Corneal Diseases in Children: Allergic Diseases

Abstract

Allergies occur frequently in all pediatric age groups, affecting up to 40% of children, with a peak age in late childhood and young adulthood. It affects the health and overall quality of life of children and their families. Patients frequently have a history of other atopic diseases, such as eczema, asthma, or, most commonly, rhinitis. Allergic conjunctivitis is the most common ocular allergy syndrome among children, with atopic keratoconjunctivitis and vernal keratoconjunctivitis being less common but potentially more severe forms of ocular allergy. Symptoms include bilateral involvement, itching, tearing, mucoid discharge, redness, eyelid edema, and chemosis. IgE and non-IgE-mediated mechanisms are involved in the development of ocular allergic eye disease. The multiple mediators and pathways are differently expressed in the different allergic disorders, inducing the distinctive clinical aspects, diagnostic features, and response to treatment. There are a variety of pharmacological interventions that are available such as vasoconstrictors/histamine (H1) receptor blockers, mast cell stabilizers, multi-action agents, topical ophthalmic corticosteroids, topical nonsteroidal anti-inflammatory drugs (NSAIDs), topical cyclosporine, and tacrolimus as well as systemic drugs. Immunotherapy is also considered in the treatment of persistent severe cases. Despite all the available therapeutic agents, there continues to be a constant need to discover more effective ways to treat the different allergic eye disorders. In this chapter, we review the clinical features, diagnosis, potential complications, and treatment of these ocular allergic pediatric conditions. Early detection is necessary to prevent potentially serious consequences that could be sight threatening. Involvement of pediatric ophthalmologists and cornea specialists may be necessary to avoid preventable vision loss in severe cases.