- Ocular allergy affects approximately one-third of the population and manifests as forms including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis and contact dermatoconjunctivitis. - These forms are mediated by type I and type IV hypersensitivity reactions and have symptoms of itching, redness, burning and watery discharge. - Treatment involves identifying allergens, avoiding triggers, using antihistamines, mast cell stabilizers, NSAIDs and corticosteroids, with immunotherapy and anti-IgE therapy for more severe cases

1. Fawzia Abo ali
Prof. of Medicine, Allergy &Immunology
Ain Shams Faculty of Medicine
Allergic conjunctivitis

2. • Approximately one-third of the
population is affected by some form of
allergic disease, about 40% of them
report ocular symptoms.
• Allergic eye diseases affect the ocular
surface, including the cornea,
conjunctiva (>80%), and eyelid.
• IgE- and/or T-cell-mediated .

3. 1- seasonal allergic
conjunctivitis
(SAC)
2-Perennial allergic
conjunctivitis
(PAC
3-atopic keratoconjunctivitis
(AKC)
4-giant papillary
conjunctivitis
(GPC)
5-vernal
keratoconjunc
tivitis (VKC)
5 types of allergic conjunctivitis
immediate (IgE mediated) delayed (cell mediated

4. Percentage of patients with a specific ocular
allergy :
Kabat A and Sowka J. Rev Optom 2014;152(10):80-1

5. 1. Seasonal and 2.perennial allergic
conjunctivitis
acute simple conjunctivitis
Typical symptoms include:
Itching, redness, burning,&
watery discharge
• symptoms in spring, or
summer
• Seasonal allergens as
plant pollens
• (hay fever ).
• occurs all year round
(PAC)
• perennial allergens as
house dust mite, animal
dander and moulds

6. 3. Atopic keratoconjunctivitis
• (AKC) is a chronic, allergic ocular disease that
occurs most often in patients with a history of
atopic dermatitis (AD) ocular form.
• Hypersensitivity reactions associated with types I
and IV contribute to the inflammatory changes of
the conjunctiva and the cornea .

7. 4. Vernal keratoconjunctivitis (spring
catarrh)
VKC is a disease of warm weather months .
• In this form, a nonspecific hyperreactivity
characterized by hyperaemia, chemosis,
photophobia, and sticky mucous
• The hallmark of the disease is the presence
of giant papillae (cobblestone appearance) .
• Patients with VKC frequently have a history
of atopic diseases, asthma, rhinitis, and
eczema.
• However, VKC is not associated with a
positive skin test in 42–47% of patients

8. 5. Giant papillary conjunctivitis
• Giant papillary conjunctivitis is a common
complication of contact lens wear. however,
never leads to the severe tissue morbidity of
VKC.

9. Contact dermatoconjunctivitis
• An allergic reaction mediated by type IV
hypersensitivity to a topically applied
agent.
• The conjunctiva is often hyperemic as a
reaction to the inflamed eyelids.
• Neomycin ointment used to treat red eye
causes this in 10% of patients
• People with celiac or gluten intolerance
could have ocular irritations when they use
makeup made from wheat products.
• Food & corn allergies can also trigger
makeup sensitivity.

11. Management of allergic
conjunctivitis

12. Diagnosis of allergic conjunctivitis:
History, clinical presentations, and ophthalmic
examination:

13. Allergy skin prick tests:

14. Allergen specific IgE antibody.
Atopy patch test (APT) in cases of delayed-type
hypersensitivity & If contact allergy is suspected

15. Tear fluid IgE can be measured.
Conjunctival provocation test
(CPT): It should be done with
standardized water-soluble allergen
extracts
Conjunctival scrapings for
eosinophils – particularly elevated in
VKC, AKC and GPC
Nasal provocation test (NPT)
• NPT is used to determine nasal
and/or conjunctival reaction to
allergens.

16. Treatment of allergic conjunctivitis:
General measures
o Allergen avoidance:
1. House dust mites, Replace carpets with linoleum
or wooden floors, Remove curtains, pets and
stuffed toys from bedroom
o AVOID ALLERGENS IN BEAUTY PRODUCTS;
• Perform a patch test
• Keep the ingredient list short and simple
• Check the expiration date
o Cold compresses
o Stop contact lens wear
o Artificial tears

17. Pharmacotherapy
1. Vasoconstrictors/antihistamines
2. Mast cell stabilisers
3. Non-steroidal anti-inflammatory drugs
4. Corticosteroids
5. Severe cases :
o short-term treatment with systemic corticosteroids
o calcineurin (Cn) inhibitors, to avoid the serious ocular
side effects of long-term corticosteroid treatment.
o Cn inhibitors are capable of inducing local
immunosuppression. Cn is the target of the
immunosuppressive drugs cyclosporine A (CsA) and,
tacrolimus (Trl),

18. Allergen-specific immunotherapy
• It is highly effective in the
treatment of patients with severe
allergic conjunctivitis(SAC ,PAC) &
/rhinoconjunctivitis
• SCIT or SLIT immunotherapy at
least for 3 years are equally
effective in induction of tolerance
against natural allergens.

19. Anti-IgE therapy
• Preliminary study indicates
Omalizumab is effective for nasal and
ophthalmic symptoms of intermittent
and perennial allergic rhinitis .
• Ongoing studies to determine the
effect of Omalizumab in atopic
dermatitis may have implications for
treatment of AKC Pharmacotherapy
of allergic disease:

21. • Ocular allergy is one of the most common
conditions encountered by allergists and
ophthalmologists.
• Forms of ocular allergy are: seasonal allergic
conjunctivitis, perennial allergic conjunctivitis, vernal
keratoconjunctivitis, atopic keratocongiuntivitis, giant
papillary conjunctivitis and contact allergy,.
• they are mediated by Type I and type 4 hypersensitivity
mechanism .
• An understanding of the immunologic mechanisms, and
clinical features may be useful to both allergist and
ophthalmologists to recognize the proper integrated
management for such patients.
Take home message:

22. • References
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