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A Journal on Ophthalmology
Minerva Oftalmologica 2006 September-December;48(3/4):67-82
Allergic conjunctivitis: pathogenesis and therapy
Leonardi A., Bortolotti M., DeDominicis C., Massignan F., Motterle L., Fregona I. A., Secchi A. G.
Dipartimento di Neuroscienze U.O.A. di Clinica Oculistica Università di Padova, Padova
The diagnosis of allergic conjunctivitis is usually clinical, however, allergic tests are indicated for a more specific diagnosis and patient management. While chronic and severe ocular allergic conditions have clear diagnostic signs and symptoms, the most common diseases, seasonal and perennial allergic conjunctivitis, have no identifying patognomonic signs. Skin tests and measurement of serum specific IgE are usually sufficient for an allergic diagnosis, however, often the results of these tests are negative in the presence of a typical clinical history. In these cases, the conjunctival provocation test and the measurement of tear mediators may provide more locally specific information. In the active form of the disease, cytological tests are indicated; the presence of tear eosinophils is indicative of an allergic reaction. The low tear volume limits the potential in vitro diagnose, thus new investigative methods have been explored. The double action agents are now the first choice in the treatment of the IgE mediated diseases, acting as mast cell stabilizers and as H1-receptor antagonists. Only in cases of chronic allergic inflammations with persistent activation of inflammatory and conjunctival cells, topical corticosteroids are indicated. Topical cyclosporin A is an alternative choice in the treatment of severe, cortico-resistant forms of atopic and vernal keratoconjunctivitis.