MEDizzy - A 45-year-old man with a history of seasonal allergic

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Allergies 1

A 45-year-old man with a history of seasonal allergic rhinitis presents with complaints of itching, tearing, and mild burning of both eyes. He has had these symptoms for several days. He has not had any vision changes or systemic symptoms. He reports that the ocular symptoms began in association with nasal congestion and rhinorrhea, a pattern he has experienced in the past. You suspect that he has allergic conjunctivitis. Which of the following statements regarding the diagnosis and treatment of allergic conjunctivitis is false?

ExplanationAllergic conjunctivitis is the ocular counterpart of allergic rhinitis. A majority of patients with this condition (approximately 70%) have another atopic condition, such as asthma, eczema, or allergic rhinitis. Symptoms usually include bilateral itching, tearing, and burning of the eyes. Findings on examination include conjunctival injection and periocular edema and erythema. If the patient has had direct hand-to-eye contact with an allergen such as pet dander, there may be unilateral involvement. The differential diagnosis includes viral or bacterial conjunctivitis: patients with infectious conjunctivitis more often have mucopurulent discharge with matting of eyelids, deeply red conjunctivae, and less bothersome itching than patients with allergic conjunctivitis. The first-line treatment consists of over-the-counter eyedrops containing a combination of antihistamine and decongestant (e.g., antazoline and naphazoline). Other treatments include selective H1 receptor antihistamine drops and, in severe or refractory cases, ophthalmic glucocorticoid preparations. Steroid eyedrops should be given only in consultation with an ophthalmologist because long-term use of these agents is associated with an increased risk of cataracts, glau- coma, and secondary ocular infection.