Allergic Conjunctivitis Lowers Children’s Quality of Life

Ill African American girl blowing a nose at home while her mother is consoling her.
Corneal allergy complications in children can even lower their parents’ quality of life.

An investigation of 188 children; 92 with allergic conjunctivitis (AC), and 96 healthy participants — along with parents for both groups — demonstrates specific reductions in health-related quality of life (QOL) for children, and it is the first controlled study to show that parents’ QOL is impacted along with their children’s, according to data published in JAMA Ophthalmology.

Clinic visits took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from November 2019 to January 2020. Participants 5 to 18 years of age completed the standardized Pediatric Quality of Life Inventory, version 4.0 (PedsQL), and parents answered the questions of PedsQL Family Impact Module. Survey scores range from 0 to 100, with higher scores showing better QOL. The Chinese language version PedsQL has been proven reliable and valid.

“An unexpected finding was that the decrease of QOL in children with AC was worse than in previous studies of children diagnosed with blinding diseases, such as glaucoma and congenital cataract, in which the same PedsQL questionnaires had been used,” the study explains. 

Children with seasonal allergic conjunctivitis (SAC) or perennial allergic conjunctivitis (PAC) exhibited the condition for a median of 12 months, although the disorder persisted for 24 months in children with vernal keratoconjunctivitis (VKC) or atopic keratoconjunctivitis (AKC). In median with interquartile range (IQR) figures, results of the PedsQL showed patients with AC —including all subtypes — scored lower, 69.6 (66.3 to 72.8), compared with control individuals, 96.7 (92.7 to 98.9). Further, scores for parents of kids with AC also correlated with their children’s score (P <.001). 

The participants also underwent an ocular examination, including corneal fluorescein staining (CFS). In the multivariate analysis, children’s health-related QOL was associated with higher CFS (P =.001). Parents’ QOL was linked to both higher CFS score (P =.001) and to “multiple consultations” (P =.02). The investigation speculates that these multiple visits may reflect a higher concern level of parents, as well as cases that are resistant to treatment or recur. Children with the rarer but more severe VKC or AKC displayed lower QOL than those with SAC or PAC (P =.004), and this also applied to their parents (P <.001).

Lowest subscale scores for children with AC emerged in school functioning, median 65.0 compared with healthy participants at 90.0; and emotional functioning, 65.0 vs the control group at 100.0. The largest difference for kids between the two groups was found in emotional functioning. In parents of kids with AC, the widest intergroup gap in subscale scores appeared for physical functioning, median 66.7 compared with the control group at 100.0.

Selection bias may have resulted from the more severely disease-affected patients visiting a tertiary clinic. Also, the ophthalmic center is located in an economically developed region, which could affect QOL numbers. However, the sample size was sufficient to show statistical power.

“Among all sub-scores of parents’ QOL, worry was the lowest and the issue worrying parents most was whether the treatment would be effective,” according to the research. “This finding suggests that more communication with parents regarding treatment and prognosis is needed.”


Zhang S, Li J, Liu R. Association of allergic conjunctivitis with health-related quality of life in children and their parents. JAMA Ophthalmol.  Published online June 10, 2021. doi:10.1001/jamaophthalmol.2021.1708