This document discusses different types of allergic eye diseases including acute allergic conjunctivitis, seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis (VKC), and atopic keratoconjunctivitis (AKC). It describes the presentation, diagnosis, and treatment of each condition. Acute allergic conjunctivitis commonly affects children and presents as itching and watering. VKC and AKC are chronic, inflammatory conditions that predominantly affect children and young adults. They can progress to involve the cornea and cause scarring if not properly treated with mast cell stabilizers, antihistamines, steroids, and immunosuppressants.

1. Allergic eye disease
Presented by: khoy sothearith
2nd
year resident

2. Outline
• Acute allergic conjunctivitis
• Seasonal and perennial allergic conjunctivitis
• Vernal keratoconjunctivitis
• Atopic keratoconjunctivitis

3. Acute allergic conjunctivitis –
presentation
• Younger children( spring or summer)
• acute itching and watering, associated with severe
chemosis

4. Acute allergic conjunctivitis –
treatment
• Usually not require
– Chemosis settle within hours
• Cool compress
• Single drop of adrenaline 1%

5. Seasonal and perennial allergic
conjunctivitis
Seasonal”hay fever eye “
• Spring and summer
• Allergen: tree and grass
polen
• Specific allergen varies
with geographic location
• Common
Perennial
• Through the year, worst in
automm
• Allegen: house dust mite,
animal dander, fungal
allergen
• Less common

6. Diagnosis
• Presentation: transient acute or subacute redness, watering and itching,
associated with sneezing or nasal discharge
• Signs:
– completely resolve within episode
– Conjunctival hyperemia
– Mild papillary reaction
– Chemosis and eyelid edema
• Investigation
– Not require
– Conjunctival scrapping -> eosinophilia

7. Treatment
• Artificial tear
• Mast cell stabilizer( sodium cromoglycate, nedocromil
sodium, lodoxamide)
• Antihistamines( emedastine, epinastine, levocabastine,
bepotastine)
• Combined preparation( antihistamine + vasoconstrictor):
Otrivin-Antistin®
• Dual action of antihistamine + mast cell
stabilizer(azelastine, ketotifen, olopatadine)
• Topical steroid
• Oral antihistamine
– Severe case

8. Vernal keratoconjunctivitis
• Affects children and young
adults
• More common in males
and in warm climates
• Itching, mucoid discharge
and lacrimation
• Palpebral
Types
• Limbal
• Mixed
• Recurrent, bilateral
Frequently associated with atopy: asthma, hay fever and dermatitis

9. Progression of vernal conjunctivitis
Diffuse papillary hypertrophy, most marked on superior tarsus
Formation of cobblestone papillae Rupture of septae - giant papillae

10. Limbal vernal
Trantas dotsMucoid nodule

11. Progression of vernal keratopathy
Punctate epitheliopathy Epithelial macroerosions
Plaque formation (shield ulcer) Subepithelial scarring

12. Atopic kertoconjunctivitis
similar to VKC, more severe and unremitting
Rare bilateral
Typically develop in adulthood
No gender preponderance
Tend to be perennial, worst in winter

13. Atopic keratoconjunctivitis
Typically affects young patients with
atopic dermatitis
Eyelids are red, thickened, macerated
and fissured

14. Progression of atopic conjunctivitis
Infiltration of tarsal conjunctiva causing featureless appearance
Inferior forniceal papillae Mild symblepharon formation

15. Progression of atopic keratopathy
Punctate epitheliopathy Persistent epithelial defects
Subepithelial scarring Peripheral vascularization

16. Treatment of VKC and AKC
management of VKC does not differ substantially
from that of AKC
• less responsive and requires more intensive and
prolonged treatment

17. General measure
• Allergens avoidance
• Cool compress
• Lid hygiene

18. Local treatment
• Mast cell stabilizer
• Antihistamine
• Combine preparation
• Steroid
• Immune modulator
– Cyclosporine 0.05%: if steroid ineffective
– Tacrolimus 0.03%

20. Systemic treatment
• Antihistamine
• Antibiotic(doxycycline 50–100 mg daily for 6 weeks or
azithromycin 500 mg once daily for 3 days) – to reduce blepharitis
• Immunosuppressive agents(e.g. steroids, ciclosporin,
tacrolimus, azathioprine)
• Aspirin