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It helps to protect the eye from insults such as smoke, bacteria and allergens in the air, as well as the damaging effects of sun and wind.

The eye is also protected by the eyelids, tears and cornea. Conjunctivitis is an inflammation of the conjunctiva of the eye, which becomes red, swollen and produces discharge, in response to these insults.

It can be caused by infection by bacteria or viruses, allergy and physical or chemical irritation.

Treatment depends on identifying the cause and severity of the condition.

There are several signs of allergic conjunctivitis.

Typical signs and symptoms of allergic conjunctivitis include: Redness in both eyes. Itching and burning of both the eye and surrounding tissues. Watery discharge, often accompanied by acute discomfort in bright sunlight light (photophobia). The conjunctiva itself may become very swollen and look light purple, and this may interfere with clarity of vision. Eyelids may also be affected by an allergic reaction, causing the loose tissues of the lid to become swollen with subsequent drooping of the eyelid.

In cases of severe swelling, the lids cannot open and the gap between the upper and lower lids becomes slit like. It is important to note that blurred vision or corneal haze require urgent referral to an eye specialist.

Allergic conjunctivitis symptoms may be: Perennial (all year

round

) due to exposure to dust mite, animal dander, indoor and outdoor mould spores and occasionally foods or food additives.

Seasonal due to airborne allergens such as pollen of grasses, trees and weeds.

Pollen allergy symptoms vary from day to day, depending on the weather, improving in wet weather and worsening on hot windy days or after thunderstorms.

There are also seasonal variations in some airborne mould spores, which may cause seasonal symptoms. Treatment depends on severity and cause of symptoms. Identifying and removing the cause of allergic conjunctivitis, where possible, is ideal when an allergic cause has been confirmed from allergy testing.

For example: House dust mite minimisation measures in the bedroom (removing carpet, using barrier encasing of pillows and mattress, washing bedding in hot water).

Removing the cat from the house in sensitive individuals. It is also important to exclude the presence of a foreign body such as dust, wood chip or an insect/s.

Symptoms of allergic conjunctivitis are generally mild to moderate and respond to bathing eyes with cold water, ice packs and cold water compresses.

Topical lubricants can also help flush allergens from the tear film.

However, symptoms can sometimes be extremely severe and debilitating and require medication. Treatment options include: Topical medications (eye drops) Antihistamine eye drops are effective but should not be used for longer than 6 weeks without medical advice. Antihistamine eye drops in conjunction with a vasoconstrictor minimise itch and remove redness, but should not be used for longer than 14 days without medical advice.

Topical vasoconstrictor eye medications twice daily have minimal side effects, unlike nasal vasoconstrictor medications, but rebound vasodilation encourages overuse. Mast cell stabilisers are generally well tolerated, however, as they can take three to seven days to show an effect, they should be used to prevent symptoms before they occur and can be used as long as necessary.

Mast cell stabilisers/antihistamines are fast acting, effective and generally well tolerated.

Steroid eye drops - are effective quickly in relieving symptoms, but are associated with cataract formation, glaucoma and bacterial and viral infections of the cornea and conjunctiva.

They should only be used short term, only under medical supervision and never in the presence of herpes infections. Oral antihistamines (tablets) Help some people when avoidance measures are difficult.

However, they may dry the eyes, nose and mouth, and may cause blurred vision. Antihistamines are usually contraindicated in glaucoma and advice should be sought from an eye specialist.

Allergen immunotherapy for specific allergens May benefit people with persistent, severe allergic conjunctivitis. However, relief of eye symptoms takes longer than nasal symptoms. Inflammation of the cornea can also be associated with allergy. The cornea has very few blood vessels (that is why it is clear), and is seldom involved in an allergic reaction.

However, there are a number of causes of small pinpoint defects in the cornea, a condition called epithelial keratitis, which is usually due to drug and chemical exposure, for example: Drug toxicity and drug allergy. Contact sensitivity to topical eye medications such as neomycin, idoxuridine, atropine and derivatives, thiomersal and some topical anaesthetics.

Specific conditions involving the cornea, which are associated with allergy are listed below.

A combined inflammation of the conjunctiva and cornea, most often associated with atopic dermatitis/eczema. Usually results in red, scaly and weeping skin of the eyelids. Secondary infection with Staphylococcus aureus is common and may cause infection of the eyelash follicles. The conjunctiva may be swollen, red and with a tenacious clear or pus containing discharge.

The condition can persist for many years and causes severe photophobia, weeping and itching. If the photophobia is severe, it can be difficult for people to open their eyes in direct sunlight.

Conjunctival scarring may occur if the persistent condition is not treated properly.

An inherited cone shaped thinning of the cornea frequently associated with atopic dermatitis. Vision is distorted due to the varying thickness of the cornea. Contact lenses may be necessary but they have particular problems in this condition. Rigid lenses are necessary for good vision but they may irritate the inflamed conjunctiva. It is important to consult an eye specialist should this condition be suspected. May be associated with the severe form of atopic dermatitis in about 8-10% of sufferers.

Occurs in children and young adults, even in the absence of steroid therapy.

Usually affects both eyes and is severe, occurring seasonally and mainly in children.



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