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allergic conjunctivitis
- 1. Allergic eye disease Presentedby: khoy sothearith 2nd year resident
- 2. Outline • Acute allergicconjunctivitis • Seasonal and perennial allergic conjunctivitis • Vernal keratoconjunctivitis • Atopic keratoconjunctivitis
- 3. Acute allergic conjunctivitis– presentation • Younger children( spring or summer) • acute itching and watering, associated with severe chemosis
- 4. Acute allergic conjunctivitis– treatment • Usually not require – Chemosis settle within hours • Cool compress • Single drop of adrenaline 1%
- 5. Seasonal and perennialallergic conjunctivitis Seasonal”hay fever eye “ • Spring and summer • Allergen: tree and grass polen • Specific allergen varies with geographic location • Common Perennial • Through the year, worst in automm • Allegen: house dust mite, animal dander, fungal allergen • Less common
- 6. Diagnosis • Presentation: transientacute or subacute redness, watering and itching, associated with sneezing or nasal discharge • Signs: – completely resolve within episode – Conjunctival hyperemia – Mild papillary reaction – Chemosis and eyelid edema • Investigation – Not require – Conjunctival scrapping -> eosinophilia
- 7. Treatment • Artificial tear •Mast cell stabilizer( sodium cromoglycate, nedocromil sodium, lodoxamide) • Antihistamines( emedastine, epinastine, levocabastine, bepotastine) • Combined preparation( antihistamine + vasoconstrictor): Otrivin-Antistin® • Dual action of antihistamine + mast cell stabilizer(azelastine, ketotifen, olopatadine) • Topical steroid • Oral antihistamine – Severe case
- 8. Vernal keratoconjunctivitis • Affectschildren and young adults • More common in males and in warm climates • Itching, mucoid discharge and lacrimation • Palpebral Types • Limbal • Mixed • Recurrent, bilateral Frequently associated with atopy: asthma, hay fever and dermatitis
- 9. Progression of vernalconjunctivitis Diffuse papillary hypertrophy, most marked on superior tarsus Formation of cobblestone papillae Rupture of septae - giant papillae
- 10.
- 11. Progression of vernalkeratopathy Punctate epitheliopathy Epithelial macroerosions Plaque formation (shield ulcer) Subepithelial scarring
- 12. Atopic kertoconjunctivitis similar toVKC, more severe and unremitting Rare bilateral Typically develop in adulthood No gender preponderance Tend to be perennial, worst in winter
- 13. Atopic keratoconjunctivitis Typically affectsyoung patients with atopic dermatitis Eyelids are red, thickened, macerated and fissured
- 14. Progression of atopicconjunctivitis Infiltration of tarsal conjunctiva causing featureless appearance Inferior forniceal papillae Mild symblepharon formation
- 15. Progression of atopickeratopathy Punctate epitheliopathy Persistent epithelial defects Subepithelial scarring Peripheral vascularization
- 16. Treatment of VKCand AKC management of VKC does not differ substantially from that of AKC • less responsive and requires more intensive and prolonged treatment
- 17. General measure • Allergensavoidance • Cool compress • Lid hygiene
- 18. Local treatment • Mastcell stabilizer • Antihistamine • Combine preparation • Steroid • Immune modulator – Cyclosporine 0.05%: if steroid ineffective – Tacrolimus 0.03%
- 20. Systemic treatment • Antihistamine •Antibiotic(doxycycline 50–100 mg daily for 6 weeks or azithromycin 500 mg once daily for 3 days) – to reduce blepharitis • Immunosuppressive agents(e.g. steroids, ciclosporin, tacrolimus, azathioprine) • Aspirin
Editor's Notes
- #9 Ig E 5 years onward 95% remit by the late teen, remainder -> AKC Rare in temperated regions
- #10 Cobblestone- macropapillae <1mm Giant papillae- septate rupture >1mm
- #11 Trantas dots- gelatinous limbal conjunctival papillae Mucoid nodule- white cellular collection
- #12 SPK- sheet of mucus on the superior cornea Epith macroerosion- epithelial toxicity from inflame mediator + direct effect from papillae Sheild ulcer- exposed Bowman membrane become coat with mucus and calcium phosphate -> inadequate wetting and delayed re-epitheliazation Scar- grey and oval
- #16 SPK- inf 1/3 of cornea Peripheral Vx- more common than VKC