Conjunctiva
Allergic Conjunctivitis
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Allergic Conjunctivitis
, Hay fever Conjunctivitis, Irritant Conjunctivitis
See Also
Medication induced
Conjunctivitis
Vernal Conjunctivitis
Causes
Related to seasons or environmental change
Recent exposure to pollen, grass
Irritants
Smog
Chlorine
Dust
Cigarette
smoke
Iatrogenic:
Topical Antibiotic
s
Gentamicin
and other
Aminoglycoside
eye preparations
Sulfonamide
eye preparations
Neomycin eye preparations
Symptoms
Typically bilateral involvement
Eye itching
Pathognomonic for Allergic Conjunctivitis
Eye tearing with stringy discharge
Eye Fullness
Sensation
Signs
Marked
Conjunctival Hyperemia
Marked
Chemosis
Red hypertrophic papillae on lid
Conjunctiva
l lining
Best seen with
Fluorescein
Appears as cobblestoning
Conjunctiva
l edema
Eye may appear to sink into
Conjunctiva
Management
Approach
Gene
ral Measures
Discontinue offending agents or medications
Avoid allergans
Consider
Allergic Rhinitis
management (oral
Antihistamine
s,
Intranasal Corticosteroid
s)
Mild Symptoms
Cold compress to eyes
Artificial tears
Moderate Symptoms
Ocular Antihistamine
s AND
Ocular NSAID
s OR
Ocular Mast Cell Stabilizer
s
Severe Symptoms
Continue agents used for mild and moderate symptoms as above AND
Consider
Topical Corticosteroid
(e.g. loteprednol 0.2% or fluorometholone 0.1%)
Exercise
caution (exclude infection first)
Management
Preparations
Ocular Mast Cell Stabilizer
s (preferred)
Cromolyn Sodium
(
Crolom
) 1 drop 4-6x/day
Lodoxamide
0.1% (
Alomide
) 1-2 drops each eye four times daily
Olopatadine
0.1% (
Patanol
, OTC in 2020) 1-2 drops each eye twice daily
Ketotifen 0.025% (
Alaway OTC
,
Zaditor
) 1-2 drops each eye twice daily
Less expensive and over-the-counter
Ocular Antihistamine
s
Naphazoline
(
Vasocon
,
Naphcon
) 1 drop twice to four times daily prn
Epinastine
(
Elestat
) 0.05% 1 drop each eye twice daily
Bepotastine
(
Bepreve
) 1.5% 1 drop each eye twice daily
Alcaftadine
(
Lastacraft
, OTC as of 2022) 0.25% (2.5 mg/mL) one drop in each eye daily
Ocular NSAID
s
Ketorolac
0.5% (Acular) 1 drop four times daily for 7 days
Diclofenac 0.1% (Voltaren) 1 drop four times daily
Oral
Antihistamine
Mild to moderate:
Non-Sedating Antihistamine
Severe:
Diphenhydramine
(
Benadryl
)
Consider
Intranasal Steroid
Consider short course of oral
Corticosteroid
s (3-5 days)
Indicated for severe, refractory cases
Resources
Patient Education
Information from your Family Doctor
http://www.familydoctor.org/handouts/678.html
References
Williams (2017) Crit Dec Emerg Med 31(2): 3-12
Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]
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