Nonseasonal allergic conjunctivitis in the tropics: Experience in a tertiary care institution

Purpose: To understand the epidemiology, severity, types of pathology, clinical features, precipitating factors, and treatment outcomes of patients with allergic conjunctivitis in a tropical climate receiving corneal subspecialist intervention. A total of 33 patients with severe allergic conjunctivitis under corneal subspecialist care in National University Hospital, Singapore were studied. Design: A retrospective, noncomparative case series. Main outcome measures: epidemiological data, clinical features, complete ophthalmological examination, and treatment types. Methods: Both eyes of 33 patients seen at the cornea subspecialist clinic between May 2005 and July 2006 were examined at baseline, and followed up. Clinical features, treatment given, and outcome variables through case sheet review were analyzed. Results: Twenty-five patients (75.8%) were male, and 8 (24.2%) were female. Seventeen patients (51.5%) had concomitant allergic rhinitis, 16 patients (48.5%) had asthma, and 17 (51.5%) had associated dermatitis. Only 9 patients (27.3%) had documented precipitating factors. None of the 33 patients said that their symptoms were seasonal; 22 (66.7%) said their symptoms were perennial. Twenty-nine patients (87.9%) had punctate epithelial erosions, and 12 patients eventually progressed to have a corneal epithelial defect or shield ulcer (36.4%). Eleven out of the 33 patients (33.3%) received topical cyclosporine 0.5%. Of these, only 1 (9.1%) had documented complaints of intolerable side effects. Conclusion: Allergic conjunctivitis in a non-temperate, non-seasonal climate has different clinical presentations, and varied precipitating factors. The disease in such conditions may respond differently to the usual anti-allergy drug options used in temperate countries.