Prevalence of dry eye disease in the patients of allergic conjunctivitis: Hospital-based cross-sectional study

Purpose: Allergic conjunctivitis (AC) is commonly associated with dry eye. This study was conducted to assess the prevalence of dry eye in different subsets of AC patients. Methods: This observational, cross?sectional study, conducted in the Department of Ophthalmology of a tertiary center in north India, included 132 patients of AC. The diagnosis of dry eye disease (DED) was made on the basis of Ocular Surface Disease Index (OSDI), Schirmer’s test, and tear film break?up time (TFBUT). Results: The prevalence of dry eye in AC patients was found to range between 31% and 36%. On OSDI scoring, 20.45% of patients had mild, 18.18% moderate, and 31.81% had a severe grade of DED, respectively. The mean OSDI score was noted to be significantly higher in patients with perennial allergic conjunctivitis (PAC) (29.82 ± 12.41), followed by seasonal allergic conjunctivitis (SAC) (25.35 ± 12.88), and least in the patients of vernal keratoconjunctivitis (VKC) (13.60 ± 8.63) (p < 0.0001), respectively. The TFBUT was found to be less than 10 s in 45.45% of PAC, 30.43% of SAC, and 20% of VKC patients, respectively. The difference between the mean TFBUT among the three groups was statistically insignificant (p = 0.683). Schirmer’s test value of <10 mm was observed in 45.45% of PAC, 43.47% of SAC, and 10% of VKC patients, respectively. Conclusion: This study revealed a high prevalence of DED in patients with AC. Among the different types of AC patients, PAC had the highest percentage of DED followed by SAC and least in VKC, respectively.

Alergia ocular / Ocular allergy

Resumen La alergia ocular consiste en un grupo de enfermedades caracterizadas por inflamación de la conjuntiva ocular, dentro de las que podemos encontrar a la conjuntivitis alérgica estacional (CAE) o perenne (CAP), la queratoconjuntivitis vernal, la queratoconjuntivitis atópica y la blefaroconjuntivitis de contacto. Aqueja aproximadamente al 10% de la población mundial, y los más afectados son pacientes con otras patologías alérgicas. El diagnóstico es clínico y se integra mediante los síntomas y hallazgos encontrados durante la exploración física oftalmológica presentes en el sujeto al momento de la visita. Los principales objetivos del tratamiento en la conjuntivitis alérgica son minimizar y controlar los signos y síntomas de la enfermedad, incluyendo la reducción del prurito, de la hiperemia y del edema de la conjuntiva y párpados, así como mejorar la calidad de vida del paciente. El tratamiento incluye medidas no farmacológicas, como evitar estímulos irritantes, el uso de lágrimas artificiales, la aplicación de compresas frías y medicamentos como vasoconstrictores, antihistamínicos, estabilizadores de mastocitos, agentes de acción dual, esteroides y fármacos inmunomoduladores, así como inmunoterapia alérgeno específica. Los cambios desencadenados por la inflamación de la conjuntiva, producen daño corneal mecánico, y en los casos graves y crónicos de la enfermedad, el daño corneal puede resultar en la disminución de la agudeza visual, lo cual disminuye la calidad de vida del paciente.

Abstract Ocular allergy is a group of diseases characterized by inflammation of the ocular conjunctiva and include seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis and contact blepharoconjunctivitis; affects approximately 10% of world population being most affected those patients with other allergic diseases; the diagnosis is clinical and is integrated through the symptoms and findings found during the physical examination. The main goals of treatment in allergic conjunctivitis are minimize and control the signs and symptoms of the disease, including the reduction of pruritus, hyperemia and edema of the conjunctiva and eyelids as well as improving the quality of life of the patient; treatment includes non-pharmacological measures such as avoiding irritant stimuli, use of artificial tears, application of cold compresses and medications such as vasoconstrictors, antihistamines, mast cell stabilizers, dual acting agents, steroids and immunomodulatory drugs, as well as specific allergen immunotherapy. Changes triggered by inflammation of the conjunctiva produce mechanical corneal damage and in severe and chronic cases of the disease, corneal damage can result in decreased visual acuity, which results in a decrease patient's quality of life.

Tear Eosinophil Cationic Protein Levels in Allergic Keratoconjunctivitis

PURPOSE: To evaluate tear eosinophil cationic protein (ECP) as a severity marker for atopic keratoconjunctivitis (AKC) and seasonal/perennial allergic conjunctivitis (SAC/PAC). METHODS: Tear ECP levels were measured by chemiluminescent immunometric assay in 7 eyes of 7 patients with AKC, 13 eyes of 13 patients with SAC/PAC, and 10 eyes of 10 healthy control subjects. All AKC and SAC/PAC patients underwent conjunctival injection and papillary formation grading. Tear ECP levels were investigated with reference to the clinical parameters of allergic conjunctivitis (papillary formation and conjunctival injection scoring). RESULTS: Tear ECP levels in patients with AKC were significantly higher than those in patients with SAC/PAC and in control subjects (p = 0.012 and p = 0.003, respectively). The number of patients with papillary formation scores of 2-3 was significantly higher in the AKC group than in the SAC/PAC group (p = 0.016). The number of patients with conjunctival injection scores of 2-3 did not significantly differ between the AKC and SAC/PAC groups (p = 0.128). All AKC patients obtained papillary formation scores of 2-3, and tear ECP levels in patients with conjunctival injection scores of 2-3 were significantly higher than in patients with scores of 0-1 in the AKC group (p < 0.001). In the SAC/PAC group, tear ECP levels in patients with papillary formation scores of 2-3 were significantly higher than in patients with scores of 0-1 (p = 0.046). CONCLUSIONS: This study suggests that tear ECP was a useful marker to diagnose and assess the severity of disease in patients with AKC as well as SAC/PAC. It would be useful to monitor therapeutic outcome in allergic conjunctivitis.

Alergia ocular: un reto diagnóstico: [revisión] / Ocular allergy: a diagnostic challenge: [review]

El ojo es uno de los órganos más sensibles y está permanentemente expuesto a diversos agentes ambientales. Dado que la conjuntiva es un tejido inmunológicamente activo, no es sorprendente que sea un sitio común de respuestas alérgicas. Las alergias oculares son un grupo de enfermedades que afectan la superficie conjuntival y están asociadas usualmente a reacciones de hipersensibilidad tipo 1. Pueden ser divididas en varias categorías: conjuntivitis alérgica estacional, conjuntivitis alérgica perenne, queratoconjuntivitis vernal y queratoconjuntivitis atópica.La inflamación de la superficie ocular produce prurito, lagrimeo, edema conjuntival y fotofobia. Como en otras enfermedades alérgicas, se puede desarrollar una condición crónica, acompañada de remodelación de los tejidos oculares. Las estrategias para el tratamiento de la alergia ocular han aumentado exponencialmente y los clínicos disponen de un inventario cada vez mayor de agentes dirigidos a la protección del ojo contra la inflamación. En este trabajo presentamos una revisión sobre las principales formas de alergia ocular, haciendo énfasis en el cuadro clínico, el diagnóstico y las nuevas opciones terapéuticas disponibles en la actualidad.