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.

Introduction

Seasonal Allergic Conjunctivitis (SAC)
  • Most common form of allergic conjunctivitis in temperate climates
  • Usually occurs and recurs at a certain period of the year (eg summer)
  • Subjectively more severe than perennial allergic conjunctivitis (PAC)

Perennial Allergic Conjunctivitis (PAC)

  • Manifests and recurs throughout the year with no seasonal predilection
  • Most common in tropical climates

Vernal Keratoconjunctivitis (VKC)

  • Most commonly affects young male individuals residing in hot, dry tropical places (eg Middle East, India, North/South America)

Atopic Keratoconjunctivitis (AKC)

  • Attributed to a positive family history of atopy
  • Most often triggered by environmental factors

Giant Papillary Conjunctivitis (GPC)

  • An inflammatory reaction by the eyelids to a foreign object
  • Most commonly associated with use of contact lenses; other causes include exposed post-operative sutures, ocular prostheses, glaucoma filtering blebs

Pathophysiology

  • 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

Signs and Symptoms

  • Ocular/periocular itching with redness, tearing, burning, stinging, photophobia, watery discharge, and/or ecchymosis (“allergic shiner”), foreign body sensation; characterized by exacerbations and remissions
    • Itching is considered the cardinal symptom
    • Identify the date and timing of onset, and progress of symptoms
    • Symptoms tend to decrease with age
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