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  Allergic conjunctivitis

Conjunctiva is moist, transparent membrane which is thin and delicate that covers the inner part of the eyelid and the entire eyeball as well except its most anterior part which is the part covered by the cornea. Any material that irritates the conjunctiva will lead to eye redness (erythema) and swelling. Other presenting symptoms include ocular itchiness, ocular pain or photosensitivity (aversion to bright light), watery eyes and presence of ocular discharge. This condition is known in medicine as conjunctivitis, or “pink eye” or “sore eyes” and allergy is one of its most common causes. Allergic conjunctivitis due to exposure to an allergen, a mild antigen which stimulates an antigen-antibody reaction most likely mediated by the immunoglobulin type E (IgE). Examples of allergen may include seasonal pollen, dust, grass and ragweed, animal skin, perfumes, cosmetics, skin medicines, air pollution and smoke. Other causes of conjunctivitis are viruses and bacterial infections. Conjunctivitis can also be caused by irritation brought about by prolonged wearing of contact lenses. For those patients wearing contact lenses, the aforementioned antigens may be responsible for initiating the events in developing allergic conjunctivitis although denatured tear solution preservatives may likewise adhere to the lens surface and initiate an allergic response.

Allergic conjunctivitis Conjunctiva
Allergic conjunctivitis

The predominant symptom among patients with allergic conjunctivitis is itching but oftentimes non-specific symptoms may be present. Other pertinent symptoms include eye redness, swelling, lacrimation or tearing and occasional serous ocular discharge. Patient’s medical history can be critical in the diagnosis because many of those with allergic conjunctivitis usually report related systemic environmental allergies. In addition, those at risk for allergic conjunctivitis may reveal tarsal follicles or a Mag Sign which is best described as an inferior bulbar conjunctiva bulging upon eversion of the eyelids. Another typical sign of allergic conjunctivitis is the “cobblestone” appearance of the palpebral (eyelid) conjunctiva upon slit lamp examination. Although allergic conjunctivitis is irritating and causes distressing symptoms to patients, it will not progress to impairment of vision or blindness.

The same with many contact lens related problems, the moment you are diagnosed with allergic conjunctivitis it is mandatory to stop wearing the contact lenses. It is not advisable to continue wearing contacts once you are diagnosed with allergic conjunctivitis because you might develop an eye infection. Wearing your eyeglasses may help until the condition is resolved.

Treatment of allergic conjunctivitis includes the following: cold compresses, ocular irrigation, mast-cell stabilizers, topical antihistamines or anti-pruritics and decongestants. Rarely, topical steroids are necessary especially in very severe allergic response because of its powerful anti-inflammatory and prostaglandin inhibitory effect. Typically, ophthalmic or eye drops may contain a combination of the aforementioned class of drugs. However, many of these eye drops can cause burning and stinging sensations when you first put them in, but this is usually temporary and goes away in a few minutes.

An adjunct treatment which is beneficial to those with more symptomatic cases of allergic conjunctivitis is the use of oral therapeutic agents like diphenhydramine (Benadryl). Other agents such as fexofenadine (Telfast), Seldane, Hismanal, and lotadine (Claritin) are effective in chronic prophylaxis. To prevent possible drug interactions, it is important to review the patient's drug history before prescribing over-the-counter or prescription antihistamines. Adjustment of the dosage to maximize the therapeutic response with the least amount of medication to avoid adverse drug reactions is suggested.

The dictum is trying to identify first then avoid the allergens (if possible) that cause your symptoms. An example is trying to stay indoors if you are allergic to pollen or mold, especially when levels of pollen and mold are high in some seasons. Always keep your doors and windows closed, and you may use an air conditioning unit during the summer months when the weather is hot and humid.

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