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Abstract Allergic conjunctivitis is a common condition affecting approximately 17 to 20% of the children, and its incidence is increasing especially in rural communities. Allergic conjunctivitis is an acute, intermittent, or chronic conjunctival inflammation usually caused by airborne allergens. The clinical presentation of the various forms of allergic conjunctivitis can vary greatly, from mild symptoms unaccompanied by ocular signs, to severe disease with visionthreatening complications. Although an IgE-mediated immediate hypersensitivity reaction has been demonstrated or postulated in many types, the Pathophysiology underlying the allergic conjunctivitis is not fully understood. Great variety of available pharmacologic options is an evidence of the complexity of the chemical reactions associated with mast cell degranulation and mediator release causing the onset of allergic signs and symptoms. Allergic conjunctivitis is traditionally divided into five categories, all of which result from a hypersensitivity reaction by ocular tissues to one or more allergens. (A) Mild, acute and transient allergies include: Seasonal allergic conjunctivitis (SAC), and Perennial allergic conjunctivitis (PAC).B) chronic allergic diseases with the potential for causing significant ocular consequences include: Giant papillary conjunctivitis (GPC), Atopic keratoconjunctivitis (AKC), and Vernal keratoconjunctivitis (VKC). Atopic and vernal keratoconjunctivitis are potentially vision-threatening conditions due to the risk of corneal ulceration, vascularization, and scarring. The cardinal feature of allergic conjunctivitis is itching, other symptoms such as tearing, burning and foreign body sensation may be present in variable degrees in all of these conditions. Diagnosis of allergic conjunctivitis is usually based on an accurate history and a proper clinical examination. In some cases clinical examination needs to be substantiated with laboratory diagnostic methods, as skin tests, assessment of specific Ig.E and conjunctival scraping. SAC and PAC are recurrent conditions, but they are easily controlled and do not typically result in permanent visual loss. Likewise, GPC does not typically result in permanent visual loss. On the other hand, VKC and AKC have sight-threatening complications including corneal ulcers and potential side-effects from the use of steroid treatment. Management of allergic conjunctivitis depends on the severity of the condition as well as medication cost and expected patient compliance.Treatment includes: (1) Non-specific medical therapy: • Cold compresses: may be all that is necessary in mild seasonal and perennial conjunctivitis. • Mucolytic drops: dissolves the abnormal mucus. • Treatment of facial eczema in AKC – lid margin hygiene. (2) Vasoconstrictors (3) Antihistamines – conventional topical antihistamine (4) Oral antihistamine preferably non sedating (5) Mast cell stabilizers These compounds are used topically to reduce mast cell degranulation, but also have a wide range of other antiinflammatory effects that may be relevant. They are usually well tolerated with very few side effects. They offer a preventative action and work most effective if taken before the onset of symptoms, where possible (e.g. at the beginning of the pollen season) or early in the disease process. AS the onset of action is slow (5-7 days) and stinging can occur, patient must be warned that their eyes might feel worse to start with. IN VKC and AKC, mast cell inhibitors act as steroid sparing agents. Cromolyn sodium is the longest established of these drugs. And both 2% and 4% drops are available for use up to 4 times per day. Nedocromil sodium is a newer, higher potency mast cell stabilizer that compares favourably to cromolyn and can be used twice daily in SAC and PAC.Lodoxamide is another recently introduced mast cell stabilizer, which may evoke fewer stings than the other. Both nedocromil and lodoxamide have a more rapid onset of action. (6) Nonsteroidal anti-inflammatory agents Topical NSAIDs appear to have some beneficial effects in allergic conjunctivitis. Topical NSAID are not as potent as steroids but have the advantage of good ocular safety profile and useful in treating non sight threatening conditions like SAC and PAC when mast cell stabilizers and antihistamines fail. (7) Steroids Topical steroids are very powerful in controlling allergic conjunctivitis, but have potentially sight-threatening side effects. Steroids are generally contraindicated in SAC & PAC; occasionally they are used in AKC and VKC. (8) Cyclosporine Topical preparation of 2% cyclosporine has been shown to provide a marked reduction in the symptoms and signs of VKC, and cyclosporine is particularly helpful as a steroid-sparing agent. (9) Immunotherapy Allergen immunotherapy have been shown to be especially beneficial in the treatment of allergic conjunctivitis, and are the only therapy available that changes the underlying problem of allergies, potentially curing the problem of eye allergies. (10) Surgery Usually limited to the treatment of the sight-reducing corneal disease in AKC & VKC. |