allergic conjunctivitis

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The patient with allergic conjunctivitis presents with:

  • intense itching
  • conjunctival oedema
  • apparent enophthalmos - the eyes sink into the surrounding oedematous tissue
  • hyperaemia may be relatively mild
  • allergic eye disease is generally seasonal

Major types of allergic conjunctivitis include:

  • atopic
  • vernal
  • pseudo-vernal
  • phlyctenular

Management principles:

  • avoidance of allergen if known
  • pharmaceutical management options include:
    • topical mast cell stabilisers
      • for example sodium cromoglycate
        • use throughout a period of allergen exposure
        • newer agents (e.g. lodoxamide and nedocromil) may be effective in those with an inadequate response to sodium cromoglicate

    • topical antihistamines may be useful
      • azelastine may also have additional mast cell stabilising properties
      • not a therapeutic option that is appropriate for prolonged use (no longer than six weeks)
      • not an appropriate treatment option in contact dermatoconjunctivitis

    • oral antihistamines such as loratadine or chlorphenamine may be used
      • especially useful when there is associated allergic rhinitis
      • can cause drowsiness, especially the older compounds such as chlorphenamine - patients need to be cautioned regarding this

    • in general, corticosteroid containing ointments or drops should be avoided unless the prescriber is able to monitor accurately for adverse effects (1) e.g. glaucoma, cataract - and also should only be used if certain of the diagnosis of allergic conjunctivitis

    • diclofenac eye drops - these are licensed for seasonal allergic conjunctivitis

    • oral corticosteroid therapy
      • a short (five-day) course may be used in severe cases where there is no doubt about the diagnosis
      • ophthalmologists may use oral steroids in severe cases of allergic conjunctivitis

Reference:

  • (1) Prescribers' Journal (2000), 40 (2), 130-137.
  • (2) Azari AA, Barney NP; Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23;310(16):1721-9.

Last reviewed 01/2018

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