Eye
Conjunctiva
Allergic conjunctivitis

Author: Deepali Jain, M.D. (see Authors page)

Revised: 24 April 2018, last major update October 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Allergic conjunctivitis [title] pathology

Cite this page: Jain, D. Conjunctiva: allergic conjunctivitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyeallergicconjuncitivitis.html. Accessed September 21st, 2018.
Epidemiology
Sites
  • Unilateral or bilateral; affects palpebral and bulbar conjunctiva
Pathophysiology
  • Ocular surface inflammation (usually mast cell driven) is associated with type 1 hypersensitivity reactions (eMedicine: Allergic Conjunctivitis [Accessed 24 April 2018])
  • May be part of systemic atopic reaction to a systemic allergen
  • Most prevalent types (95%) are perennial and seasonal (hay fever eyes) (Curr Opin Allergy Clin Immunol 2013;13:543)
  • Most frequent allergens are tree and grass pollens
  • More severe forms
    • Chronic vernal keratoconjunctivitis: more common in spring ("vernal"); conjunctival scarring, eyelid thickening, ptosis, corneal neovascularization, ulceration, thinning, infection, keratoconus, and vision loss
    • Atopic keratoconjunctivitis: eyelid tightening, loss of eyelashes, cataracts
    • Giant papillary conjunctivitis: eyelid inflammation and ptosis
Clinical features
  • History of allergy, asthma, or eczema
  • Itching (pruritus), chemosis, tearing and redness with or without sneezing and nasal discharge
  • 2 - 3x increased risk for herpetic infection (Curr Eye Res 2006;31:721)
Diagnosis
  • Cobblestoning (vernal) or papillary hypertrophy (giant papillary) of upper tarsal conjunctiva in chronic forms
Treatment
  • Allergy type medications; topical cyclosporine if severe (Cornea 2007;26:1035)
  • Patient education, lifestyle modification, and topical medications (antihistamines, mast cell stabilizers, corticosteroids, immunomodulators)
Clinical images

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Atopic kerato-conjunctivitis

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Giant papillary conjunctivitis

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Seasonal and perennial allergic conjunctivitis

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Vernal conjunctivitis

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Vernal keratoconjunctivitis

Microscopic (histologic) description
Cytology description
Differential diagnosis
  • Atopic keratoconjunctivitis
  • Giant papillary keratoconjunctivitis: lymphocyte and eosinophil predominant, versus predominance of mast cells and eosinophils in allergic cases
  • Vernal keratoconjunctivitis