- 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
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
There are five main types of ocular allergy: seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), and giant papillary conjunctivitis (GPC). VKC and AKC are chronic, bilateral, and severe forms of allergic inflammation affecting the ocular surface. These two relatively uncommon types of allergic eye disease can cause severe damage to the ocular surface, leading to corneal scarring and vision loss if not treated properly (this occurs more commonly with AKC than VKC). Type I hypersensitivity reactions are important in these diseases, although they are not the only pathophysiologic mechanism. VKC is reviewed in this topic. AKC is discussed separately. (See "Atopic keratoconjunctivitis".)
GPC is an inflammatory disorder that represents a reaction to lid movement over a foreign substance, such as contact lenses. Toxic conjunctivitis is not allergic in nature, but it is frequently confused with allergic ocular disease. It develops with protracted use of topical medications, mostly due to preservatives. GPC is discussed in detail separately. (See "Giant papillary conjunctivitis" and "Toxic conjunctivitis".)
Seasonal and perennial allergic conjunctivitis, the most common forms of ocular allergy, are also discussed separately. (See "Allergic conjunctivitis: Clinical manifestations and diagnosis".)
Vernal keratoconjunctivitis (VKC) most commonly occurs in boys living in warm, dry, subtropical climates, such as the Mediterranean, the Middle East, Central and West Africa, South America, and Asian countries, such as Japan, Thailand, and India . The limbal form of VKC is seen most often in dark-skinned individuals from Africa and India. VKC is generally rare in cooler climates, such as Northern Europe and the temperate areas of North America. However, the prevalence in these regions has increased, probably due to immigration of individuals from susceptible populations .
Exacerbations are common in the spring (hence the name "vernal"), although reactivation often occurs in the winter. Initially, the exacerbations are seasonal, but perennial attacks increase after a few years.
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- CLINICAL MANIFESTATIONS
- PHYSICAL FINDINGS
- Differential diagnosis
- Nonpharmacologic measures
- Topical antihistamines and mast cell stabilizers
- Topical corticosteroids
- - Allergy referral for immunotherapy
- Calcineurin inhibitors
- Additional agents
- - Nonsteroidal anti-inflammatory drugs
- - Oral antihistamines
- Treatment of corneal shield ulcers
- SUMMARY AND RECOMMENDATIONS