the conjunctival epithelium. During the delayed phase, additional mast cell activation occurs within the conjunctiva, which increases the severity of the response.
The other types of allergic conjunctivitis (other than SAC and PAC) are considered more serious, and referral to an ophthalmologist is generally warranted. Chronic vernal keratoconjunctivitis (VKC) is associated with conjunctival scarring, eyelid thickening, ptosis, corneal neovascularization, ulceration, thinning, infection, keratoconus, and vision loss. Individuals suffering from atopic keratoconjunctivitis (AKC) can experience eyelid tightening, loss of eyelashes, and cataracts in addition to the sequelae mentioned for VKC. Giant papillary conjunctivitis (GPC) is associated with eyelid inflammation, which can cause ptosis or a drooping of the eyelid.
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