Allergic Conjunctivitis Severely Affects Children's Quality of Life

Laird Harrison

June 15, 2021

Allergic conjunctivitis harms quality of life for children and their parents, apparently causing greater day-to-day worries than potentially blinding diseases, researchers report.

Parents worry especially that treatments might not be effective, according to Shi-yao Zhang, MD, and colleagues from Sun Yat-sen University, in Guangzhou, China. "This finding suggests that more communication with parents regarding treatment and prognosis is needed," they write in an article published online June 10 in JAMA Ophthalmology.

One of the most prevalent eye disorders in children, allergic conjunctivitis is often chronic, leading patients to ask repeatedly for help from physicians. It can take an emotional toll and can cause children to miss school.

Dr Yi Ning J. Strube

"With any sign of a slightly pink eye or any sign of a runny nose, which are very common with allergies, children are being sent home, because everyone's concerned about COVID," said Yi Ning J. Strube, MD, an associate professor of ophthalmology and pediatrics at Queen's University, in Kingston, Canada, whose commentary appears in the same issue of JAMA Ophthalmology.

Adolescents are also sometimes accused of smoking cannabis because of their red eyes, she said.

However, little research has examined the effects of allergic conjunctivitis on the quality of life of children and their guardians, Zhang and colleagues write. To fill that gap, the researchers administered the Pediatric Quality of Life Inventory (PedsQL) to 92 children with allergic conjunctivitis and their parents. The children were aged 5 to 18 years.

The researchers administered the same questionnaire to 96 healthy children of the same ages, along with their parents. These participants served as a control group.

On a scale of 0 to 100, in which a higher score signifies a better quality of life, the median total PedsQL score was 69.6 for children with allergic conjunctivitis vs 96.7 for the control group.

Subscores of physical, emotional, social, and especially school functioning were all significantly lower for the children with allergic conjunctivitis than for the control persons. "Because children generally spend most of their time in the school environment, this outcome raises an issue regarding whether children have a poorer performance in their education," Zhang and colleagues write.

Strube recommends that physicians educate their patients about allergic conjunctivitis using handouts or high-quality websites. She often refers patients and their families to the allergic conjunctivitis webpage of the American Association for Pediatric Ophthalmology & Strabismus.

She tells parents to have their child "take a shower and wash their hair when they get home before they rub their pollen-filled hair on their pillowcase and make their allergy symptoms worse."

Parents and schools should try to filter pollen and other allergens from indoor air, she added.

Parents of the children with allergic conjunctivitis in the study also reported lower quality of life; they scored 68.8, vs 96.5 for parents of children in the control group. The differences for both parents and children were statistically significant (P < .001). Overall, the parents' quality-of-life scores correlated with their children's (correlation coefficient, r = 0.59; P < .001).

Children with vernal or atopic keratoconjunctivitis scored 3.3 points lower on health-related quality of life than those with seasonal allergic conjunctivitis.

Children with higher corneal fluorescein staining scores also had lower quality-of-life scores. Parents whose children had higher corneal fluorescein staining scores and also those who had multiple consultations with healthcare practitioners also reported lower quality of life.

The quality-of-life scores of the children with allergic conjunctivitis were lower than scores in previous studies for children with vision-threatening diseases, such as glaucoma and congenital cataract. This may be because glaucoma and cataracts do not typically cause discomfort even if they impair the patient's vision, said Strube.

She pointed out one potential flaw in the study: In the cohort with allergic conjunctivitis, 83.7% were boys, compared to 42.7% of the control group. Vernal keratoconjunctivitis affects more boys than girls, and not controlling for this factor could have confounded the data, Strube said.

It could be useful to replicate the study in other countries to see whether geographic or cultural factors affected the results, she said. "A lot of these big centers around the world, including in China, have poor air quality, so that may be contributing to patients' symptoms," she said. "With regards to reported health quality of life and impact on education, results from different parts of the world may be different, due to parenting styles and education styles," she said.

The study was supported by the National Natural Science Foundation of China and the Science Foundation of Guangdong Province. Zhang and colleagues reported no relevant financial relationships. Strube reported receiving personal fees from Santen Canada Advisory Board Consultant outside the submitted work.

JAMA Ophthalmol. Published online June 10, 2021. Abstract, Commentary

Laird Harrison writes about science, health and culture. His work has appeared in national magazines, in newspapers, on public radio and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at lairdharrison.com or follow him on Twitter: @LairdH.

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