The anatomical and functional relationship between allergic conjunctivitis and allergic rhinitis.
There are numerous anatomic connections between the allergic conjunctivitis and allergic rhinitis. The most obvious reason is the physical connection via the nasolacrimal apparatus. However, a closer look at innervation, circulatory, lymphatic, and neurogenic systems reveals much more than a physical connection. The eye is richly innervated by parasympathetic nerves that enter the eyes after traveling in conjunction with the parasympathetic input to the nasal cavity. Parasympathetic innervation governing the tear film and nasal secretion can intersect at the pterygopalatine ganglion. Neurogenic inflammation affects both the eye and the nose as evidenced by the presence of the same neurogenic factors. Venous flow is in the SOV area connecting the eye and the nose, once thought to be without valves. In the past, this thinking is the basis for concern about the danger triangle of the face. Recent literature has shown otherwise. Although valves are present, there are still pathways where bidirectional flow exists and a venous connection is made. The most likely area for venous communication is the pterygoid plexus and cavernous sinus. The venous flow and connections also offers a pathway for allergic shiners. Understanding the mutual connections between the nasal mucosa and the ocular surface can also affect treatment strategies.
private practice, Azusa, CA and.
Milton M
MM
Hom
Department of Medicine, Rutgers University, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
Leonard
L
Bielory
Allergic conjunctivitis; cavernous sinus; naso-ocular reflex; nasolacrimal; neurogenic inflammation; ocular allergy; pterygoid plexus; pterygopalatine ganglion; rhinitis