13-year-old Wu Xiaodi has been suffering from allergies since he was a child. His eyes are often itchy and have secretions. This gets worse every spring. The more he rubs his eyes, the more itchy he becomes. He may even be itchy to the point where he cannot sleep well. In recent years, his parents noticed that his right eye was gradually getting smaller, so they sought ophthalmology consultation.
After examination, it was found that Wu Xiaodi had severe allergic conjunctivitis, which caused inflammation and fibrosis of the conjunctiva of his right eye. It was also complicated by corneal astigmatism and eyelid droop, so his eyes looked smaller, which also affected his vision.
What is allergic conjunctivitis?
The conjunctiva is a transparent film covering the whites of the eyes and the inside of the eyelids.
Allergic conjunctivitis is an inflammatory reaction of the conjunctiva to allergens . It often occurs in people with allergies, such as allergic rhinitis , asthma, atopic dermatitis , and those who are allergic to specific substances.
Common substances that cause allergic conjunctivitis include dust, smoke, dirty air, mold, cockroaches, mites, animal dander, pollen, grass, trees, etc.
One in five people in the world suffers from eye allergies , and the trend is gradually increasing. The average age of onset is 20 years old, and symptoms slow down with age.
Old people may also suffer from eye allergies, especially when there are new changes in the environment, such as getting a new pet, moving, etc. In addition, the symptoms of eye diseases such as dry eye syndrome, blepharitis that the elderly are susceptible to, and allergic conjunctivitis are very similar, so further differentiation is needed to avoid delaying treatment.
Allergic conjunctivitis generally rarely affects vision, but a few severe cases may cause ocular surface damage, thereby affecting vision.
Symptoms of allergic conjunctivitis
Most people have allergic symptoms in both eyes at the same time, but the symptoms in one eye will be more severe. Symptoms include:
• Itchy eyes
• Tears
• Increased secretions
• Red and swollen eyelids
• Red and swollen conjunctiva
• Stinging, foreign body sensation, burning sensation
• Sensitivity to light, mild photophobia
• Frequent blinking, Rubbing eyes
• Blurred vision
• Suborbital edema, dark circles
• Wrinkles appearing on the lower eyelids
Patients are also prone to symptoms of blepharitis and dry eye at the same time.
How to diagnose allergic conjunctivitis?
The patient's family history of allergies, whether the patient has other allergic conditions, the age and time when the symptoms appeared, whether they were exposed to second-hand smoke, the air quality of the place where they live, the working environment and other factors can all help to diagnose the cause.
In addition to clinical symptoms, ophthalmic instruments can check for allergic inflammation of the eyes.
can usually record the time when allergies occur and the substances they are exposed to, and further estimate the allergens. If necessary, a skin allergy test, blood drawing to measure IgE concentration, and conjunctiva scraping for cell analysis can be performed to confirm the diagnosis.
Types of allergic conjunctivitis
Types of allergic conjunctivitis include acute, seasonal, perennial, atopic, spring type, and giant mastoid conjunctivitis. The latter three are more severe allergic conjunctivitis and may cause visual damage.
1. Acute allergic conjunctivitis
Acute allergic conjunctivitis is a sudden onset allergic reaction, usually to exposure to a known allergen, such as pet dander.
There will be severe eye itching, congestion, tearing, conjunctival edema, and eyelid edema. Symptoms come and go quickly, with onset occurring within 30 minutes of exposure to the allergen. Once the allergen is removed, symptoms may subside within 24 hours.
2. Seasonal allergic conjunctivitis
Compared with acute allergic conjunctivitis, the symptoms of seasonal allergic conjunctivitis are milder, but can last for days to weeks and only occur in specific seasons, especially spring and summer. Seasonal allergies to grass, pollen, and spores.
Rhinitis is often associated with sneezing, runny or stuffy nose, and can be attributed to pollen spread outdoors. Patients often have a history of asthma, allergic rhinitis, etc.
3. Perennial allergic conjunctivitis
is allergic to environmental allergens that exist throughout the year, especially indoor allergens, such as dust mites, cockroaches, mold, and animal dander.
Although the symptoms are relatively mild, they can occur chronically over a long period of time, with symptoms getting better and worse.
4. Vernal keratoconjunctivitis
Vernal keratoconjunctivitis is a seasonal, easily relapsed, severe allergic conjunctivitis that can lead to ocular surface damage and vision loss.
More males suffer from this disease. The onset time is usually around the beginning of puberty and before the age of 10. The symptoms decrease with age. It is more likely to occur when the weather is warm in spring and summer, and symptoms will slow down in winter.
is associated with allergies or other inflammatory diseases and family history, such as asthma, allergic rhinitis, psoriasis and thyroiditis.
Most patients respond well to treatment and only need treatment during seasonal attacks. Vision loss is rare, but if left untreated, eyelid thickening, eyelid ptosis, blepharospasm, corneal neovascularization or scarring, corneal ulcers or infections, amblyopia, keratoconus, and conjunctival scarring may occur. This in turn affects vision.
The earlier the disease starts, the more likely it is to relapse and affect vision. Therefore, once symptoms are discovered, active treatment should be received immediately.
5. Atopic keratoconjunctivitis
Atopic keratoconjunctivitis is a chronic, easily relapsed, severe allergic conjunctivitis that can lead to ocular surface damage and vision loss.
More males suffer from this disease, and the onset time is mostly in late adolescence. People with allergies or family history are also more likely to suffer from this disease.
The most common symptom is severe itching of the eyes throughout the year, and some patients may experience it worse in specific seasons.
The eyes show signs of chronic inflammation, including conjunctival edema and congestion, papillary hyperplasia of the inferior conjunctiva; intermittent eyelid swelling, thickening and fibrosis, scaly appearance, sclerosis and inflammation, blepharopharosis of the eyelids, ectropion or drooping of the eyelids, and inability to close the eyes. ; Eyelash loss, eyelid ulcers, blepharitis, periorbital skin pigmentation.
Most patients are well controlled after treatment, and vision loss is rare. However, if not treated in time, conjunctival scars; corneal neovascularization, sterile ulcers or infections, keratoconus, corneal thinning or perforation; and anterior/posterior subcapsular cataracts may occur, thereby affecting vision.
6. Giant papillary conjunctivitis
, also known as foreign body-related papillary conjunctivitis, is an inflammatory reaction caused by foreign body stimulation in the eye.
It is common among people who wear contact lenses, especially those who do not change lenses frequently, wear them for a long time, have poor lens hygiene, inappropriate curvature, and are allergic to maintenance cleaning solutions.
Symptoms can occur as early as 3 weeks after wearing contact lenses. Soft contact lenses are more likely to absorb substances and secretions than hard contact lenses, so they are more likely to cause giant papillary conjunctivitis.
Other substances that can induce giant papillary conjunctivitis include prosthetic eyes, foreign bodies in the eye, protruding scleral buckles, post-glaucoma follicles, band keratopathy, ocular implants, and ocular sutures.
Allergy-prone constitution is also related to giant papillary conjunctivitis. The symptoms will be more obvious especially in spring and autumn, which may be due to the increase of pollen allergens in the air.
Early symptoms include mild eye itching, foreign body sensation, and a little discharge. If left untreated, symptoms will gradually worsen and include increased discharge, intense eye itching, blurred vision, and contact lenses that are uncomfortable or impossible to wear. The upper conjunctiva showed giant papillary changes, conjunctival congestion, conjunctival fibrosis, eyelid thickening, and eyelid ptosis.
The main treatment method is to remove the irritation of the foreign body. Usually the symptoms can improve within a week.
Daily care for allergic conjunctivitis
• Find out the allergens and avoid them. Prevention is better than cure.
• Keep the environment dry and clean, use an air purifier, and replace the filter.
• Keep indoor humidity between 30-50%, use humidity monitors, dehumidifiers, and air conditioners to reduce humidity, and avoid using humidifiers.
• Wash pillowcases, sheets, quilt covers, sofa covers, curtains, carpets, and stuffed animals every week, and use a dryer at high temperature to dry them.
• Use anti-mite products to completely wrap pillows, mattresses, quilts, and furniture.
• Reduce the amount of clutter, rugs, sofas, upholstered furniture, fabric curtains, and stuffed toys.Upholstered furniture should be made of leather or wood, and curtains should be made of easy-to-clean styles such as roll-type or blinds.
• Clean air conditioners regularly, remove sources of standing water, remove indoor plants, repair leaky pipes, and remove bathroom carpets.
• Use dilute bleach (30 mL bleach in 1 liter of water) to remove mold in showers, tubs, and sinks.
• Use trash cans with lids and should be disinfected and cleaned regularly.
• Shower before bed to remove allergens from your hair and skin.
• To stabilize the body against resistance, get enough sleep, exercise moderately, reduce stress, drink enough water, eat a healthy and balanced diet, and avoid cold drinks, sweets, baked and fried foods.
• If you have other allergic symptoms, you should go to the relevant department for treatment at the same time according to the symptoms.
• Keep pets out of the patient's bedroom or avoid having pets.
• When air quality is poor or during pollen season, reduce outdoor activities, close car windows and windows, and use air conditioning. Wear a mask, sunglasses or goggles when going out.
• Avoid exposure to additional stimuli such as wind, high temperatures, and sunlight.
• Change contact lenses regularly and clean them well.
• Reduce the irritation of cosmetics, especially eyeliner, eye shadow, false eyelashes, perfume, etc. Change makeup regularly and store in a dry place.
• Avoid rubbing your eyes, blowing on them, or applying heat.
• Avoid overusing over-the-counter medicines or washing your eyes with plain cold water.
• People who are at risk of atopic dermatitis are recommended to use skin moisturizing lotion or petroleum jelly every day, supplement vitamin D, and maintain good hygiene.
• People at risk for allergic rhinitis should avoid exposure to second-hand smoke and reduce exposure to indoor allergens (such as dust mites).
The treatment of allergic conjunctivitis
Graded treatment
Treatment will vary depending on the severity of the condition. If symptoms occur at the same time every year, prevention can be started 1-2 weeks in advance.
• Ice: Relieves symptoms and can reduce eyelid and orbital edema.
• artificial tears : dilute allergens and inflammatory factors. It is recommended to use preservative-free artificial tears. Artificial tears can be kept in the refrigerator to cool down.
• Topical antihistamine/vasoconstrictor: Rapid relief of symptoms. Vasoconstrictors can reduce congestion, but can cause rebound redness with long-term use.
• Topical second-generation antihistamine
• Topical antihistamine + mast cell stabilizer: long-term use has good preventive effect, but the acute phase effect is less obvious. Especially for patients who have symptoms year-round or are more severe, it is recommended to use compound drug treatment.
• Topical steroids : fast-acting, used in more severe cases. It should be noted that steroids may cause glaucoma, cataracts and infection. They should not be abused for a long time and require eye examination.
• Oral steroids, oral antihistamines: used in more severe cases or when other allergic symptoms occur.
• Topical nonsteroidal anti-inflammatory drugs
• Immunomodulatory eye drops (topical cyclosporin 2%): used in more severe cases or as an alternative to long-term steroid therapy.
Treat dry eye and blepharitis at the same time
Allergic conjunctivitis often combines dry eye and blepharitis. Dry eye can also aggravate allergic symptoms, so it needs to be treated at the same time.
Correct use of contact lenses
If the allergy is caused by wearing contact lenses, the following is the recommended way to use contact lenses:
• Use enzyme to remove protein, 1-3 times a week.
• Reduce wearing time.
• Change lens type and/or design to daily disposable or hard contact lenses.
• Discontinue contact lenses for at least 2-4 weeks, wait 2-3 weeks for symptoms to improve before re-wearing, and new lenses should be used.
• For other wearing precautions, please refer to the Safe Wearing Guidelines for Contact Lenses.
Tips
Prevention is better than cure, so avoiding allergens is the most important!
If you have eye discomfort, you should go to the ophthalmologist for further detailed examination to determine the cause and the timeliness of treatment.
If you have other allergies, you should go to the relevant department for treatment according to the symptoms to effectively control the condition.
Only by actively cooperating with each stage of treatment and persevering in lifestyle adjustments can we have the opportunity to reduce the chance of allergic keratoconjunctivitis, reduce the chance of subsequent medication, and avoid the occurrence of other allergies.
