- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines
Conjunctivitis (Acute Allergic)
Contents
Aetiology
A self-limiting urticarial reaction to an allergen (often unidentified) that comes into contact with the conjunctiva provoking an immediate (Type I) IgE-mediated response
Common in children
Allergens include: grass pollen, animal dander
Predisposing factors
History of allergic disease; can also occur without such history
Symptoms of acute allergic conjunctivitis
Sudden eyelid swelling
Ocular itching
May be unilateral (if a direct contact response)
Signs of acute allergic conjunctivitis
Lid oedema and erythema
Conjunctival hyperaemia and chemosis (oedema): may bulge over lid margin or limbus
Watery or mucoid discharge (mild)
Usually no papillae
No corneal involvement
Differential diagnosis
Seasonal allergic conjunctivitis
Chemical trauma
Insect bite or sting
Preseptal or orbital cellulitis
Management by optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere
Non pharmacological
Reassure patient: most cases resolve spontaneously within a few hours
Advise against eye rubbing (causes mechanical mast cell degranulation)
Cool compresses may give symptomatic relief
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
If possible identify allergen (take careful history) and advise future avoidance
Advise patient to return/seek further help if symptoms persist
Pharmacological
Not normally required (although ocular lubricant drops and/or topical anti-histamines may provide symptomatic relief)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
If condition recurrent, prescribe prophylactic topical mast cell stabiliser, e.g. gutt. sodium cromoglicate 2% (as POM), or gutt lodoxamide 0.1%, or dual-acting antihistamine/mast cell stabiliser, e.g. gutt. olopatadine 0.1% (off-label use), or gutt ketotifen 0.025% (off-label use)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Management category
B2: alleviation/palliation – normally no referral
Possible management by ophthalmologist
Not normally referred
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and Evaluation (see www.gradingworkinggroup.org)
Sources of evidence
Bilkhu PS, Wolffsohn JS, Naroo SA, Robertson L, Kennedy R. Effectiveness of non-pharmacologic treatments for acute seasonal
allergic conjunctivitis. Ophthalmology. 2014;121(1):72-78.
Buckley RJ. Allergic eye disease – a clinical challenge. Clinical &Exp Allergy 1998;28:39-43
del Cuvillo A, Sastre J, Montoro J, Jáuregui I, Dávila I, Ferrer M, Bartra J, Mullol J, Valero A. Allergic Conjunctivitis and H1 Antihistamines. J Investig Allergol Clin Immunol. 2009;19,Suppl.1:11-18
Summary
What is Acute allergic conjunctivitis?
Acute allergic conjunctivitis is an allergic reaction of the eyes, which causes a sudden swelling and redness of the eyelids and conjunctiva (the clear membrane covering the white of the eye), often associated with itching. It usually occurs in sensitised people who come into contact with grass pollen or animal fur.
How is Acute allergic conjunctivitis managed?
Most cases get better within a few hours without the need for treatment. However, anti-allergy eye drops may help to control symptoms in the short term and in people with recurrent episodes.
Conjunctivitis (Acute Allergic)
Version 14
Date of search 08.12.22
Date of revision 23.02.23
Date of publication 30.03.23
Date for review 07.12.24
© College of Optometrists
- Abnormalities of the Pupil
- Atopic Keratoconjunctivitis (AKC)
- Basal cell carcinoma (BCC) (periocular)
- Blepharitis (Lid Margin Disease)
- CL-associated Papillary Conjunctivitis (CLAPC), Giant Papillary Conjunctivitis (GPC)
- Cellulitis, preseptal and orbital
- Chalazion (Meibomian cyst)
- Concretions
- Conjunctival pigmented lesions
- Conjunctival scarring
- Conjunctivitis (Acute Allergic)
- Conjunctivitis (bacterial)
- Conjunctivitis (viral, non-herpetic)
- Conjunctivitis (seasonal & perennial allergic)
- Conjunctivitis, Chlamydial
- Conjunctivitis medicamentosa (also Dermatoconjunctivitis medicamentosa)
- Corneal (or other superficial ocular) foreign body
- Corneal Transplant Rejection
- Corneal abrasion
- Corneal hydrops
- Dacryocystitis (acute)
- Dacryocystitis (chronic)
- Dry Eye (Keratoconjunctivitis Sicca, KCS)
- Ectropion
- Endophthalmitis (post-operative) (Exogenous endophthalmitis)
- Entropion
- Episcleritis
- Facial palsy (Bell's Palsy)
- Fuchs Endothelial Corneal Dystrophy (FECD)
- Glaucoma (chronic open angle) (COAG)
- Herpes Simplex Keratitis (HSK)
- Herpes Zoster Ophthalmicus (HZO)
- Hordeolum
- Keratitis (marginal)
- Keratitis, CL-associated infiltrative
- Microbial keratitis (Acanthamoeba sp.)
- Microbial keratitis (bacterial, fungal)
- Molluscum contagiosum
- Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction)
- Ocular hypertension (OHT)
- Ocular rosacea
- Ophthalmia neonatorum
- Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
- Phthiriasis (pediculosis ciliaris)
- Pigmented fundus lesions
- Pinguecula
- Post-operative suture breakage
- Primary Angle Closure / Primary Angle Closure Glaucoma (PAC / PACG)
- Pterygium
- Recurrent corneal epithelial erosion syndrome
- Retinal Vein Occlusion
- Scleritis
- Steroid-related Ocular Hypertension and Glaucoma
- Sub-conjunctival haemorrhage
- Sub-tarsal foreign body (STFB)
- Trauma (blunt)
- Trauma (chemical)
- Trauma (penetrating)
- Trichiasis
- Uveitis (anterior)
- Vernal Keratoconjunctivitis
- Vitreomacular Traction and Macular Hole
- How to use the Clinical Management Guidelines
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