Treatment Guideline Chart
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.

Conjunctivitis%20-%20allergic,%20seasonal%20-and-%20perennial%20(pediatric) Diagnosis


  • Allergic conjunctivitis are usually diagnosed by history and clinical presentation


  • 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
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