Information for Patientss

What is Eye Allergy?

Alergia Ocular

Eye allergy is a common condition usually affecting the eye conjunctiva; therefore it is generally known as allergic conjunctivitis.

It is characterized by a recurrent and bilateral eye inflammation, most frequently caused by allergens (any substance that, when in contact with the tissues, induces a state of sensitivity and/or resistance to said substance) such as pollen, pet dander or mites.

The conjunctiva is a thin transparent moist membrane covering the anterior surface of the eyeball and inner surface of the eyelids. It is the most immunologically active tissue of the outer eye since it acts as a barrier before infections and traumatism.


What are the symptoms of Eye Allergy?

Alergia Ocular

The usual initial symptoms of allergic conjunctivitis include redness, tearing, burning sensation, localized pain and itchiness which are the typical symptoms of allergic conjunctivitis. Other symptoms appear with different frequency in the different categories of the disease.


Are there different kinds of Eye Allergies?

Eye allergy is classified into 5 large categories:

1. Seasonal allergic conjunctivitis also known as allergic rhino conjunctivitis:
It can be seasonal or perennial.

Symptoms:
Mild itchiness
Tearing
Burning sensation
Pressure sensation in the posterior part of the eye.

Signs:
Occasionally, clinically observable signs are not observed
Conjunctiva edema
Dilatation of conjunctival vessels
Slight eyelid inflammation
A papillary reaction might take place. Large papillas are not observed.

Pathogenic factors:

Type -I hypersensitivity response to air allergens, mastocite degranulation in the conjunctiva and release of pharmacologically active mediators, causing vasodilatation and itchiness, edema and redness, local tissue eosinophilia which contributes to the inhibition of the inflammatory reaction.

Differential Diagnosis:
Irritation due to toxic substances
Foreign body under the upper eyelid
Contact Dermatitis
Mild dry eye

2. Atopic keratoconjunctivitis: Most patients suffering from this condition are men between 29 and 47 years old. This condition appears during late youth and it extends up to the fourth or fifth decade of the patient´s life.

Symptoms:
Perennial
Minimally related to changes to hot weather
Mild to severe itchiness
Burning sensation
Tearing with aqueous or mucopurulent secretion
Photophobia

Signs:
Indurated and lichenified palpebral margins
Pale conjunctiva with papillary hypertrophy
Hyperemia
Atopic dermatitis, eczema

Corneal Alterations:
Pannus
Ulceration
Cicatrix
Keratoconus
Punctate epithelial keratitis
Cataracts in 10% of the cases

Pathogenic factors:
Unknown cause
Infiltration of mastocites, basophiles, eosinophils and perhaps lymphocytes.
Perhaps, cell-mediated immune response

3. Vernal keratoconjunctivitis: it especially occurs in places with dry and warm weather. The name “vernal” is due to the fact that symptoms worsen during spring time, although for many patients this condition appears during the whole year. The seasonal peak is between October and February with a peak in December. The distinctive signs and symptoms are: intense itchiness (that worsens at night), hot sensation, pressure and sensitivity in the eyes; tearing, photophobia, yellowish or whitish secretion.

Symptoms:
Intense itchiness that worsens at night
Hot sensation, pressure and sensitivity in the eyes.
Tearing
Photophobia

Signs:
Yellowish or whitish secretion
Palperbral and limbar forms coexist although one of them usually predominates.
High and hard papillas of different sizes.
Epithelial keratitis with punctate cornea
Rare vernal ulcers

Conjunctival alterations:
Formation of large papillas

Limbar alterations:
Edema and thickening
Formation of grayed nodules
Formation of Trantas points

Corneal alterations:
Fine punctate keratopathy
Fine punctate epithelial erosions
Formation of corneal ulcer
Formation of plates
Formation of pannus

Pathogenic Factors:
Type -IV Hypersensibility
Type -I Hyepersensibility
Large collagen proliferation
Mastocites in the epithelium
Eosinophils and basophils in the epithelium and in the "substantia propria"
Lymphocytes in the substantia propria
Most of the monocytes are degranulated

4. Giant papillary conjunctivitis: it is an inflammatory condition of the conjunctiva associated with the prolonged use of contact lenses. Eye prosthesis and prominent sutures can cause giant papillary conjunctivitis.

Symptoms:
Secretion and slight itchiness during the morning
Profuse mucous during the morning
Sticking eyelids
Pain while wearing contact lenses
Itchiness when wearing contact lenses
Lenses movement

Signs:
Lenses covered by amorphous and dull material
High Papillas with flattened ends
Erythema and edema of the upper tarsal conjunctiva

Pathogenic Factors:
Trauma of the upper eyelid due to foreign substances (e.g. contact lenses, protuberant suture, prosthesis)
Exposure of the upper eyelid to allergens
Abnormal cell infiltration
Epithelium mastocites
Eosinophils and basophils in the epithelium and substantia propria
One third of the mastocites are degranulated.

Differential Diagnosis:
Vernal Keratoconjunctivitis

5. Allergic contact conjunctivitis: it appears in patients with reiterated exposures to sensitizer agents, such as ophthalmic medicines, cosmetics, preservatives in solution, soaps, etc.

Symptoms:
Severe itchiness
Burning Sensation
Tearing
Photophobia

Signs:
Conjunctiva showing deep vasodilatation and chemosis
Papillary response
Opacity and epithelial punctuate keratitis can develop.
Eyelids can show redness, edema and ulcers

Pathogenic factors:

Reiterated exposures to sensitizer agents, such as ophthalmic medicines, cosmetics, preservatives in solutions, soaps, etc. Subsequent exposure to the casual substance, after the sensitization can lead to an allergic reaction.

Upper eyelid trauma due to a foreign substance (e.g. contact lenses, protuberant suture, prosthesis).

Differential Diagnosis:
Eczematous Dermatitis
Seborrheic blepharitis

How is Eye Allergy diagnosed?

The specialist will write the medical history of the patient, detailing:

• Family or personal allergy background

Description of the symptoms: eye pruritus, tearing, photophobia, edema, foreign body sensation, association of symptoms of other organs (sneezes, nasal itchiness, nasal obstruction, skin or nasal itching or lesions, cough, dyspnea, etc).

• Seasonality of the symptoms (they appear during a particular time in the year or they continue during the whole year);

Identification of possible allergens: presence of pets, characteristics of the house, and other usual environments, etc. In order to confirm the possible allergens causing allergic conjunctivitis, some of the following tests can be carried out:

Identification of possible allergens: presence of pets, characteristics of the house, and other usual environments, etc. In order to confirm the possible allergens causing allergic conjunctivitis, some of the following tests can be carried out; Prick test for allergy tests: a small puncture, generally in the inner surface of the forearm, is made, and a drop of allergen is placed. When the allergen penetrates in the skin, a reaction of the sensitized cells is produced and this will lead to site redness and itchiness.

• Determination of total and specific IgE: it is a laboratory test.

• Conjunctival Challenge Test: the allergen is applied in the conjunctiva of one of the eyes and the possible appearance of allergic symptoms is observed.

How can Eye Allergy be treated?

There are two ways of treating Eye Allergy:

Non- Drug Treatment:

Allergen Removal: to eliminate or avoid places where dust can accumulate (carpets, sofas, curtains, books, etc);

Clean with wet cloth or vacuum;
Use covers in pillows and matrixes to avoid acarus;
Avoid contact with pet dandruff and hair;
Clean grids, and heating and air filters;
Reduce environmental humidity;
Perform ablutions with saline solution and apply cold compresses to relief eye symptoms.

Drug Treatment: there are several treatment options. According to their specific function, the ophthalmic anti-allergic agents can be classified into:

Vasoconstrictor agents: they reduce eye redness and palpebral edema by causing blood vessel constriction. Their action is purely asymptomatic. See BAÑO OCULAR POEN®. ALOSOL®.

Anti-allergic and antihistaminic agents: they act by inhibiting the degranulation of mastocites and blocking histamine-receptors. See CLAROFTAL®; BRIXIA®; ALKET®

Non- steroid anti inflammatory agents: they have anti inflammatory, analgesic, and anti- pruriginous effect. See POENKERAT®. NATAX®

Steroids: Their action is totally anti-inflammatory. See: LOTESOFT®; SEDESTEROL®; LARSIMAL®; TRIAMPOEN®. TALOF®. Immunosuppressive agents.

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