conjunctivitis%20-%20allergic,%20seasonal%20-and-%20perennial%20(pediatric)
CONJUNCTIVITIS - ALLERGIC, SEASONAL & PERENNIAL (PEDIATRIC)
Allergic conjunctivitis is the direct exposure of ocular mucosal surfaces to the environment that causes an immediate hypersensitivity reaction in which triggering antigens couple to reaginic antibodies (IgE) on the cell surface of mast cells and basophils, leading to the release of histamines that causes capillary dilation and increased permeability and thus conjunctival injection and swelling.
Nerve endings are also stimulated causing pain and itching.
Seasonal allergic conjunctivitis is the most common form in temperate climates. It usually occurs and recurs at a certain period of the year and subjectively more severe than perennial allergic conjunctivitis.
Perennial allergic conjunctivitis manifests and recurs throughout the year with no seasonal predilection. It is most common in tropical climates.

Diagnosis

  • Allergic conjunctivitis are usually diagnosed by history and clinical presentation

History

  • Personal or family history of other allergic conditions (eg atopic dermatitis, allergic rhinitis, asthma)

Determine Possible Trigger Factors

  • Review history with regards to:
    • History of exposure to allergens
      • House dust mites, animal dander, & feathers are the major allergens implicated in perennial allergic conjunctivitis (PAC) and atopic keratoconjunctivitis (AKC)
    • Occupational exposure
    • Travel
    • Use of eye care products, topical medications, or solutions
    • Use of contact lenses (lens hygiene, duration of use, frequency of lens replacement)

Physical Examination

  • Clinical signs are usually bilateral and vary based on patient’s age, mediating cell type and association with other conditions
  • Conjunctival chemosis, hyperemia and a predominantly papillary conjunctival reaction

Laboratory Tests

  • Rarely needed to make diagnosis
  • Usually done for academic or confirmatory purposes

Conjunctival Scrapings

  • If positive for eosinophils it is strongly suggestive of allergy
  • Negative scraping is inconclusive

Confocal Microscopy

  • A non-invasive procedure used to evaluate for atopic keratoconjunctivitis (AKC) and other ocular disease with underlying conditions

Cytological Exam of Tear Fluid

  • Collect tear sample with capillary tube, spread on slide & stain
  • Allergic response is indicated by presence of eosinophils, neutrophils and/or lymphocytes
    • Tear histamine or tryptase levels can also be measured

Immunoassay Testing of Tear Fluid

  • Measure mast cell’s activity by determining the level of tryptase using immunoassay testing
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Saras Ramiya, 3 days ago
US researchers show split liver transplantation and living donor liver transplantation (LDLT) may be superior to whole liver transplantation in improving outcomes in paediatric patients.
27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1
Sudeta D Connolly, Sonali Nanayakkara, 01 Aug 2011

Anxiety disorders are one of the most common psychiatric disorders in children and adolescents, but they often go undetected or untreated. Identification and effective treatment of childhood anxiety disorders can decrease the negative impact of these disorders on academic and social functioning in youth and their persistence into adulthood. Because of the national shortage of child and adolescent psychiatrists in the US, paediatricians are increasingly called on to be front-line partners with child mental health professionals to coordinate care—with screening and early identification as well as with multimodal treatment of childhood anxiety disorders.

2 days ago
Dr Michael Lim, consultant of the Division of Paediatric Pulmonary and Sleep in National University Hospital, Singapore, shares his insights with Pearl Toh on diagnosing and managing paediatric asthma in the primary care setting.