- 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 and toxic conjunctivitis are 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".)
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. In the past, prevalence in these regions has been approximately 0.03 percent of the population. As an example, prevalence for Western Europe was 3.2 in 10,000, whereas a higher prevalence ranging from 2.4 to 27.8 in 10,000 was seen in Italy, a country with a Mediterranean climate . However, the prevalence in cooler regions has increased, probably due to immigration of individuals from susceptible populations .
Males are more commonly affected than females. In one series, the male-to-female ratio was 3.2:1 in patients <20 years of age but was nearly equal in older patients . Age at onset is generally before 10 years, with the earliest reported onset at five months of age , although VKC can infrequently occur in adults. Patients usually "outgrow" the disease with the onset of puberty.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Basic eye care and avoidance of triggers
- Initial topical therapy
- Add-on initial therapy for moderate to severe disease
- Treatment of refractory disease
- - Topical corticosteroids
- - Allergen immunotherapy
- - Calcineurin inhibitors
- Topical cyclosporine
- Topical tacrolimus
- Systemic cyclosporine
- Treatment for subsequent seasons
- Treatment of corneal shield ulcers
- Additional agents
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS