Predisposing factors and Risk factors-

1. Patient may have family history of atopic disease- hay fever,asthama,allergic rhinitis, atopic dermatitis. Their eosinophil count may be high in blood.
2. Age- specially 4-20 years. Boys > girls
3. Season-  Summer is the main season “ warm weather conjunctivitis” . Spring Catarrah is known to be a misnomer.
4. More prevalent in tropical areas than tundra region.

Symptoms-

• Marked burning and itching sensation in eyes – intolerable and aggravated by warm and humid condition.
• Mild Photophobia
• Ropy discharge ( string like)
• Lacrimation
• Heaviness of lids.

Signs-

Palpebral form- Cobblestone or pavement stone arrangement of inflamed papillae on the Upper Tarsal conjunctiva. Cauliflower like giant papillae can be seen in extreme cases. White ropy discharge.

Bulbar form- Characterized by (DGTal- Mnemonic Dusky red triangle, Gelatinous accumulation, Tranta’s Spot)

1. Dusky red triangular congestion of the bulbar conjunctiva in palpebral area.
2. Gelatinous accumulation aroung the limbus ( junction of cornea and conjunctiva)
3. Tranta’s spot- discrete white dots along the limbus.

Mixed form. Features of both.

Vernal Keratopathy- Corneal lesions

PUS PV- Punctate Epithelial Keratitis, Ulcerative vernal Keratitis, Subepithelial scarring,Pseudogerontoxon, Vernal cornela plaques.

Prognosis- Disease is usually self-limiting and resolves in 5-10 years but may result in complications like Keartoconus.

Treatment-

General Measures-

• Dark goggles
• Cold compression
• Extreme cases shifting to a colder region may be necessary

Local-

1. Topical Steroids – Q4hrly for 2 days then Q6-8hrly for 2 weeks
2. Mast Cell stabilizer- Sodium cromoglycate 2 % drops 4-5 times a day, Azelasine drops.
3. Topical Antihistaminics
4. Acetyl Cysteine 0.5% used a muclytic .
5. Topical Cyclosporine 1% in severe and unresponsive cases.

Systemic therapy-

• Oral antihistaminics
• Oral steroids

Treatment of large papillae-

• Supratarsal injection of long acting steroid
• Cryo-application
• Surgical excision.

Reference: Ophthalmology- A K Khurana, Web

Classification-

1. Simple Allergic
   1. Hay fever Conjuctivitis
   2. Seasonal Allergic Conjunctivitis
   3. Perrenial allergic Conjunctivitis
2. Vernal Keratoconjunctivitis
3. Atopic Keatoconjunctivitis (often associated with atopic dermatitis)
4. Giant papillary Conjunctivitis ( Contact lens related)
5. Phlyctenular Keratoconjunctitvitis
6. Contact Dermoconjunctivitis

We will be discussing details on Simple Allergic conjuctivitis.

SIMPLE ALLERGIC CONJUNCTIVITIS-

It is  a milder, non-specific allergic state of conjunctiva, Acute or subacute urticarial reaction, with symptoms like itching, hyperemia ( prominent vessels and redness) and mild papillary response .

Occurs in response to pollens (grass, weed, or tree) . Weed pollens – summer and the beginning of fall, grass – tree pollens -spring and well into the summer.

Sometimes- cosmetics, cigarette smokes,dust and dust mites, fungal spores, and mold can cause perennial problem.

Etiology or Cause-

• Hay fever conjunctivitis- Very commonly occurs in association with allergic rhinitis. Common allergens like pollens, animal dandruff and grass are responsible for this condition.
• Seasonal Allergic Conjunctivitis- Very commonly occurring condition in response to seasonal allergens like pollen grass.
• Perennial Allergic Conjunctivitis- Occurs in response to allergy to house dust and mites that person remains exposed to all the time. It is rarer.

Pathology- Vascular , Cellular and Conjunctival response are responsible for SAC.

Symptoms-

• Intense itching,
• burning in eyes,
• watery discharge and
• mild photophobia ( sensitivity of eye to bright light).

Signs-

• Hyperemia and chemosis: swollen boggy appearance of conjunctiva,
• Edema of lids and mild papillary reaction.

Diagnosis is made from clinical features, normal flora on culture and abundant eosinophils in discharge.

Treatment-

1. Allergens – source of dust, mites, pet animals must be avoided.
2. Local measures- for immediate relief

Vasocontrictors like adrenaline,ephedrine

Sodium Chromoglycate drops are quite effective

Steroids drops must be AVOIDED.

1. Systemic antihistaminics
2. Desensitization- may be tried.

Reference- Comprehensive Ophthalmology-A K Khurana, allergyescape.com.

READ ABOUT VERNAL KERATOCONJUCTIVITIS or VKC

Sty  is an acute small staphylococcal abscess of a lash follicle and its associated gland of Zeis or moll.

Stye with Yellow pus point

Symptoms:

1. sty are  redness, tenderness, and pain in the affected area.
2. The eye may feel irritated or “scratchy.”
3. Later  swelling, discomfort , watering of the eye, and sensitivity to light.
4. small, yellowish point at the center of the bump that develops as pus expands in the area.

Signs:

• Tender Inflamed swelling in the lid Margin, which points anteriorly thought the skin.
• More than one lesion may be present and occasionally minute abscess may involve the entire lid margin.
• In severe case a mild preseptal cellulitis may be present.

Treatment:

1. No treatment is required in most cases because styes frequently resove spontaneously or discharge anteriorly
2. Hot compresses
3. Epilation
4. Systemic Antibiotics may be necessary.

Complications:

Complicated external hordeolum or stye

• Progression to Chalazion
  
• disruption of lash growth,
• lid deformity or lid fistula.
• Eye Cellulitis

Prevention

Stye prevention is closely related to proper hygiene. Proper hand washing can not only reduce the risks of developing styes, but all other types of infections.

Upon awakening, application of a warm washcloth to the eyelids for one to two minutes may be beneficial in decreasing the occurrence of styes by liquefying the contents of the oil glands of the eyelid and thereby preventing blockage. Some studies suggest oral flaxseed supplementation to prevent the occurrence of styes.

In order to prevent developing styes it is recommended to never share cosmetics or cosmetic eye tools with other people. People should also keep their eye tools clean and generally having proper eye hygiene. Women are recommended to remove makeup every night before going to sleep and discard old or contaminated eye makeup.