Eye
Conjunctiva
Conjunctivitis
Allergic conjunctivitis
Author: Deepali Jain, M.D.
Last author update: 1 October 2014
Last staff update: 18 December 2020
Copyright: 2004-2023, PathologyOutlines.com, Inc.
PubMed Search: Allergic conjunctivitis [title] pathology
Table of Contents
Epidemiology | Sites | Pathophysiology | Clinical features | Diagnosis | Treatment | Clinical images | Microscopic (histologic) description | Cytology description | Differential diagnosisCite this page: Jain D. Allergic conjunctivitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/eyeallergicconjuncitivitis.html. Accessed October 2nd, 2023.
Epidemiology
- Prevalence of 15 - 40% (Curr Opin Allergy Clin Immunol 2011;11:471)
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
Images hosted on other servers:
Atopic kerato-conjunctivitis
Giant papillary conjunctivitis
Seasonal and perennial allergic conjunctivitis
Vernal conjunctivitis
Vernal keratoconjunctivitis
Microscopic (histologic) description
- May have eosinophils in conjunctival scraping (Acta Ophthalmol (Copenh) 1988;66:381)
Cytology description
- Consistent with clinical diagnosis (Indian J Pathol Microbiol 1992;35:118)
Differential diagnosis
- Atopic keratoconjunctivitis
- Giant papillary keratoconjunctivitis: lymphocyte and eosinophil predominant, versus predominance of mast cells and eosinophils in allergic cases
- Vernal keratoconjunctivitis
