Conjunctivitis - Allergic, Seasonal & Perennial Initial Assessment

Clinical Presentation

Signs and Symptoms

Allergic conjunctivitis commonly presents with signs and symptoms such as eyelid edema; ocular or periocular itching accompanied by redness, tearing, burning, stinging, and photophobia; watery or white stringy mucoid discharge; ecchymosis around the eyes (“allergic shiner”); and a foreign body sensation. These symptoms are typically characterized by periods of exacerbation and remission. Ocular itching is considered a cardinal symptom. There is usually bilateral involvement, although one eye may be more affected than the other. Symptoms tend to decrease with age.

History

Seasonal and perennial allergic conjunctivitis are usually diagnosed based on history and physical examination. Inquire about the patient’s personal history or family history of other allergic conditions (eg atopic dermatitis, allergic rhinitis, asthma). A thorough review of the patient’s history regarding exposure to trigger factors, such as a history of exposure to allergens; occupational exposure; and travel, should be done. The use of eye care products, topical medications, solutions, or contact lenses should also be noted. Benzalkonium chloride (BAK) is the most common preservative in these solutions and has the potential to induce ocular surface damage. Identify the date and timing of onset and progress of symptoms, which may be intermittent (<4 weeks) or persistent (>4 weeks). Include questions about symptom presentation (unilateral or bilateral), characteristics of discharge, history of trauma, recent surgery, and mucus-fishing behavior (ie repetitive manipulation leading to mechanical irritation).

Physical Examination

Ophthalmologic Examination

Conjunctivitis - Allergic, Seasonal and Perennial_Initial Assesment