Allergic conjunctivitis - External and Internal Eye
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Synopsis

Seasonal / perennial allergic conjunctivitis (SAC / PAC) is a common cause of ocular irritation and itching that is noninfectious. Allergens can be seasonal, such as pollen and ragweed, or nonseasonal, such as dust, eye drops, mold, or cosmetics. The process is an immunoglobulin E (IgE)-mediated hypersensitivity reaction, and a personal or family history of atopy is common.
Typical symptoms of allergic conjunctivitis include swollen eyelids, mucoid discharge, and intense ocular itching. Itching is the most commonly reported symptom, and patients may also complain of a feeling of dirt or sand in the eyes. At times, the edema of the eyelids can be quite severe and be associated with scaling and fissure formation of the periocular skin.
Atopic keratoconjunctivitis (AKC), giant papillary conjunctivitis (GPC), and limbal and tarsal vernal keratoconjunctivitis (VKC) are rarer, more severe forms of allergic conjunctivitis. Although GPC may be recurrent, it does not carry as great a risk of long-term corneal damage and vision loss as AKC and VKC. People with other forms of atopic disease are more likely to develop AKC or VKC, often associated with atopic dermatitis and allergic rhinitis, respectively. Some of these forms of allergic conjunctivitis are discussed in more detail elsewhere; this writeup will focus on seasonal and perennial disease.
Typical symptoms of allergic conjunctivitis include swollen eyelids, mucoid discharge, and intense ocular itching. Itching is the most commonly reported symptom, and patients may also complain of a feeling of dirt or sand in the eyes. At times, the edema of the eyelids can be quite severe and be associated with scaling and fissure formation of the periocular skin.
Atopic keratoconjunctivitis (AKC), giant papillary conjunctivitis (GPC), and limbal and tarsal vernal keratoconjunctivitis (VKC) are rarer, more severe forms of allergic conjunctivitis. Although GPC may be recurrent, it does not carry as great a risk of long-term corneal damage and vision loss as AKC and VKC. People with other forms of atopic disease are more likely to develop AKC or VKC, often associated with atopic dermatitis and allergic rhinitis, respectively. Some of these forms of allergic conjunctivitis are discussed in more detail elsewhere; this writeup will focus on seasonal and perennial disease.
Codes
ICD10CM:
H10.10 – Acute atopic conjunctivitis, unspecified eye
H10.45 – Other chronic allergic conjunctivitis
SNOMEDCT:
473460002 – Allergic Conjunctivitis
H10.10 – Acute atopic conjunctivitis, unspecified eye
H10.45 – Other chronic allergic conjunctivitis
SNOMEDCT:
473460002 – Allergic Conjunctivitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Viral conjunctivitis
- Bacterial conjunctivitis
- Toxic conjunctivitis
- Contact dermatitis
- Other subtype of severe allergic conjunctivitis – GPC, AKC, or VKC
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:08/25/2019
Last Updated:08/17/2021
Last Updated:08/17/2021

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