Allergic conjunctivitis: current concepts on pathogenesis and management.

Area of Science:

• Ophthalmology
• Immunology
• Allergy

Background:

• Allergic conjunctivitis (AC) is a frequent ocular surface disease impacting over 30% of young adults, with increasing incidence.
• It often co-occurs with other atopic conditions like asthma, necessitating a multidisciplinary approach.
• Pathogenesis extends beyond traditional allergy, involving innate immunity and neuroinflammation in severe forms like atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC).

Purpose of the Study:

• To review the diverse clinical spectrum, pathogenesis, diagnosis, and management of allergic conjunctivitis.
• To highlight the evolving understanding of AC, including non-allergic immune pathways.
• To discuss current and novel therapeutic strategies for mild to severe forms of AC.

Main Methods:

• Review of current literature on allergic conjunctivitis.
• Analysis of pathogenic mechanisms, clinical presentations, and diagnostic methods.
• Evaluation of existing and emerging treatment options.

Main Results:

• AC encompasses various forms with differing incidence and severity, characterized by symptoms like itching, swelling, and tearing.
• Severe forms (AKC, VKC) involve corneal complications, photophobia, and pain, with specific clinical signs like tarsal papillary reaction.
• Diagnosis relies on clinical history, eye examination, and allergological tests, including conjunctival scraping for eosinophils.

Conclusions:

• Effective management of AC ranges from antiallergic eye drops for mild cases to topical steroids for severe forms with corneal involvement.
• Novel steroid-sparing therapies like Cyclosporine A and topical Tacrolimus offer promising alternatives for managing severe VKC and AKC.
• A comprehensive understanding of AC's complex immunology and clinical presentation is crucial for optimizing patient outcomes and preventing visual impairment.