What Are the Different Types of Allergic Conjunctivitis Treatment?

Allergic conjunctivitis, also known as allergic conjunctivitis, is a hypersensitivity reaction of the conjunctiva to external allergens. It mainly includes type I allergies and type IV allergies, of which allergic conjunctivitis caused by type I allergies is the most common. Allergic conjunctivitis caused by type allergies is rapid, mainly refers to allergic conjunctivitis, including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, giant papillary conjunctivitis, spring keratoconjunctivitis, atopic Keratoconjunctivitis, etc .; allergic conjunctivitis caused by type IV allergic reactions is delayed, mainly vesicular conjunctivitis.

Basic Information

Also known as: Allergic conjunctivitis
English name: anaphylacticconjunctivitis
Visiting department: Ophthalmology

Common locations: Eye conjunctiva
Common causes: Pollen, fungi, dust mites, animal dander, etc.
Common symptoms: Itchy eyes, tears, burning sensation, photophobia, increased secretions, etc.
Contagious: no

Causes of allergic conjunctivitis

Both seasonal and perennial allergens can trigger an allergic immune response. Seasonal allergens include: tree pollen, grasses, weed pollen, and outdoor fungi. Perennial allergies to original dust mites, indoor fungi, and animal dander (mostly cats and dogs).

Clinical manifestations of allergic conjunctivitis

The most common symptom of allergic conjunctivitis is itchy eyes, which can occur in almost all patients with allergic conjunctivitis, and spring keratoconjunctivitis is usually the most obvious. Other symptoms include tearing, burning sensation, photophobia and increased secretions. The secretions are mostly mucus. Some of the more severe allergic conjunctivitis, such as spring keratoconjunctivitis and atopic keratoconjunctivitis, can sometimes cause vision loss.

The most common sign of allergic conjunctivitis is conjunctival congestion. Conjunctival papillary hyperplasia is another common sign. Nipples often appear in the upper eyelid conjunctiva. Nipples of giant papillary conjunctivitis and spring keratoconjunctivitis have specific morphological characteristics. Atopic keratoconjunctivitis often shows changes in conjunctival fibrosis (scarring). Conjunctival edema can also occur during the onset of seasonal allergic conjunctivitis, especially in children. Corneal damage is most common in spring with keratoconjunctivitis and atopic keratoconjunctivitis.

Allergic conjunctivitis examination

1. Conjunctival secretion smear and conjunctival scrape examination

Degenerate epithelial cells and eosinophils can be found in about half of patients with seasonal allergic conjunctivitis, perennial allergic conjunctivitis and spring keratoconjunctivitis. Very low.

2. Quantitative analysis of IgE in tears

It is a semi-quantitative method to quantify IgE by drawing tears from the lower fornix through acetic acid nitrocellulose membrane filter paper. This method is simple to operate, but its sensitivity and specificity are not high. The presence of IgE in tears supports the diagnosis of allergic conjunctivitis to a certain extent, but the lack of IgE cannot rule out the diagnosis.

3. Skin test and conjunctival allergen challenge test

It can be used for the diagnosis of allergic diseases, the search for allergens, the observation of the clinical manifestations caused by allergens, and the evaluation of the effect of anti-allergic treatments. This test is often used to determine the allergens before desensitization treatment. This test is mostly used for seasonal and perennial allergic conjunctivitis, but the positive rate is not high, and the occurrence of false positives should be noted.

4. Blotted cell inspection

This is a non-invasive examination. Patients with allergic conjunctivitis can often find an increase in degeneration of epithelial cells and eosinophils.

5. Conjunctival biopsy

Conjunctival biopsy is used only when other methods cannot be diagnosed, and is mainly used for the diagnosis of patients with suspected atopic keratitis (AKC).

6.Conjunctival scraper

In allergic conjunctivitis, the occurrence rate of eosinophils in conjunctival scrapings is 20% to 80%. Negative eosinophils in the smear test does not exclude the diagnosis of allergic conjunctivitis.

7. Skin test

It has certain diagnostic value for confirming whether the diagnosis has reacted to a suspected allergen. Tests can be performed on the surface of the skin and, if necessary, intradermal. Allergens typically tested include tree grass, pollen mites, and animal dander.

8. Radioactive Allergen Adsorption Test (RAST)

It is one of the in vitro methods for measuring the specific IgE level of a specific allergen in vitro. RAST is less sensitive than skin tests and is more expensive, so this method or other in vitro tests should only be used when skin tests cannot be performed, such as patients with severe rashes and inability to stop antihistamines.

9. Detection of tryptase

Increased tear tryptase levels can be detected in allergic conjunctivitis using a sensitive immunoassay. Because tryptase is released from mast cells, elevation is limited to early responses. The determination of tryptase levels is of certain value in assessing the therapeutic effect of mast cell stabilizers.

10. Histological testing.

Diagnosis of allergic conjunctivitis

Many allergic conjunctivitis lack the characteristic symptoms and signs. When you make a diagnosis, you need to carefully ask your medical history, such as family and personal allergies, medication history, contact lens wearing history, season of onset, time and speed of onset, duration of disease, etc., and closely combine its clinical manifestations, supplemented if necessary. Laboratory inspection.

Seasonal conjunctivitis has its special history and clinical manifestations, and the diagnosis is not difficult. For some atypical cases, conjunctival pathological biopsy or conjunctival scraping can be done for cytology. In most cases, more eosinophils are common, or piles of eosinophils are left as a result of the disappearance of eosinophilic degeneration and disintegration nuclei, which is also of diagnostic significance. In addition, it can be used for the determination of IgE content in serum or tears, which can not only assist the diagnosis, but also be an indicator to predict the course of the disease.

Allergic Conjunctivitis Treatment

The purpose of treatment is to reduce clinical symptoms and avoid sequelae. At the same time, care should be taken to avoid iatrogenic complications.

General treatment

Dissociation of allergens is the most ideal and effective treatment. Try to avoid contact with possible allergens. Such as removing rags and blankets in the room, paying attention to the hygiene of the bed, using insecticides to destroy the insect mites in the room, avoiding contact with grass, tree flowers, etc. during the pollen transmission season, stop wearing or replace high-quality contact lenses and care solutions. Cold eyelids can temporarily relieve symptoms.

2. Drug treatment

(1) Antihistamines Antihistamines are usually used topically. The common eye drops are 0.1% emestine, 0.05% Levocabastine, 0.1% Olopatadine, and 0.5% Ketorolac. If you have extraocular symptoms, you can take it orally, but the effect is not as good as topical. Commonly used oral medications include diphenhydramine, chlorpheniramine, and promethazine. The combined use of antihistamines and vasoconstrictors can often achieve better therapeutic effects, such as moisturizing and so on.

(2) Mast cell stabilizers Commonly used are disodium colored glycinate and nedocromil. Although the overall therapeutic effect of mast cell stabilizers is inferior to antihistamines, it seems to be more effective in suppressing tearing. It is best to use it before contacting the allergen.

(3) Non-steroidal anti-inflammatory drugs can be used in the acute phase and the intermittent phase of the onset of allergic diseases. It shows a certain therapeutic effect on the relief of eye symptoms and signs such as itchy eyes, conjunctival hyperemia, and tearing. Can reduce the dosage of hormones, commonly used indomethacin (diclofenac sodium), aspirin and so on.

(4) Vasoconstrictive agents Commonly used drugs for local use are epinephrine, oxymetazoline, tetrahydrozoline, etc., which can improve eye discomfort and reduce ocular surface congestion.

(5) Glucocorticoids Only consider using severe allergic conjunctivitis when other drugs are ineffective, and the use time should not be too long, so as to avoid complications such as cataract, glaucoma virus infection, fungal infection, and delayed corneal epithelial healing. Commonly used are dexamethasone, betamethasone and flumetrolone.

(6) Immunosuppressants are mainly cyclosporin A and FK506. For some cases of severe keratoconjunctivitis requiring the use of hormones, topical application of 2% cyclosporine A can quickly control local inflammation and reduce hormone use. the amount. However, it is easy to relapse after discontinuation.

3. Desensitization treatment

This method is mainly used for seasonal allergic conjunctivitis. For other subtypes of allergic conjunctivitis, the treatment effect is often not ideal, so it is rarely used.

4. Cryotherapy

This method is mainly used for spring keratoconjunctivitis. Cryotherapy is commonly used on the upper eyelid conjunctiva, reducing the temperature to -80 ° C to -30 ° C for 30 seconds. Cryotherapy can be repeated 2 to 3 times.

5. Psychotherapy

Eye allergic disease is an acute or chronic recurrent disease, and radical cure is often very difficult. Therefore, it causes greater psychological pressure on some patients. In particular, some children with keratoconjunctivitis in the spring may have certain psychological disorders, which should be paid attention to.