Current reviews of allergy and clinical immunologyAllergic and immunologic disorders of the eye. Part II: Ocular allergy☆,☆☆
Section snippets
Allergy
The allergic inflammatory component in allergic rhinitis has been extensively studied because of the high incidence of this condition, the significant morbidity it imposes, and the accessibility of nasal tissue. However, ocular symptoms are less well studied as an independent entity, and much of the clinical information is commonly buried within the rhinoconjunctivitis literature.1 Allergic conjunctivitis is commonly associated with allergic rhinitis and symptoms of watery (88%), itchy (88%),
Seasonal and perennial allergic conjunctivitis overview
Allergic conjunctivitis is caused by direct exposure of the ocular mucosal surfaces to the environment and is the most common hypersensitivity response of the eye.5 Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) are the most prevalent forms of ocular allergy and are seldom followed by permanent visual impairment. Of the two, SAC is more common. Of the aeroallergens, ragweed is the most common cause of allergic conjunctivitis accompanying allergic rhinitis.
Late-phase reactions
A conjunctival late-phase reaction has been described.16, 17, 18, 19, 20 In this model used by Leonardi et al, the late-phase reaction manifested itself in several forms including a classic biphasic response (33%), a multiphasic response (25%), and a single prolonged response (41%).21 The histologic evaluation of the conjunctiva revealed the typical influx of nonspecific cells of the inflammatory response including neutrophils, basophils, and eosinophils. Tears collected from timed periods over
Atopic keratoconjunctivitis
Atopic keratoconjunctivitis (AKC) is a chronic inflammatory process of the eye with disabling symptoms most commonly involving the lower tarsal conjunctiva. When it involves the cornea, it can lead to blindness. A family history of atopy, such as eczema and asthma, is very common, with more than 95% of AKC patients also having eczema and 87% having history of asthma. However, the inverse (ie, the reported incidence of ocular involvement in AKC patients with atopic dermatitis) reveals a range of
Vernal keratoconjunctivitis
Vernal keratoconjunctivitis (VKC) is a severe bilateral recurrent chronic ocular inflammatory process of the upper tarsal conjunctival surface. It has a marked seasonal incidence, and its frequent onset in the spring has led to the term vernal catarrh. It occurs most frequently in children and young adults who have a history of seasonal allergy, asthma, and eczema. Interestingly, a physiologic correlation of VKC with bronchial responsiveness to methacholine has been reported.59
The age of onset
Clinical features
GPC has been directly linked to chronic exposure to foreign bodies, such as the continued use of contact lenses,81 ocular prostheses,82 sutures,83 scleral buckles,84 cyanoacrylate adhesive,85 filtering blebs,86 and elevated corneal deposits.87 There is an increase of symptoms during spring pollen season. Symptoms include itching, tearing, and excessive ocular discomfort and mucus production. Signs include a white or clear exudate on awakening, which chronically becomes thick and stringy.
Ocular allergy treatment
It is apparent that the treatment of ocular allergies is based largely on the important aspect of the interference with quality of life that the patient experiences (ie, severity of symptoms).98 It has been demonstrated that such quality-of-life parameters may take up to 2.5 weeks to improve with treatment. The easiest and most direct therapeutic method is the direct placement of a “topical” agent on the affected tissue. Several topical agents are available for the treatment and, to some
Summary
Ocular allergy includes a spectrum of clinical disorders that involve different levels of activity of the TH2-directed immune response at the conjunctival interface. The spectrum can be better appreciated through immunopathologic and molecular immunologic techniques. In SAC there are minimal pathologic changes such as an increase in mast cell activation, minimal presence of migratory inflammatory cells, and early signs of cellular activation at the molecular level. In PAC, these markers are
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Supported by a grant from Astra Pharmaceuticals, Westborough, Mass
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Reprint requests: Leonard Bielory, MD, UMDNJ–Asthma and Allergy Research Center, 90 Bergen St, DOC Suite 4700, Newark, NJ 07103.