ALLERGIC

CONJUNCTIVITIS
Introduction

 Allergic conjunctivitis is an inflammation of

the conjunctiva (the membrane covering the
white part of the eye) due to allergy.
 If something irritates this conjunctiva, eyes

may become red and swollen. The eyes also

may itch, hurt or watery.
 It is also known as “pink eye”.
Types of allergic conjunctivitis:

Allergic simple conjunctivitis

Spring catarrh

Phlyctenular kerato-conjunctivitis

Giant papillary conjunctivitis

Allergic simple conjunctivitis

• Definition : Occurring as the result of exposure to a wide

variety of allergens
• Simple allergic conjunctivitis often results from exposure to
eye medications or contact lens solutions (or their
preservatives).

• Symptoms:
• Itching and tearing in response to antigen exposure.

• Signs :
• Unilateral or bilateral
• Mild to moderate conjunctiva hyperaemia
• Chemosis
 Management:
 General measures include:
 Avoid allergen where possible
 Avoid wearing contact lenses until symptoms and
signs resolve

 Avoid rubbing the eyes

 Cool compresses and preservative-free lubricants may
also help

If severe,
- Oral or topical anti-histamine
- Mast cell stabilizer
Phlyctenular conjunctivitis

 Definition: Kerato-conjunctivitis produced as an allergy

to an endogenous agent.
 Aetiology: It is a manifestation of allergy to an
endogenous toxin as
 Tuberculo-protein
 Intestinal parasites
 Septic foci as in tonsils and adenoids

 Symptoms :
 Discomfort and lacrimation
 If cornea involved,photophobia and blepharospasm
occur
 Signs :
◦ Phlyctens
 Rounded nodules
 Size 1-3 mm
 Grayish in color
 Eleveated above the surface
 Surrounded by a small area of injection
• Complications:
(1)Cornea
 A-Corneal phlycten

 B-Phlyctenular ulcers

 C-Phlyctenular pannus

(2)Eczema of lids
(3)Muco-purulent conjunctivitis: due to secondary infection
with staph. Aureus
(4)Recurrence: are common if the cause is not removed.

• Treatments :
 Local cortisone drops and ointment
 Atropine if cornea is involved
 Fascicular ulcer needs cautery with carbolic + Periotomy &
cautery of vessel
Spring catarrh (Vernal Conjunctivitis)

 Definition : It is a bilateral seasonal conjunctivitis

recurring in the warm seasons.
 Aetiology : It is an allergy of the conjunctiva to an
unknown exogenous factor.
 The contributing factors are :
 U.V rays
 Heat
 Dust
 Incidence :
 Age : Children
 Sex : boys more
 Season : summer (not spring)

 Symptoms :
 Itching
 Photophobia
 Lacrimation
 Ropy discharge (thread): formed of
mucus,eosinophils and epithelial debris so that it is
scanty,white and elastic
Palpebral type (70%)
• Large flat-topped papillae
• Bluish white color
• Cobble stone arrangement
• Fornix always free
• Milky white film (ropy discharge)

Bulbar type (10%)

• Gelatinous masses (due to thickened epithelium and hyaline degeneration )
• Tranta spots (white spots)

Mixed type (20%)

• Keratitis superficialis vernalis of Tobgy
• Superficial ulcers
• Epithelial plaque formation that should be scraped
• Weakness of the cornea with higher incidence of Keratoconus and Keratectesia
 Treatment:
General:
-Antiallergy drugs (antistine,Benadryl,calcium etc)

Local:
-Dark glasses for photophobia
-Cold compression for sensation of heat
-Frequent washing with cold lotion as 4 % boric acid
-Local antihistaminic as antistine of preisoline drops
-Local vasoconstrictor as adrenaline or privine for
hyperaemia
-Local cortisone drops (Dexamethasone 0.1 %) pulse
therapy during an attack every 2 hours for 5 days only to
guard against its complication (may induce glaucoma)
-Local disodium chromoglycate eye drops to stabilize the
Giant papillary conjunctivitis

 Definition : It is an allergic conjunctivitis characterized by the

formation of giant papillae.
 It occurs most probably due to mechanical irritation of the
palpebral conjunctiva in case of :
-Contact lenses (more with extended wear CL and with lens
deposits)
-Artificial eyes
-Prominent suture following surgery
 Symptoms :
-Red Eye -Mucoid discharge
-Itching
 Signs :
 Conjunctival hyperaemia
 Giant papillae on superior tarsal conjunctiva
 Superficial punctuate keratitis
 Peripheral corneal subepithelial infilterates

 Treatment :
 Stops using contact lenses for 2 weeks
 Topical mast cell stabilizer (disodium chromoglycate) 4 times
daily
 Topical steroids for few days only
 Use new daily wear lenses after complete cure