MACHO 17

Eye Department KCMC Newsletter

Issue 3 Volume 5 Serial 17                                                                     30 September 2015

Allergic Conjunctivitis

Allergic Conjunctivitis is an inflammatory reaction of the conjunctiva to environmental allergens causing itchy sensation in the eyes, redness and tearing. Eye rubbing makes the condition worse rather than make it better. After each session of eye rubbing, the eye itch even more eliciting a more intense rubbing.

Allergic Conjunctivitis is the most common eye disease encountered among children, there is no gender predilection. The type of Allergic Conjunctivitis that is encountered here in North-eastern Tanzania is known as Vernal Keratoconjunctivits.

Table: Number of Allergic Conjunctivitis Cases at Eye Department KCMC

	2010	2011	2012	2013	2014
Cases	2794	2974	3481	4248	4787
Rank	Nr 5	Nr 5	Nr 3	Nr 3	Nr 1
Percentage of Total	12.5%	12%	14%	17%	18%

All allergic reactions are generically termed as Hypersensitivity Reactions, of which there are of four kinds. Allergic Conjunctivitis is Hypersensitivity Type I (Anaphylaxis) and IV (Cell Mediated Reaction). These patients mount an exaggerated immune response to substances that for the rest of the population there is no reaction. Some of the allergens involved include house dust (Excrement of arthropods who feed on desquamated human skin on furniture). Patients with Allergic Conjunctivitis tend to have also Allergic Rhinitis. Mast Cells in conjunctiva degranulate Histamine which causes the inflammation and eye itch.

A patient with Allergic Conjunctivitis would report Itchy Eyes, Red Eyes, Tearing, Photophobia and Eye Discharge. The symptoms may be periodic or continuous.

Upon examination, clinician would note the following:

1. Inflamed Conjunctiva.

2. Excessive Tearing.

3. Nodular elevations of the Conjunctiva lining the inner surface of the upper eyelid known as Tarsal Papillae.

4. Pigmentation of the Conjunctiva in chronic cases.

5. Nodular elevations on the Limbus peaked with white granular deposits known as Trantas Dots.

6. Punctate Keratitis.

7. Cornea Shield Ulcer in severe cases.

Allergic Conjunctivits and its severe form Vernal Keratoconjunctivits if left untreated will lead to the following possible complications:

1. Keratoconus.

2. Cornea Scarring from Shield Ulcer.

3. Surface Cornea Vascularization known as Pannus.

Treatment options available for Allergic Conjunctivits are as follows:

1. Cold water compresses on the closed eyelids.

2. In mild forms of Allergic Conjunctivitis, vasoconstriction drugs such as Naphazoline 0.1% and Olopatadine 0.1% Eye Drops can be used as needed.

3. Antihistamine Eye Drops such as Emedastine 0.05% given three times a day in case of Seasonal Allergic Conjunctivits in adults.

4. Topical Corticosteroid Eye Drops such as Prednisolone 1% or Dexamethasone 0.1% in cases of severe symptoms. Remember that although Corticosteroids give almost instantaneous results they also put the eye at risk of Cataract, Glaucoma and Infections.  

5. Mast Cell Stabilizers such as Sodium Cromoglycate 2% and Lodoxamide 0.1% Eye Drops given four times a day are ideal drugs because of their limited side effects on long term use. They act slowly and takes up to five days for the patient to feel the difference, by this time some patients have already abandoned the use of the drugs.

6. In severe cases, sub-conjunctiva injections of Triancinolone can be used, given once every three months.

7. Topical Cyclosporine 2% Eye Drops given three times a day or topical Tacrolimus 0.1% applied once per day can be used in severe cases. 

 Trantas Dots                                                    

Giant Papillae on Tarsal Conjunctiva

Editor: W. Makupa, Eye Department KCMC, P.O.Box 3010 Moshi – Tanzania

Tel: +255 784 332 667 Fax: +255 27 275 4381 Email: makupauw@yahoo.com