Pathophysiology

The conjunctiva of the eye is often the first site of contact with an environmental allergen. Mast cell degranulation occurs, resulting in the release of mediators. The earliest mediator is histamine, which causes itching, redness, and swelling. Leukotrienes and prostaglandins cause increased mucus secretion and cellular infiltration along with chemosis, resulting in conjunctival vasodilation. The mast cells also release cytokines,

chemokines, and growth factors which trigger inflammatory processes.

Treatment of ocular allergy is aimed at slowing or stopping these processes. Antihistamines block the histamine receptors and some prevent histamine production and/

or inhibit mediator release from the mast cells. Mast cell stabilizers inhibit the degranulation of mast cells, preventing mediator release. Some topical agents have multiple mechanisms of action, combining antihistaminic, mast cell stabilization, and

anti-inflammatory properties (Tables 63-4, 63-5, and 63-6).

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