Abstract Allergic conjunctival diseases (ACDs) are the common immunological inflammatory diseases of the anterior surface of the eye. Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) are the most frequent causes of ACDs. Clinically presents as bilaterally conjunctival hyperemia, tearing, conjunctival chemosis, with pruritus. Atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), and Giant papillary conjunctivitis can potentially induce deleterious effects on the anterior surface of the eyes can further progress to decease in visual acuity, photophobia, severe foreign body sensation, and corneal opacity. The clinical course, severity, duration, and comorbidities are varied in different types of ACDs. Moreover, ACDs commonly overlap with other anterior ocular diseases such as blepharitis, infections, and dry eye syndrome. ACDs are under-treated or mistreated by primary care physicians with topical and systemic corticosteroids. Accurate diagnosis is essential for the management of ACDs. Total immunoglobulin E (IgE) in tears, allergen-specific IgE, skin prick test, and patch test are done for IgE and non-IgE mediated diseases, while Schirmer’s test, tear osmolarity, and tear matrix metalloproteinase should be evaluated for dry eye syndrome. Topical antihistamine decongestant and mast cell stabilizer are the first choice of treatment for ACDs, but topical corticosteroids are still a major concern for adverse events. Topical calcineurin inhibitors (cyclosporin A and tacrolimus) are considered in severe cases of PAC and AKC. Allergen immunotherapy (AIT) should be considered only when IgE-mediated immunological reaction is evidenced. This review provides an overview of classification, immunopathology, and updated management of ACDs.
Kathuria et al. (Tue,) studied this question.