Non-allergic triggers of conjunctivitis

In common with other allergic diseases (such as eczema, rhinitis and asthma), allergic conjunctivitis may be aggravated by non-allergic triggers. Failure to understand this could lead to many a wild-goose chase. Maureen was one such patient. She had moved into the area some three years earlier, and since doing so developed 'hay fever' symptoms. Her most troublesome symptom was watering of the eyes, but she also had rhinitis. Her symptoms were particularly bad whenever she went outdoors during the summer months. She was convinced that something in the air was affecting her. However, the skin tests failed to show a relevant summer allergy. She was not allergic to any of the pollens. Nor was she allergic to mould. Her only positive reaction was to our old friend, the house dust mite. This didn't fit with her expectations, and she remained convinced that 'we were missing something'. Going back into her history, she told me that her eyes were especially bad on bright, windy days. 'Maybe it's the silage, or the fertiliser being spread by neighbouring farmers,' she thought out loud, 'They never did that near my last house, you know.' Maureen had an allergic conjunctivitis and rhinitis related to the house dust mite. Her 'seasonal exacerbations' were in fact the result of non-allergic triggers: the combination of wind and sunlight. Other non-allergic triggers include inert dusts, such as chalkdust and the chemical vapours commonly found in household products.

Are there any complications?
Allergic conjunctivitis is a miserable condition. It can disrupt academic performance and summer holidays, and impair the overall quality of life. It can be particularly nasty when associated with eczema, because it may affect the cornea, the transparent part of the eye through which we see the outside world. Allergic inflammation of the cornea can result in scarring, ulceration, cataract formation and corneal deformity. We call this 'atopic keratoconjunctivitis': atopic referring to the allergic disposition, and kerato- referring to the corneal involvement.



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