Allergic conjunctivitis

                     Allergic conjunctivitis 

Allergic conjunctivitis refers to eye inflammation resulting from an allergic reaction to substances like pollen or mold spores.

The inside of your eyelids and the covering of your eyeball have a membrane called the conjunctiva. The conjunctiva is susceptible to irritation from allergens, especially during hay fever season. Allergic conjunctivitus is quite common and affects about one-fifth of the population. It is your body’s reaction to substances it considers potentially harmful.

. Some of the substances that cause this reaction are:

• household dust
• pollen from trees and grass
• mold spores
• animal dander

• chemical scents (e.g., household detergents or perfume)

• Red, itchy, watery, and burning eyes are common symptoms of allergic conjunctivitis. You may also wake up in the morning with puffy eyes.

The current treatment options  include 

 (1) avoiding the offending allergen and using cold compresses to reduce the associated heat and swelling initially.

(2) ocular surface-lubricating agents such as saline solution or artificial tears to help remove the allergens from the ocular surface and minimize exposure.
(3) Ointments or time-released tear replacements, used at night, are a longer-lasting alternative for lubricating the ocular surface.
(4) Topical decongestants, antihistamines, mast cell stabilizers, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are other drugs used.
 Keterolac 0.4% had greater anti-inflammatory effects than diclofenac

Corticosteroids have been the cornerstone of treatment for various allergic disorders including asthma, atopic dermatitis, and allergic rhinitis.
 Ciclesonide, a prodrug corticosteroid, is activated by esterases to an active metabolite, desciclesonide .

 Loteprednol etabonate is an ester corticosteroid structurally similar to prednisolone, but was designed with a 17β-chloromethyl ester at the C-20 position in order to be hydrolyzed to an inactive carboxylic acid moiety.As a result, loteprednol etabonate is a 'soft' or 'smart' corticosteroid which is active in the ocular tissues in which it is needed and becomes inactive shortly thereafter.

 Loteprednol etabonate (0.5%) administered prophylactically for 6 weeks prior to the onset of the allergy season 

Precautions:

1. 1. Any patient using ocular steroids for more than 2 weeks should be monitored for increased IOP, persistent ocular complaint, presence of ciliary blush suggesting uveitis
   2. The patient should then be considered for treatment with topical or systemic corticosteroids.
2. 1. Patient should be evaluated for presence of systemic atopy (eczema, rhinitis, sinusitis, asthma)
   2. Patient should be considered for systemic immunomodulation (immunotherapy)
   3. Subsequently the patient should undergo systemic assessment of an autoimmune process

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