These patients often have ‘worse’ times of the year, typically Spring and Autumn. They have often been seen with more typical hay fever conjunctivitis signs and symptoms and often have a history of atopia; hay fever, asthma, eczema, psoriasis, or similar problems.

Look carefully for the following features:

• a porcelain-like, lustrous conjunctival surface quality
• some level of follicular hypertrophy on eversion of lower lids
• some level of flat-topped papillae on eversion of upper lids
• significant relief 1-2 minutes following instillation of topical anaesthetic

The most common cause is chronic atopic blepharoconjunctivitis.

Management

• lubrication and lavage
• cool compresses
• mast-cell stabilization (1 drop 4-5x daily)
• topical non-steroidal anti-inflammatory (1 drop 4-5x daily for 10-14 days)
• recommend wash hair and shower before bedtime, change pillowcase often.