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Allergic Disease of the Conjunctiva and Cornea

  • Chapter
Cornea and External Eye Disease

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Core Messages

  • Allergic conjunctivitis is not a single disease.

  • Allergic conjunctivitis is characterized by one or more of the following symptoms: itching, tearing (commonly with anterior rhinorrhea), or lid swelling.

  • The severity of allergic conjunctivitis ranges from mild and intermittent to seriously debilitating.

  • Seasonal and perennial allergic conjunctivitis (PAC) are the most common entities and do not involve the cornea.

  • The cornea may be involved in vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), or contact blepharoconjunctivitis, but never in seasonal conjunctivitis or PAC.

  • An accurate clinical history and evaluation of signs and symptoms allow the diagnosis of ocular allergy and the definition of possible sensitizing antigens.

  • IgE-mediated hypersensitivity and mast cell degranulation are the initial pathophysiological mechanisms.

  • Th2-type of cytokines, chemokines, and other multiple mediators are overexpressed in ocular allergy.

  • Epitheliotoxic proteins, cytokines, and chemokines liberated from eosinophils and Th2 cells may act concomitantly in the pathogenesis of shield ulcer.

  • Keratoconus (KC) is frequently associated with atopy.

  • Infections can rarely complicate corneal inflammation in VKC and AKC.

  • Allergic conjunctivitis is important in the context of corneal transplantation.

  • Nonpharmacological measures and avoidance are extremely important for disease management.

  • Therapy should not include vasoconstrictors and, if possible, corticosteroids.

  • Mast cell stabilization and histamine antagonism are the main pharmacological interventions.

  • Dual action drugs are the first choice in the treatment of ocular allergy.

  • The cost of treating allergic conjunctivitis and indirect costs related to loss of workplace productivity from the disease are substantial.

  • Severe cases need intense treatment.

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  1. Ophthalmology Unit, University of Padua, Via Giustiniani, Padua, 2, I-35128, Italy

    Andrea Leonardi

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  1. University Eye Hospital, Killianstraβe 5, Freiburg, 79106, Germany

    Thomas Reinhard (Professor and Chairman) (Professor and Chairman)

  2. Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, United Kingdom

    Frank Larkin

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Leonardi, A. (2010). Allergic Disease of the Conjunctiva and Cornea. In: Reinhard, T., Larkin, F. (eds) Cornea and External Eye Disease. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85544-6_8

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