The classical symptoms of allergic conjunctivitis include itching, redness in the white of the eye, eyelid swelling, eye discharge, tearing, photophobia and foreign body sensation often associated with pain [4] [5], which usually concerns both eyes without compromising vision. Itching is undoubtedly the most typical of these symptoms, being reported by more than 75% of the people showing signs of AC [4]. Without itching the diagnosis of AC is suspect. Symptoms can sometime be seasonal and usually are marked in patients living in areas with warm and dry weather [5]. In certain situations the symptoms might affect patient’s life, limiting common activities like going outdoor, driving, or reading [4].

According to the nature of allergen, there are 5 main types of AC:

• Seasonal allergic conjunctivitis and perennial allergic conjunctivitis: Seasonal allergic conjunctivitis (SAC) is undoubtedly the most common form of ocular allergy [5] [6] and comes when the eye is exposed to allergens with seasonal occurrence like grass and weed pollens. The symptoms, conjunctival injection, chemosis and discharge, tend to last a few weeks and appear in different moments of the year [7]. The affected subjects tend to be symptom-free during winter months, when due to the meteorological conditions the airborne transmission of allergens decreases. Perennial allergic conjunctivitis (PAC) is a particular form of AC which presents itself when the symptoms become perennial. It is mainly due to house dust mite, mold or animal dander and is usually associated with perennial allergic rhinitis and symptoms like sneezing and runny nose. These signs tend to be worse each morning when the subject wakes up.
• Vernal keratoconjunctivitis: Vernal keratoconjunctivitis (VKC) is characterized by the marked itching, burning and conjunctival injection, and sometime is associated with the involvement of the cornea. Other key symptoms include photophobia, intense lacrimation, watery discharge and eyelid heaviness. This type of conjunctivitis is bilateral, chronic and much less common in the general population, although particularly frequent in young boys. 
• Atopic keratoconjunctivitis: The symptoms of atopic keratoconjunctivitis (AKC) are similar to those of VKC, even though they appear to be perennial. It is a manifestation of atopy, the predisposition to develop certain allergic hypersensitivity reactions and its symptoms might even appear after several years from the onset of the atopy itself. This inflammation involves the eyelids through a bilateral itching generally associated with the classical symptoms of watery discharge, redness, photophobia and pain. Loss of eyelashes and the appearance of papillary hypertrophy in the underside of the upper lid are also quite common. In severe cases, scarring of the conjunctiva, corneal neovascularization, ulcers an scars may occur.
• Giant papillary conjunctivitis: Giant papillary conjunctivitis (GPC) is the inflammation of the conjunctiva [8] lining the upper eye generally associated with the use of contact lens. The exact cause of this condition is unclear, even though the possible reagent might be debris or dust caught behind the lens itself. The primary symptoms are itching, mucoid discharge and a persistent foreign body sensation when using contact lenses, which might result in a potential visual acuity reduction. Very common is also the emergence of small papillae that, when combined, can give the eye a cobblestone appearance. 

AC can sometime be passed down from generation to generation in the same families, and might include reactions to some medicines such as eye drops or contact lens solutions.

• Inflammation

  Allergic conjunctivitis is characterised by an allergic inflammation on the eye surface. It may manifest alone or accompanied by other allergic diseases, such as allergic rhinitis. Allergic disorders of the eye are very common. [alergia.leti.com]

  Make an Appointment Conjunctivitis means inflammation of the conjunctiva. The conjunctiva is the transparent ‘skin’ that covers the white part of the eyes and the inside of the eyelids. [londonallergy.com]

  Definition Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Allergic conjunctivitis is common, especially during the allergy season. [flipper.diff.org]

  Contact dermatoconjunctivitis and giant papillary conjunctivitis occasionally cause inflammation and ulceration of the cornea (keratitis). Some permanent loss of vision may occur if these are left untreated. [provisu.ch]

  Conjunctivitis refers to any inflammation of the conjunctiva, which can be triggered by different agents. [symptoma.com]

• Pain

  Seasonal conjunctivitis is characterised by itching and a sensation of burning or sharp pain, watery eyes or reddening of the conjunctiva. The symptoms progress with exacerbations and remissions during the entire allergy season. [alergia.leti.com]

  Pain : Infective conjunctivitis is more likely to have pain with increased itching and irritation. Severe allergic conjunctivitis can mimic infective closely. [allergyadvice.com]

  The eyes are generally uncomfortable, but are not normally particularly painful. [myvmc.com]

  The eyes become irritated as the small capillaries in the conjunctiva membrane dilate. • Pain—some individuals may have pain in one or both eyes. [pharmacytimes.com]

• Fever

  Antihistamine tablets can also be helpful, and will usually control hay fever also. Perennial Allergic Conjunctivitis (PAC) is rarer than SAC but produces similar symptoms. [college-optometrists.org]

  Management Topical cromolyn, vasoconstrictors, cold compresses, oral antihistamines, air-conditioning. allergic conjunctivitis Ophthalmology Allergy-induced conjunctival inflammation which may accompany hay fever Clinical Itchy, red, tearing eyes Management [medical-dictionary.thefreedictionary.com]

  Spring and fall tend to be the two main hay fever seasons. [entofwarrensburg.com]

  Seasonal allergic conjunctivitis, or hay fever, is the most common type of ocular allergy. [umkelloggeye.org]

  Steroid injections - eg, triamcinolone (Kenalog®): years ago it was common for patients to ask their doctor for a steroid injection once per hay fever 'season'. This could be quite effective in reducing the symptoms of hay fever. [patient.info]

• Chills

  Using chilled tear supplements and cold compresses and avoiding known allergens can help reduce symptoms. Drops that have an antihistamine, such as ketotifen, may be enough for mild cases. This drug can be bought without a prescription. [merckmanuals.com]

  Chilled tears, as well as any topical medication, provide an added degree of relief, as well as homeopathic vasoconstriction. [emedicine.medscape.com]

  The symptoms can be alleviated with artificial tears (chilled for a soothing effect) or cool compresses. Antibiotic drops or ointment are not indicated, as these are anti-bacterial, not anti-viral. [visionaware.org]

• Asymptomatic

  METHODS: Thirteen asymptomatic patients (24.7 ± 2.8 years) with proven seasonal allergic conjunctivitis due to cedar pollen were studied. [ncbi.nlm.nih.gov]

  At least 50 percent of affected adults have concurrent, possibly asymptomatic chlamydial urethritis or cervicitis. 15 – 17 Coin-fection with pathogens that cause other sexually transmitted diseases (e.g., syphilis and gonorrhea) is not uncommon. [aafp.org]

• Rhinitis

  It may manifest alone or accompanied by other allergic diseases, such as allergic rhinitis. Allergic disorders of the eye are very common. Seasonal conjunctivitis is the most common form and is generally associated to rhinitis in 65% of cases. [alergia.leti.com]

  SUMMARY: Little focus has been set on the impact of allergic conjunctivitis as comorbidity to asthma and rhinitis in atopic patients. [ncbi.nlm.nih.gov]

• Cough

  The common symptoms of eye allergies are: Redness Itchiness Burning feeling Watery eyes Swollen eyelids Feeling like there is dirt or grit in your eyes You may also have a runny or itchy nose, sneezing, coughing or a sinus headache. [aafa.org]

  Post nasal drip symptoms—chronic cough, hoarse voice and dripping down the back of your throat—are easily remedied with steroid nasal sprays. If you’re pregnant though, you may wonder if they’re safe to use. [goodrx.com]

  You can also have a headache, an itchy or sore throat or coughing. What causes eye allergies? An allergy is when the body’s immune system reacts to an allergen that is normally harmless. [aao.org]

• Rhinorrhea

  Symptoms (sneezing, rhinorrhea, nasal obstruction, ocular itching, and lacrimation) were assessed in each subject along with the activities of daily living (ADL) score and the total ocular symptom score for allergic conjunctivitis. [ncbi.nlm.nih.gov]

  Common symptoms of nonallergic rhinitis include nasal congestion, postnasal drip, rhinorrhea, and sneezing, with no allergic etiology. The differential diagnosis of rhinitis can include allergic, nonallergic and mixed rhinitis. [clinicaladvisor.com]

  Oral antihistamines (eg, fexofenadine, cetirizine, or hydroxyzine) can be helpful, especially when patients experience other allergic symptoms (eg, rhinorrhea). [msdmanuals.com]

  Oral antihistamines (eg, fexofenadine, cetirizine, or hydroxyzine ) can be helpful, especially when patients experience other allergic symptoms (eg, rhinorrhea). [merckmanuals.com]

• Eczema

  People with SAC often have allergic symptoms affecting the nose, throat and sinuses, and they may have asthma, eczema and food or drug allergy also. [college-optometrists.org]

  These patients usually have a personal history of systemic allergies, like asthma, allergic rhinitis, or eczema. This is one of the two Allergic Conjunctivitis that may be vision threatening. [eyesurgeonsnyc.com]

  It is more frequent in men and occurs in up to 25% of patients with atopic eczema. There is usually a personal or family history of atopic disease. [worldallergy.org]

  It is most common among males aged 5 to 20 years who also have eczema, asthma, or seasonal allergies. Vernal keratoconjunctivitis typically reappears each spring and subsides in the fall and winter. [msdmanuals.com]

  Atopic forms of keratoconjunctivitis are associated with hay fever (allergic rhinitis), asthma and eczema. [dermnetnz.org]

• Dermatitis

  Atopic keratoconjunctivitis (AKC) AKC refers to inflammation of the conjunctiva and eyelids, which is most commonly bilateral and strongly linked to atopic dermatitis. [myvmc.com]

  In 1953, Hogan first described the association between atopic dermatitis and conjunctival inflammation. [2] He reported 5 cases of conjunctival inflammation in male patients with atopic dermatitis. [2] Atopic dermatitis is a common hereditary disorder [emedicine.medscape.com]

  Allergic conjunctivitis can be seasonal (during one time of year) or perennial (year-round), atopic keratoconjunctivitis (associated to atopic dermatitis), contact or vernal (chronic variety associated to states of atopia or allergy). [alergia.leti.com]

  The effectiveness of oral tolerance has been reported in the context of autoimmune diseases, food allergies, asthma, atopic dermatitis, and allergic rhinitis in both human patients and animal models. [ncbi.nlm.nih.gov]

• Flushing

  Normal vision Absence of focal pathology (eg stye or blepharitis ) The following "red flags" point to other more serious diagnoses, such as keratitis ( inflammation of the cornea ), iritis, or angle closure glaucoma : Changes in visual acuity Ciliary flush [dermnetnz.org]

  Careful flushing of the eyes with saline is a standard treatment for chemical conjunctivitis. People with chemical conjunctivitis also may need to use topical steroids. [aoa.org]

  Sometimes flushing and cleaning the eye to rid it of the chemical or object causes redness and irritation. Signs and symptoms, which may include watery eyes and a mucous discharge, usually clear up on their own within about a day. [mayoclinic.org]

• Pruritus

  Symptoms include burning, foreign-body sensation, and discomfort rather than pruritus. [mdedge.com]

  Abstract Seasonal and perennial allergic conjunctivitis are IgE-mediated, hypersensitivity conditions characterized by ocular pruritus, epiphora, and hyperemia. Proper diagnosis is usually made clinically based on history and physical examination. [ncbi.nlm.nih.gov]

  […] thinning, infection, keratoconus, and vision loss Atopic keratoconjunctivitis: eyelid tightening, loss of eyelashes, cataracts Giant papillary conjunctivitis : eyelid inflammation and ptosis Clinical features History of allergy, asthma, or eczema Itching (pruritus [pathologyoutlines.com]

  The positivity of the challenge may be assessed by a sign and symptom scoring system that includes subjective and objective signs such as conjunctival erythema, chemosis, tearing, and pruritus. [flipper.diff.org]

• Photosensitivity

  Its clinical signs (itching, tearing, conjunctival hyperaemia and oedema and, in some cases when the cornea is also involved, blurred vision, photosensitivity) are similar to other forms of allergic conjunctivitis. [ncbi.nlm.nih.gov]

  Common signs and symptoms are foreign body sensation, dry ocular surface, itchy eyes, photosensitivity, hyperemia, chemosis, tearing and lid swelling, he said. [healio.com]

  Symptoms and Signs of Allergic Conjunctivitis Patients with allergic conjunctivitis report having Bilateral mild to intense ocular itching Conjunctival hyperemia Photosensitivity (photophobia in severe cases) Eyelid edema Watery or stringy discharge Concomitant [msdmanuals.com]

  Symptoms and Signs Patients with allergic conjunctivitis report having Bilateral mild to intense ocular itching Conjunctival hyperemia Photosensitivity (photophobia in severe cases) Eyelid edema Watery or stringy discharge Concomitant rhinitis is common [merckmanuals.com]

• Photophobia

  Photophobia : The bright light can be annoying in allergic but severe photophobia is usually indicative of infective conjunctivitis. Discharge : Drainage tends to be more copious, thicker and more yellow or dark greenish in infective conjunctivitis. [allergyadvice.com]

  This inflammation involves the eyelids through a bilateral itching generally associated with the classical symptoms of watery discharge, redness, photophobia and pain. [symptoma.com]

  The ocular surface inflammation (usually mast cell driven) results in itching, tearing, lid and conjunctival edema-redness, and photophobia during the acute phase and can lead to a classic late-phase response (with associated eosinophilia and neutrophilia [ncbi.nlm.nih.gov]

  (itching, watering, photophobia; range 0‐3) (redness; range 0‐3) 14 days Itching: Mean (SD): 0.33 (0.60) Watering: Mean (SD): 0.03 (0.15) Photophobia: Mean (SD): 0.05 (0.22) Itching: Mean (SD): 1.09 (0.52) Watering: Mean (SD): 0.40 (0.66) Photophobia [dx.doi.org]

• Chemosis

  The degree of conjunctival injection and chemosis was also determined by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. [ncbi.nlm.nih.gov]

  Chemosis (swelling of the conjunctiva) seen under the microscope … see my chemosis video 5. Papillary “bumps” on the inner surface of the eyelids. [rooteyedictionary.com]

• Blepharitis

  Signs Red, thickened, scaly and occasionally fissured lids (lid eczema and blepharitis). Cicatrisation of the conjunctiva in advanced cases. Keratopathy (including keratoconus). [patient.info]

  Patients who have blepharitis, dry eye, and other types of conjunctivitis may experience itching. It is worthwhile to pinpoint the location of itching. [flipper.diff.org]

  […] are characterised by: Redness and discharge in one or both eyes Diffuse redness around the globe including the underside of the upper and lower lids Adhesion of the upper and lower eyelids on waking Normal vision Absence of focal pathology (eg stye or blepharitis [dermnetnz.org]

• Conjunctival Injection

  The temperature increase was significantly correlated with the conjunctival injection scores (r = 0.63; p < 0.001). [ncbi.nlm.nih.gov]

  Atopic keratoconjunctivits (AKC) Bilateral conjunctival injection with associated eczematoid belpharitis, watery/mucoid discharge, and boggy edema. [eyewiki.aao.org]

  The symptoms, conjunctival injection, chemosis and discharge, tend to last a few weeks and appear in different moments of the year. [symptoma.com]

• Conjunctival Hyperemia

  Ocular itching and conjunctival hyperemia of allergic conjunctivitis were assessed after the conjunctival allergen challenge test. [ncbi.nlm.nih.gov]

• Irritability

  From Wikidata Jump to navigation Jump to search chronic conjunctivitis that is an inflammation of the conjunctiva involing red, itchy, and watery eyes a resulting from an exposure to an allergen or an irritant allergic form of conjunctivitis (disease) [wikidata.org]

  An eye allergy or allergic conjunctivitis is a condition when the eyes react to an allergen or trigger, making them red, itchy, hurt, irritated, tearful, stinging and/or swollen. [premierallergist.com]

  Irritants like dirt, smoke, chemicals, and chlorine can also cause swelling and redness of the eyes. This reaction is not an allergic reaction. Viruses and bacteria can also cause the same irritation of the eyes. [aafa.org]

  Risk factors (which in most of the cases occur in both diseases) include history of atopy, high concentration of the irritant agent and multiple irritant agents in the air of the workplace. [ncbi.nlm.nih.gov]

  Allergic conjunctivitis occurs when an irritant or allergen in the air or environment comes into contact with your eyes and causes irritation, and people with asthma or allergic rhinitis are more likely to experience eye allergies. [leader-call.com]

• Papilledema

  A funduscopic examination may reveal papilledema. Valsalva may temporarily reduce tinnitus associated with venous hums or a patulous eustachian tube. The weber may lateralize from the head or the ankle to an ear with superior canal dehiscence. [entad.org]

The clinical diagnosis is based on medical history, signs and symptoms, course of the disease, and physical exam findings. There are three main methodologies for diagnosing AC:

• Revealing the presence of eosinophils
• Revealing the presence of papillae in the everted upper lid with scraping
• Revealing the presence of suspected allergens through positive skin tests

In SAC and PAC, conjunctival scraping might not be sufficient to make the diagnosis of AC, because eosinophils are typically present in the deep layers of the substantia propria and therefore could go undetected with this superficial method. Measuring the levels of IgE in tears and allergen-skin prick testing may be used to test for the offending allergen. Other tear-specific markers such as EPC, IL-4 and IL-5 may also be useful for the diagnosis of AC. 

In VKC conjunctival scraping is performed which shows an abundant presence of eosinophils. Through biopsy a marked quantity of mast cells within the substantia propria can also be detected. Eosinophils are numerous in AKC too, although no eosinophilic granule can be seen in this case, and mast cells and IgE can also be detected in greater quantities. Pronounced presence of inflammatory cells as well as elevated tear immunoglobulin levels characterize the diagnosis of GPC.

The treatment of allergic conjunctivitis involves a series of general measures, like avoiding the use of contact lenses until the symptoms have gone or trying not to rub the eyes. Home care can be added, which should be characterized by a combination of preventive strategies and activities to minimize allergen exposure, like closing the windows, keeping home dust-free, using an indoor air purifier or avoiding contact with harsh chemicals such as dyes and perfumes. In any case, it is important to detect the cause of the condition and try to avoid it. In this regard, it is useful to get a detailed history of the patient, which helps finding the cause of reaction or the offending allergen.

In the more severe cases home care might not be enough, and more specialized measures might be needed. The inflammatory symptoms can be reduced by causing vasodilatation through the use of ocular decongestants and ocular steroids, or by blocking histamine action through the use of antihistamines or mast cell stabilizers. Immunotherapy is also gaining momentum as mainstay in ocular allergy management, especially with the sublingual immunotherapy SLIT [8] which appears to have a moderate effect on the signs and symptoms of this disorder [9].

Treatment also varies based on the type of allergic conjunctivitis concerned. For example, the use of eye drops is particularly advised in seasonal and perennial conjunctivitis, since it allows to effectively reduce contact with the allergen and alleviate the ocular symptoms. Removal of the foreign body from the eye is the definitive treatment for giant papillary conjunctivitis, along with an improved contact lenses hygiene and a frequent contact lenses change. Permanent relocation to a cooler climate, with an easy management of the air-conditioned environment and dust particle control, is the most effective treatment for VKC and AKC, together with the use of mast cells stabilizers and corticosteroids. Some patients affected by AKC might even benefit from plasmapheresis [10].

Prognosis of AC is usually very favorable. Symptoms can be easily prevented or relieved with the appropriate medications and measures, and usually go away with treatment unless the subject continues to be exposed to the allergen. Complications are rare, but if left untreated they can cause major problems like keratitis (inflammation and ulceration of the cornea) or even permanent loss of vision which seriously affect the quality of life. 

Conjunctivitis refers to any inflammation of the conjunctiva, which can be triggered by different agents. In the case of allergic conjunctivitis the agent concerned is an allergen, in other words any type of antigen which, although totally innocuous and harmless, is perceived by the body as a threat and fought off through an immune response. This type of conjunctivitis is common in people who already suffer for another allergic condition like hay fever or asthma [1].

Allergic conjunctivitis is very frequent and affects around 20% of the general population each year. About one-half of these people have a personal or a family history of atopy [2] which might have a hereditary nature. The occurrence of AC is very common, especially in the areas with high seasonal allergens and tropical and temperate climates, such as the Mediterranean, the Middle East or Africa. Many studies appear to underline the tendency of AC to become more and more frequent with the passing of time, perhaps due to the increased quantities in our environment of substances such as air pollution or cigarette smoke.

Allergic conjunctivitis is usually a type I (immediate) hypersensitivity reaction coordinated by mast cells [3]. The allergen causes cross-linkage of IgE which triggers mast cell degranulation. The mast cells secrete histamine, tryptase, chymase, heparin, chondroitin sulfate, prostaglandins and other inflammatory mediators. Histamines in turn bind both to H1 receptors on the nerve endings, causing pruritus, and to H2 receptors on the blood vessel epithelial cells, causing the classical inflammatory symptoms of vasodilatation, migration of eosinophils and neutrophils and increased vascular permeability.

Certain forms of AC may also be caused be mechanical irritation of the conjunctiva, often in due to contact lenses. The pathophysiological mechanism of vernal keratoconjunctivitis and atopic keratoconjunctivitis are not fully understood.

The condition is frequently acute, but in the worst and most advanced cases it might turn into a chronic state, marked by remodeling of the ocular surface tissues [4]. Furthermore, as conjunctiva is very similar to the nasal mucosa from a molecular point of view, the allergens which trigger rhinitis usually provoke AC as well.

The simplest and most effective measure to prevent allergic conjunctivitis is to limit the exposure to the environmental factors which trigger the inflammation. Identifying the allergens might be difficult, and collecting information about the personal and family history is highly recommended. This allows to pinpoint past allergic and inflammatory episodes which can help recognize the triggering factor. It might also be useful to follow general measures, such as frequently washing hands, not wearing contact lenses or not sharing personal items.

Allergic conjunctivitis (AC) occurs when the eye is exposed to allergens like pollen, mold, household dust and animal dander. The inflammatory reaction is characterized by the classical symptoms of redness, swelling and itching, which in this condition are combined with increased lacrimation. AC is very common among adults as well as children, and is popularly known as “pink eye”.

Allergic conjunctivitis (AC) is the inflammation of conjunctiva, the transparent thin epidermal layer which covers the white part of the eye. This inflammation occurs when the eye is exposed to allergens like pollen or mold, and is popularly known as “pink eye.” AC is very frequent and affects around 20% of the general population each year, especially those who already suffer for another allergic condition. The classical symptoms of AC include itching, redness in the white of the eye, eyelid swelling, eye discharge, tearing, photophobia and foreign body sensation, which usually interest both eyes.

According to the triggering factor, AC can be categorized in the following 5 types:

• Seasonal allergic conjunctivitis (SAC)
• Perennial allergic conjunctivitis (PAC)
• Vernal keratoconjunctivitis (VKC)
• Atopic keratoconjunctivitis (AKC)
• Giant papillary conjunctivitis (GPC)

The diagnosis is usually made based on history, signs and symptoms, course of the disease and physical exam findings. Diagnostic tests such as conjunctival scraping, allergen-skin tests or biopsy may be needed to diagnose AC.

The disorder can be treated by following a series of general measures, like closing the windows, or in the worst cases by using more specialized treatments such as using ocular decongestants or ocular steroids. The simplest and most effective AC prevention strategy is to limit the exposure to the environmental factors which trigger the inflammation itself, together with some commonsense measures like frequently washing hands or not sharing personal items.

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2. O'Connell EJ. The burden of atopy and asthma in children. Allergy. 2004 Aug;59 Suppl 78:7-11.
3. Liu G, Keane-Myers A, Miyazaki D, Tai A, Ono SJ. Molecular and cellular aspects of allergic conjunctivitis. Chem. Immunol. Chemical Immunology and Allergy 1999 73: 39–58.
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5. Bielory L, Friedlaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am 2008 28 (1): 43–58, vi.
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10. Aswad MI, Tauber J, Baum J. Plasmapheresis treatment in patients with severe atopic keratoconjunctivitis. Ophthalmology. Apr 1988;95(4):444-7.