Ocular allergic disease

Ocular allergy is a common condition that usually affects the conjunctiva o f the eye and is therefore often referred to as allergic conjunctivitis. Th e severity of the disease can range from mild itching and redness, as seen in seasonal allergic conjunctivitis, to the more serious vision threatening forms of ocular allergy which affect the cornea, such as atopic keratoconj unctivitis. The pathogenesis of allergic conjunctivitis involves a complex mechanism which centers around IgE-mediated mast cell degranulation and rel ease of multiple preformed and newly formed inflammatory mediators. The dia gnosis of allergic conjunctivitis is usually a clinical one which can be ma de based on a thorough history and careful examination. Treatment of ocular allergy should begin with conservative measures including allergen avoidan ce, environmental control, ocular irrigation and cold compresses. Pharmacot herapy of allergic conjunctivitis consists of several classes of drugs. Ant ihistamines are widely used to treat mild conditions such as seasonal and p erennial conjunctivitis and potent new agents such as levocabastine and eme dastine are now available. Mast cell stabilizers such as sodium cromoglycat e are both safe and effective and are commonly used in ocular allergy. More effective mast cell stabilizers such as nedocromil, lodoxamide and olopata dine are now being used. Nonsteroidal antiinflammatory drugs have demonstra ted only limited efficacy and, as such, are not widely used. Topical steroi ds are very effective in treating signs and symptoms but are reserved for o nly refractory cases due to their serious side effects. Loteprednol and rim exelone are newer corticosteroids which reportedly have less of an effect o n intraocular pressure. Cyclosporine has recently been shown to be highly e ffective in cases of vernal keratoconjunctivitis and atopic keratoconjuncti vitis while producing no adverse effects. (C) 1998 Prous Science. Ail right s reserved.