Allergic blepharo-conjunctivitis. Avoiding misdiagnosis and mismanagement

Misdiagnosis and hence mismanagement of the red eye can convert a relatively innocuous, self-limited problem to a serious, vision-threatening disease. At no time is this danger greater than when distinguishing between allergic inflammatory disease and nonallergic blepharoconjunctivitis. Ocular allergy may be strongly suspected if (1) itching is the primary symptom, (2) the symptom complex is related to the season, environmental factors, medication, or contact lens wear, (3) the patient has a history of atopy, or (4) prominent signs include chemosis, papillary hypertrophy, lid edema, or mucoid discharge. In general, the therapeutic approach to the patient with suspected ocular allergic disease should emphasize withdrawal of the offending antigen, if identifiable, and the use of supportive measures to maximize comfort. In most cases, evaluation by an ophthalmologist is warranted, especially if disease is severe enough to require application of topical corticosteroids.