title: Actinic conjunctivitis in children: Clinical features, relation to sun exposure, and proposed staging and treatment.
abstract: BACKGROUND
  Actinic conjunctivitis is an ocular photosensitivity reaction found mainly in children in certain populations in the Andean regions of South America, Mexico, and in the southwestern United States. Its clinical features, treatment, and possible relation to duration of sun exposure have not been fully described in the ophthalmologic literature.
  
  
  METHODS
  A 20-member ophthalmic team traveled to an Andean region of Ecuador to provide ophthalmic care to children. All children with conjunctivitis were examined. A novel 3-stage classification of actinic conjunctivitis, devised by one of the authors, was used to stage the disease. The parents of each child with actinic conjunctivitis were asked how much time the child spent outside. Histopathological evaluations were performed on children who underwent surgery.
  
  
  RESULTS
  A total of 206 children were examined, of whom 36 had changes consistent with actinic conjunctivitis. Stage 1 disease was diagnosed in 17 children, stage 2 in 9, and stage 3 in 10 in the most severely affected eye. The amount of time the child spent outside correlated with disease severity (r = 0.77, p < 0.001). Histopathologic samples showed an intense inflammatory response with hyperplasia of the vascular endothelium, pigmentary migration, and occasional eosinophilia.
  
  
  CONCLUSIONS
  Actinic conjunctivitis is prevalent among children of the highlands of Ecuador. Although it has an allergic component, our data suggest that the severity of the disease is significantly associated with sun exposure. The finding that the lesions are found only in the exposed conjunctiva supports the hypothesis that UV exposure is the main cause of the disease.
authors.affiliation: Department of Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. engel@uceyecenter.com
authors.forename: J Mark
authors.initials: JM
authors.lastname: Engel
authors.forename: Andrea
authors.initials: A
authors.lastname: Molinari
authors.forename: Barbara
authors.initials: B
authors.lastname: Ostfeld
authors.forename: Malik
authors.initials: M
authors.lastname: Deen
authors.forename: Oscar
authors.initials: O
authors.lastname: Croxatto
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000473:pathology* / Q000528:radiation effects*; D003231:Conjunctivitis / Q000208:ethnology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D004484:Ecuador / Q000453:epidemiology; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data; D008297:Male; D010787:Photosensitivity Disorders / Q000208:ethnology / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D015995:Prevalence; D012720:Severity of Illness Index; D013472:Sunlight / Q000009:adverse effects*