Allergic conjunctivitis

February 8th, 2012 |

Author: Kantatasamsara

Allergic conjunctivitis:
Allergic conjunctivitis may be classified into the followings :
1. Simple Allergic conjunctivitis
2. Vernal conjunctivitis
3. Atopic conjunctivitis
4. Phlyctenular conjunctivitis
5. Giant papillary conjunctivitis
Allergic rhino conjunctivitis /Simple Allergic conjunctivitis:
1.Acute allergic rhinoconjunctivitis
2.seasonal allergic conjunctivitis ( hay fever), with onset during
the spring and summer .
3.perennial allergic conjunctivitis causes symptoms through out
the year with exacerbation in the autumn .
Diagnosis:

Presentation
Symtomps

Transient,acute attacks of redness, watering and itching.

Associated with sneezing and nasal discharge

Signslid oedemachemosis and a papillary reaction

Treatment:

Mast cell satbilizers

Antihistamines

Combined antihistamines and mast cell stabilizers

Steroids

Vernal kerato conjunctivitis:

Vernal
Keratoconjunctivitis is a bilateral, recurrent, disorder in which IGE and cell mediated
immune mechanisms plays important roles.It primarily affects boys and usually
presents in the first decade of life. 95% of cases remit by the late teens and the
remainder develops atopic keratoconjunctivitis.Classification:
o

Palpebral disease primarily involves the upper tarsal conjunctiva.

Limbal disease typically affects black and Asian people.

Mixed has features of both palpebral and limbal disease.

Diagnosis:

Symptoms consists of intense itching, which may be associated with

lacrimation,photophobia, a foreign body sensation, burning and thick mucoid
discharge
Palpebral disease

Diffuse papillary hypertrophy on the superior tarsus

Macropapillae(1mm)(cobblestones)

Giant papillae

Limbal disease

Gelatinous papillae on the limbal conjunctiva that may be associated with

discrete white spots at their apices(Trantas dots)

In tropical regions limbal disease may be very severe

Keratopathy

Punctate epithelial erosions

Epithelial macroerosions

Shield ulcer and plaque

Pseudogenerontoxon

Perpheral superficial vascularization

Herpes simplex keratirtis

Treatment:
o
o

Topical
Mast cell stabilizers

Antihistamines

Steroids

Acetylcysteine

Ciclosporin

Supratarsal steroid injection

Systemic

Immunosupressive agent

Oral antihistamines

Surgery

Superficial keratectomy

Amniotic membrance overlay graft

Atopic kerato conjunctivitis:

Atopic keratoconjunctivitis is a rare bilateral and symmetrical disease that typically
develops in young men following a long history of severe atopic dermatitis.
Diagnosis:
o
o

Symptomps are similar to VKC but often more severe and unremitting.
Eyelids

Red,thickened,macerated and fissured lids with chronic staphylococcal

blephiaritis and madarosis.

Tightening of the facial skin may cause lower lid ectropion and epiphora.

Conjunctiva

Micropapillary conjunctivitis

Giant papillae

Scarring and infiltration

Cicatricial conjunctivitis

Symblepharon

Keratopathy:

Punctate epithelial erosions

Persistent epithelial defect

Prediposing to keratoconus

Treatment:

Topical

Mast cell stabilizers

Ketorolac

Antihistamines

Steroids

Acetylcysteine

Ciclosporin

Antibiotics

Supratarsal steroid injection

Systemic antihistamines

Antibiotics

Ciclosporin

Phlyctenular conjunctivitis:

It is an allergicreaction of the conjunctiva caused by endogenous bacterial toxins and

characterised by bleb or nodule formation near the limbus.
o
o

Aetiology:
Tuberculo-protien

Toxins from staphylo-coccus or streptococcus.

Toxins from intestinal parasites.

Clinical types:

Phyctenular conjunctivitis

Phlyctenular kerato-conjunctivitis.

Phlyctenular keratitis.

Symptoms:

Redness with formation of bleb.

Irritation and lacrimation.

Pain and photophobia.

Signs:

One or more,small ,round and raised nodule at or near the limbus

Localised bubar congestion

No conjunctival discharge.

Secondary infection.

Complications:

Phlyctenular keratitis

Fascicular ulcer

Superficial phlyctenular pannus.

Ring ulcer.

Investigations:

To detect tuberculosis:

Sputum for AFB.

Blood for TLC,DLC,ESR.

X-ray chest.

Mantoux test.

ENT consultation to exclude chronic tonsilitis or adentis.

Stool for OPC.

Conjunctival swab and corneal scraping.

Treatment:

Corticosteroid eye drop.

In case of secondary infection, first treat bacterial conjunctivitis,by local

antibiotic drops and then treat with local cortico-steroid drops.

When cornea involved-atropin(1%) eye oinment

Improvement of the nutritional status

Treatement of causal factors.

Treatement of tuberculosis

Treatement of tonsilitis or adenitis

Antihelmintics for intestinal parasites.