Allergic Conjunctivitis


What is the conjunctiva?

 

 

The conjunctiva is the membrane that covers the front part of the eyeball.  When you look at the eye and see the “white” of the eye, you are actually looking through the conjunctiva to the white shell of the eyeball (the sclera). 

 

The conjunctiva is a very thin, moist membrane – like the lining on the inside of your mouth and nose.  When the eyes are red it is almost always the blood vessels within the conjunctiva that become swollen – the sclera does not have any blood vessels of its own.

 
What is conjunctivitis?

When the conjunctiva is inflamed, for anyreason, this is termed conjunctivitis.   Signs and symptoms of conjunctivitis include redness, swelling of the lids, tearing, itching, and (sometimes) light sensitivity.  While there are many causes of conjunctivitis the end result looks pretty much all the same; since all types of conjunctivitis look similar, the history takes on a particular importance. 

 

For example, if all the kids in a school have conjunctivitis and this is taking place during the season when there is an epidemic of infectious conjunctivitis, then the likely diagnosis is infectious conjunctivitis.  Similarly, if a child has seasonal allergies and now has itchy, uncomfortable eyes, and there is a lot of pollen in the air, then allergic conjunctivitis is most likely.  The reason to visit an ophthalmologist is that not all red eyes are conjunctivitis, and not all types of conjunctivitis are treated the same way.


What to do for allergic conjunctivitis?

There are several ways to attack the problem. 

 

1.         First, and best, is to stop exposing the patient to the allergen – this is possible if the cause is a new pet , a new laundry detergent, or a new carpet, but it is next to impossible if the patient is allergic to ubiquitous environmental such allergens dust or pollen (in which case desensitization treatment may be indicated). 

 

2.      Simultaneously, treat the conjunctivitis itself. Over the past decade or so a very useful class of antihistamine eyedrops has come to market – these medications are very safe and usually very effective (Zaditor, Patanol, Alamast, Optivar, Livostin).  These medications require 1 to 2 weeks for their full benefit to kick in, but there is almost always some immediate improvement when they are used.   Sometimes, one of these medicines won’t work but a different one in the same category will. 

 

When antihistamines are not doing the job, or if the allergic reaction is severe and needs to be quieted down more rapidly, steroid eyedrops are used.  While short-term use of steroid eyedrops is safe, there are definite risks from using them improperly – you should never use any steroid unless it is under the supervision of a physician.  When steroids fail (which is very rare, there are other forms of anti-inflammatory eyedrops that can be used; some of these are actually weak formulations of chemotherapy drugs.

 

3.      Finally, desensitization should be considered.  If your child suffers from allergies on a regular basis, or suffers very severely during certain allergy seasons, then you might consider asking your pediatrician for a referral to an allergist.  Allergists can determine what the patient is allergic to and then expose them to small amounts of the allergen until they become desensitized to it.  Usually, this involves injecting the allergen under the skin in gradually increasing concentrations.

   
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