Allergies in general and allergic infections of the eyes in particular are a global health issue. Self-protection against allergens, drinking plenty of water, and regularly consuming vitamin C are the best personal protective measures before medicine can offer more effective treatment methods.
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| Two types of spring keratoconjunctivitis: with peripheral lesions (left) and with “island ulcers” on the cornea (Photo: TTO) |
Spring is a season with high humidity, where daily temperatures fluctuate significantly by 8-10 degrees. The concentration of allergens in the air (pollen, dust, mold, and fungi) increases dramatically compared to other seasons. It is evident that people with allergic predispositions will suffer from the disadvantages posed by the aforementioned weather conditions. Conditions such as asthma, allergic rhinitis, and eye allergies are likely to flare up. In ophthalmology, there is a noticeable increase in patients visiting for various types of allergic conjunctivitis, as well as eye injuries caused by insects.
Allergic Infections
Seasonal Allergic Conjunctivitis: This condition commonly occurs in patients with allergic predispositions, such as those with allergic rhinitis. The density of allergens in the air rises significantly during spring, with pollen, dry grass, and insect hairs and dust being prevalent. It is clear that these will trigger allergic infections in the respiratory tract and the eyes. Due to its association with type I hypersensitivity mediated by IgE antibodies, patients will quickly experience symptoms after exposure to allergens: swollen eyelids, itchy eyes, redness, and sticky discharge from the eyes.
This condition is seasonal and relatively straightforward to treat. Cold compresses can provide significant relief for patients. There is a wide variety of eye drops available on the market: topical vasoconstrictors that quickly reduce swelling and redness, artificial tears or saline solution to wash away allergens and soothe the eyes, and antihistamines and mast cell stabilizers in eye drop form that are generally very effective.
Spring Keratoconjunctivitis: While the name of this condition might sound romantic, the troubles it causes for patients and physicians are anything but “romantic.” This disease predominantly affects adolescent males and tends to recur cyclically in spring and summer, greatly impacting the educational performance of these children and causing distress for parents. It is often seen in children with a history of allergies such as eczema or asthma.
The primary symptoms include itching; the more they scratch or rub their eyes, the more relief they feel, which is related to the potential complication of corneal ulcers due to excessive rubbing. The eyes do not appear very red, and the discharge is moderate. In cases where there is corneal damage, patients may experience a burning sensation, light sensitivity, and continuous tearing.
Upon examination, the lesions may present as:
– A localized form in the conjunctiva: characterized by papillary hyperplasia primarily in the upper conjunctiva, sometimes developing into large papillae resembling stones.
– A form with peripheral lesions: often occurring in darker-skinned individuals and generally with a better prognosis. Patients exhibit localized limbal congestion, thickening that appears gelatinous, with many opaque white nodules.
– A form with lesions on the cornea: accompanied by punctate epithelial keratitis, ulceration, and necrosis resembling “island ulcers,” with subepithelial scarring…
Non-steroidal anti-inflammatory medications, mast cell stabilizers, and various types of artificial tears may provide some relief for patients. Acute episodes only significantly improve with potent medications – corticosteroids. Patients’ urgency often pressures physicians to resort to these powerful treatments, or they may self-medicate, which can lead to unfortunate consequences: complications from prolonged corticosteroid use that everyone fears, such as glaucoma, corneal ulcers, and necrosis from fungal, bacterial, or herpes infections, and cataracts. In the case of this inflammatory condition, the treatment approach includes:
– Cold compresses to help alleviate itching and minimize rubbing.
– Artificial tears are never excessive, preferably those without preservatives.
– Mast cell stabilizers and steroid preparations should be used alternately. Steroids are recommended during acute episodes, at a high dose for 5-7 days, then discontinued, followed by topical antihistamines, mast cell stabilizers, or non-steroidal anti-inflammatory medications.
Atopic Keratoconjunctivitis: is a rare condition. Typical cases occur in patients with atopic dermatitis, affecting the neck, the dorsal surface of the arms, and natural skin folds. Additionally, the patient or their family members may have a history of asthma or allergic rhinitis.
Clinical signs are not highly specific: there are few or no acute episodes, moderate papillary growth diffusely affecting both upper and lower conjunctiva, significant conjunctival edema, and corneal neovascularization. Over time, the condition often leads to conjunctival scarring or eyelid adhesion. Corneal scarring frequently results in reduced vision, especially if the patient has coexisting infections from herpes or streptococcus.
Treating this condition is very challenging due to the high dependency on corticosteroids. Oral antihistamines can be used if the patient experiences significant itching.
Allergies in general and allergic infections of the eyes in particular are a global health issue. Humanity has made significant strides in personal hygiene. As a result, the incidence of diseases caused by infections and parasites seems to have decreased. However, allergies to causes intertwined with genetic factors, family history, immune disorders, and industrial pollution are becoming increasingly common. Self-protection against allergens, drinking plenty of water, and regularly consuming vitamin C are the best personal protective measures before medicine can offer more effective treatment methods.
