II. Causes
- Related to seasons or environmental change
- Recent exposure to pollen, grass
- Irritants
- Iatrogenic: Topical Antibiotics
- Gentamicin and other Aminoglycoside eye preparations
- Sulfonamide eye preparations
- Neomycin eye preparations
III. Symptoms
- Typically bilateral involvement
- Eye itching
- Pathognomonic for Allergic Conjunctivitis
- Eye tearing with stringy discharge
- Eye Fullness Sensation
IV. Signs
- Marked Conjunctival Hyperemia
- Marked Chemosis
- Red hypertrophic papillae on lid Conjunctival lining
- Best seen with Fluorescein
- Appears as cobblestoning
-
Conjunctival edema
- Eye may appear to sink into Conjunctiva
V. Management: Approach
-
General Measures
- Discontinue offending agents or medications
- Avoid allergans
- Consider Allergic Rhinitis management (oral Antihistamines, Intranasal Corticosteroids)
- Mild Symptoms
- Cold compress to eyes
- Artificial tears
- Moderate Symptoms
- 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)
VI. Management: Preparations
-
Ocular Mast Cell Stabilizers (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 Antihistamines
- 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 NSAIDs
- 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 Corticosteroids (3-5 days)
- Indicated for severe, refractory cases
VII. Resources: Patient Education
- Information from your Family Doctor
VIII. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Cronau (2010) Am Fam Physician 81(2): 137-44 [PubMed]