Allergic conjunctivitis: Clinical manifestations and diagnosis
- Pedram Hamrah, MD
Pedram Hamrah, MD
- New England Eye Center/Tufts Medical Center
- Tufts University School of Medicine
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
The most prevalent forms of allergic conjunctivitis are acute allergic conjunctivitis, which develops upon episodic exposure to an allergen, as well as seasonal and perennial allergic conjunctivitis. These are relatively benign ocular diseases that cause significant suffering and use of healthcare resources, although they typically do not threaten vision.
The clinical manifestations, epidemiology, pathogenesis, diagnosis, and differential diagnosis of seasonal and perennial allergic conjunctivitis are reviewed here. The management of these disorders is reviewed separately. (See "Allergic conjunctivitis: Management".)
An overview of conjunctivitis and discussions of other specific types of atopic conjunctivitis are presented elsewhere. (See "Conjunctivitis" and "Vernal keratoconjunctivitis" and "Atopic keratoconjunctivitis" and "Giant papillary conjunctivitis".)
Ocular allergy is estimated to affect at least 20 percent of the population on an annual basis, and the incidence is increasing [1-4]. It is predominantly a disease of young adults, with an average age of onset of 20 years. Symptoms tend to decrease with age, but older adults can continue to have severe symptoms.
It is possible to develop allergic conjunctivitis for the first time as an older adult, although this is not typical. The patient should be questioned about environmental changes (eg, a newly acquired pet or a new living arrangement) and symptoms earlier in life. In older adults, dry eye disease, blepharitis, and toxic conjunctivitis can mimic allergic conjunctivitis. (See 'Differential diagnosis' below.)
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