Japanese Guideline for Allergic Conjunctival Diseases

Abstract

The definition, classification, pathogenesis, test methods, clinical findings, criteria for diagnosis, and therapies of allergic conjunctival disease are summarized based on the Guidelines for Clinical Management of Allergic Conjunctival Disease (Second Edition) revised in 2010. Allergic conjunctival disease is defined as "a conjunctival inflammatory disease associated with a Type I allergy accompanied by some subjective or objective symptoms." Allergic conjunctival disease is classified into allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Representative subjective symptoms include ocular itching, hyperemia, and lacrimation, whereas objective symptoms include conjunctival hyperemia, swelling, folliculosis, and papillae. Patients with vernal keratoconjunctivitis, which is characterized by conjunctival proliferative changes called giant papilla accompanied by varying extents of corneal lesion, such as corneal erosion and shield ulcer, complain of foreign body sensation, ocular pain, and photophobia. In the diagnosis of allergic conjunctival diseases, it is required that type I allergic diathesis is present, along with subjective and objective symptoms accompanying allergic inflammation. The diagnosis is ensured by proving a type I allergic reaction in the conjunctiva. Given that the first-line drug for the treatment of allergic conjunctival disease is an antiallergic eye drop, a steroid eye drop will be selected in accordance with the severity. In the treatment of vernal keratoconjunctivitis, an immunosuppressive eye drop will be concomitantly used with the above mentioned drugs.

Alcaftadine 0.25% versus Olopatadine 0.1% in Preventing Cedar Pollen Allergic Conjunctivitis in Japan: A Randomized Study

“…Alcaftadine was superior to vehicle treatment at all other time points (7 and 20 min) (p < 0.001; Table 3). Additionally, alcaftadine 0.25% when challenged at 4 h post-dose demonstrated statistical superiority over vehicle at all post CAC time points (7,15, and 20 min, p < 0.001). At 15 min post CAC, the conjunctival hyperemia score in alcaftadine 0.25%-treated eyes (median = 1.00) challenged 8 h post-dose was noninferior to olopatadine 0.1%-treated eyes (median = 1.50) challenged 4 h post-dose (Table 3); the upper limit of the 95% CI for treatment difference (95% CI: −0.50, 0.00) was below 0.5.…”

“…Conjunctival, ciliary, and episcleral hyperemia, chemosis, and ocular mucous discharge were scored by the investigator at 7, 15, and 20 min following the allergen challenge. Subjects who met the qualifying criteria of a post-challenge bilateral itching score ≥2 at 5 min and at least one of the 3-or 7-min time points, and conjunctival hyperemia score ≥2 at two of the three time points (7,15, and 20 min) continued to the treatment visits.…”

“…Conjunctival hyperemia was numerically lower in alcaftadine 0.25%-treated eyes compared with olopatadine 0.1%-treated eyes at 20 min post CAC, but did not reach statistical significance. A sensitivity analysis assessing the effect of the correlation between two eyes and period effect demonstrated statistically significant differences in conjunctival hyperemia scores between alcaftadine 0.25%-treated eyes challenged 8 h post-dose compared with olopatadine 0.1%-treated eyes challenged 4 h post-dose, at all time points (7,15, and 20 min) ( Table 3) Alcaftadine for Cedar Pollen Allergic Conjunctivitis 5…”

“…[3][4][5][6] In Japan, the estimated prevalence of allergic conjunctivitis is 15-20% and is most commonly associated with Japanese cedar pollen. 7 In susceptible individuals, ocular exposure to allergens leads to immunoglobulin E-mediated mast cell degranulation and subsequent release of histamine and other inflammatory mediators. 8,9 Activation of histamine receptors in the conjunctiva triggers ocular itching, the hallmark symptom of allergic conjunctivitis, and other signs and symptoms including conjunctival redness, tearing, eyelid swelling, and chemosis.…”

Atopic keratoconjunctivitis: long-term results of medical treatment and penetrating keratoplasty

“…These complications may be mild or severe and include superficial punctate keratitis, exfoliated superficial punctate keratitis, corneal erosions, and shield ulcers that progress to ulceration and neovascularization, conjunctival subepithelial fibrosis, fornix shortening, and symblepharon formation (16,17) . In our study, corneal opacity, corneal neovascularization, punctate keratitis, and persistent epithelial defects were observed in 75%, 62.5%, 62.5%, and 25% of patients, respectively.…”