Allergic Conjunctivitis Differential Diagnoses

Author: Mark Ventocilla, OD, FAAO; Chief Editor: Hampton Roy Sr, MD more...

Updated: Jan 20, 2012

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Diagnostic Considerations

Allergic conjunctivitis must be differentiated from viral and bacterial conjunctivitis. Clinical features (eg, recent exposure to an individual with infective conjunctivitis) may be helpful in this regard.

The main distinction between seasonal and perennial allergic conjunctivitis, as implied by the names, is the timing of symptoms (see Pathophysiology). Major differentiating factors between vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) are shown in the table below.

Table. Major Differentiating Factors Between VKC and AKC (Open Table in a new window)

Characteristics	VKC	AKC
Age at onset	Generally presents at a younger age than AKC	-
Sex	Males are affected preferentially.	No sex predilection
Seasonal variation	Typically occurs during spring months	Generally perennial
Discharge	Thick mucoid discharge	Watery and clear discharge
Conjunctival scarring	-	Higher incidence of conjunctival scarring
Horner-Trantas dots	Horner-Trantas dots and shield ulcers are commonly seen.	Presence of Horner-Trantas dots is rare.
Corneal neovascularization	Not present	Deep corneal neovascularization tends to develop
Presence of eosinophils in conjunctival scraping	Conjunctival scraping reveals eosinophils to a greater degree in VKC than in AKC	Presence of eosinophils is less likely

Differential Diagnoses

Proceed to Workup

Contributor Information and Disclosures

Author

Mark Ventocilla, OD, FAAO Clinical Professor, Michigan College of Optometry; Editor, American Optometric Association Ocular Surface Society Newsletter; Chief Executive Officer, Elder Eye Care Group, PLC; Chief Executive Officer, Mark Ventocilla, OD, Inc; President, Lakeshore Professional Eyecare, PC

Mark Ventocilla, OD, FAAO is a member of the following medical societies: American Academy of Optometry and American Optometric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Marc R Bloomenstein, OD, FAAO Director of Optometric Services, Schwartz Laser Eye Center; Adjunct Assistant Professor, Arizona College of Optometry; Adjunct Assistant Professor, Southern California College of Optometry

Marc R Bloomenstein, OD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, Arizona Optometric Association, and International Society of Cataract and Refractive Surgeons

Disclosure: Nothing to disclose.

Parag A Majmudar, MD Associate Professor, Department of Ophthalmology, Cornea and Refractive Surgery Service, Rush University Medical Center

Parag A Majmudar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery, and Phi Beta Kappa

Disclosure: Allergan Honoraria Speaking and teaching; AMO Honoraria Speaking and teaching; Alcon Honoraria Speaking and teaching; Inspire Honoraria Review panel membership

Chief Editor

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Jerre Freeman, MD Founder and Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center College of Medicine

Jerre Freeman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

Kosina-Hagyó K, Veres A, Fodor E, Mezei G, Csákány B, Németh J. Tear film function in patients with seasonal allergic conjunctivitis outside the pollen season. Int Arch Allergy Immunol. 2012;157(1):81-8. [Medline].
Hogan MJ. Atopic keratoconjunctivitis. Am J Ophthalmol. 1953;36:937-947.
Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. May 1977;83(5):697-708. [Medline].
Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham S. Sublingual immunotherapy for treating allergic conjunctivitis. Cochrane Database Syst Rev. Jul 6 2011;CD007685. [Medline].
Aswad MI, Tauber J, Baum J. Plasmapheresis treatment in patients with severe atopic keratoconjunctivitis. Ophthalmology. Apr 1988;95(4):444-7. [Medline].
Abelson MB, Gomes PJ, Vogelson CT, Pasquine TA, Turner FD, Wells DT, et al. Effects of a new formulation of olopatadine ophthalmic solution on nasal symptoms relative to placebo in two studies involving subjects with allergic conjunctivitis or rhinoconjunctivitis. Curr Med Res Opin. May 2005;21(5):683-91. [Medline].
Abelson MB, Greiner JV. Comparative efficacy of olopatadine 0.1% ophthalmic solution versus levocabastine 0.05% ophthalmic suspension using the conjunctival allergen challenge model. Curr Med Res Opin. Dec 2004;20(12):1953-8. [Medline].

Table. Major Differentiating Factors Between VKC and AKC

Table. Major Differentiating Factors Between VKC and AKC

Characteristics	VKC	AKC
Age at onset	Generally presents at a younger age than AKC	-
Sex	Males are affected preferentially.	No sex predilection
Seasonal variation	Typically occurs during spring months	Generally perennial
Discharge	Thick mucoid discharge	Watery and clear discharge
Conjunctival scarring	-	Higher incidence of conjunctival scarring
Horner-Trantas dots	Horner-Trantas dots and shield ulcers are commonly seen.	Presence of Horner-Trantas dots is rare.
Corneal neovascularization	Not present	Deep corneal neovascularization tends to develop
Presence of eosinophils in conjunctival scraping	Conjunctival scraping reveals eosinophils to a greater degree in VKC than in AKC	Presence of eosinophils is less likely

View Table List

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