CORNEA 30 EWAP MARCH 2024 by Liz Hillman Editorial Co - Director Perspectives on ocular allergy and allergic conjunctivitis Contact information Akpek: esakpek@jhmi.edu Bielory: drlbielory@gmail.com The topic of ocular allergy and associated conjunctivitis is broad, ranging from seasonal to perennial, acute/ episodic to chronic. EyeWorld asked ophthalmologist and ocular surface specialist Esen Akpek, MD, and ocular allergist/ immunologist Leonard Bielory, MD, to provide an overview on the topic. Dr. Bielory said the area of ocular allergy is multidisciplinary. He also said it’s important to realize that “for something to be clinically relevant, we all have different tolerances.” He explained that patients have different thresholds where they think an allergy is impacting their quality of life. “When it comes to symptoms, we all have the propensity to develop allergies; 40% complain of them,” he said. “It reaches a level where it breaks through what I call their level of tolerance.” Once that level is reached, that’s when the patient seeks professional medical help. Ocular symptoms for most allergies, Dr. Bielory said, are red, itchy, and/or tearing eyes. Depending on what their symptoms are seems to determine what type of medical professional the patient seeks help from first. Dr. Bielory pointed to the Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys published in 2014, which found that patients who had itchy eyes were seeking medical treatment from pediatricians, ophthalmologists/optometrists, and nurse practitioners/ physician assistants, while nasal congestion as a symptom had patients visiting otolaryngologists, allergist/ immunologists, and family medicine physicians. 1 While ophthalmologists will see patients who experience ocular allergy, Dr. Bielory said he thinks ophthalmologists will try a few strategies and if those don’t work, refer to an allergist. The chances of allergic symptoms being only in the eyes occurs in 5 –10% of cases, Dr. Bielory said. If physicians see and treat only the eyes, they’re not dealing with the whole patient. “The patient might not be satisfied just taking eye drops when they have sneezing, nasal congestion, and a variety of other conditions. The allergist acts like a medical ophthalmologist because ophthalmologists are primarily surgeons, but they treat symptoms that they see — tear film dysfunction as well as ocular allergy and more severe forms,” he said. With more severe ocular allergy cases, such as atopic keratoconjunctivitis, vernal conjunctivitis, and giant papillary conjunctivitis, Dr. Bielory said an allergist who might see the patient first needs to work in concert with an ophthalmologist. “The international consensus of treatment on ocular allergy … shows there should be cross This article originally appeared in the December 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Slit lamp images of micro-giant papillary conjunctivitis in a patient with a perennial allergic conjunctivitis (left) and vernal keratoconjunctivitis (right). Source: Esen Akpek, MD
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