This document discusses the treatment of allergic eyes. It begins by explaining that allergic conjunctivitis is a very common cause of eye issues in India. It can be acute (seasonal or perennial) or chronic (vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis). The pathophysiology involves mast cell degranulation and inflammatory mediator release causing symptoms like itching. Chronic types involve constant inflammation from eosinophils and cytokines. The document then outlines treatment options for different severity levels based on a grading system from 0-30 of symptoms like itching, discomfort and chemosis. Mild cases use antihistamines, mast cell

1. TREATING ALLERGIC
EYES
DR KINJAL DESAI
THIRD YEAR RESIDENT
DR PAWAN JARWAL
THIRD YEAR RESIDENT
SSG HOSPITAL AND BARODA MEDICAL COLLEGE

2. INTRODUCTION
• ALLERGIC conjunctivitis is the one of the most common cause of ocular
morbidity in India. It is also the leading cause of school absenteeism in children
because of distressful symptoms.
• Ocular allergic diseases can be of ACUTE or CHRONIC type.
1) ACUTE TYPES:
a) Seasonal allergic conjunctivitis
b) Perennial allergic conjunctivitis
2) CHRONIC TYPES:
a) Vernal keratoconjunctivitis
b) Atopic keratoconjunctivitis
c) Giant papillary conjunctivitis

3. The exposure of an allergen to a sensitized mast cell is the
basis for mast cell degranulation. The subsequent release of
many inflammatory mediators give rise to the clinical signs
and symptoms of allergic conjunctivitis; of which, conjunctival
congestion and ocular itching are mainly due to the action of
histamine on H1 receptors.
In chronic types , the pathophysiology is quite complex as
there is a constant inflammatory response due to predominance
of eosinophils and cytokine release mediated by Th2 cells.
The signs and symptoms of allergic conjunctivitis include
ITCHING, DISCOMFORT, STINGING, FOREIGN BODY
SENSATION, WATERING, PHOTOPHOBIA, LID EDEMA,
REDNESS, CHEMOSIS, PAPILLARY REACTION, PANNUS.

4. The pharmacologic agents that are available as ophthalmic solutions, used in
treatment of allergic conjunctivitis belong to different classes:
(1) ANTI HISTAMINICS- which block H1 receptors. e.g Azelastine.
(2) MAST CELL STABILIZERS-which increase calcium influx to the mast cell
and prevent changes in membrane permeability resulting in stability of
membrane decreasing degranulation of mast cells e.g Sodium cromoglycate.
(3) DUAL ACTING AGENTS- they have both antihistaminic and mast cell
stabilizing properties. e.g Olopatadine , Ketotifen.
(4) NSAIDS- e.g Ketorolac, Flurbiprofen.
(5)CORTICOSTEROIDS- e.g Prednisolone, Hydrocortisone, Fluromethalone.

5. Symptoms and signs 0 1 2 3
1) Itching Absent Not disturbing daily
activities
disturbing daily activities Unabe to do daily
activities2) Discomfort
3) Stinging
4) Foreign body
sensation
5) Watering
6)Photophobia
7) lid edema Detected on palpation Able to open the eyes on
their own
Not able to open eyes on
their own
8) congestion Diffuse Individual vessel
discernible
Not easily discernible
9) Chemosis Conjunctival edema
without dellen
Conjunctival edema with
dellen
Edema with prolapse of
conjunctiva through
palpebral aperture
10)Papillary reaction Minimal hyperemia with
papillary reaction; size of
papillae <0.5mm
Injecton , thickening of
conjunctiva with size of
papillae 0.5 to 1.00 mm
Injection, thickening and
total obscuration of
normal vascular pattern
with apical staining
:

6. PAPILLARY REACTION COBBLESTONE APPEARANCE

7. PURPOSE: The purpose is to judge severity and provide a simple and
practically applicable grading system and a stepladder algorithm for
treatment of allergic conjunctivitis.
Minimum score = 0
Maximum score = 30
Mild = 1 – 10
Moderate = 11 – 20
Severe = 21 – 30
If there is presence of any other specific sign like TRANTAS DOTS,
COBBLESTONES, PANNUS, SPEE, CORNEAL SCARRING, then it is
severe.

8. RESULTS:
Mild :
 Allergen avoidance
 Lubricants
 Any one of ANTIHISATAMINICS, MASTCELL
STABILIZERS, DUAL ACTINGS, NSAIDS.
Moderate:
 Treatment as MILD plus LOW DOSE STEROIDS.
Severe:
 Same as above plus POTENT STEROIDS.
Chronic cases can be maintained with TOPICAL CYCLOSPORINE
and if needed SYSTEMIC STEROIDS OR CYCLOSPORINE.

9. CONCLUSION: Grading of severity and periodicity of
disease can be very useful in management. Severe and
chronic allergies are serious condition with remarkable
morbidity and may not satisfactorily treated by current
options.