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Dr.s.veni priya17.2.16 ni conj & xerophthalmia
- 2. Revision Acute conjunctivitis – bacterial, viral , ophthalmia neonatorum Chronic – trachoma
- 3. Plan of the class Allergic conjunctivitis Immune mediated conjunctivitis – phlycten Xerophthalmia
- 4. ALLERGIC CONJUNCTIVITIS Acute allergic rhino conjunctivitis Vernal kerato conjunctivitis Atopic kerato conjunctivitis Giant papillary conjunctivitis
- 5. Allergic conjunctivitis IgE mediated hypersensitivity reaction on exposure to environmental allergens ALLERGENS : pollen ,dust, bacterial antigens, cosmetics, animal , birds , etc
- 7. Clinical features SYMPTOMS Itching , itching, itching Mild redness Mucoid discharge ( ROPY DISCHARGE)
- 8. CLINICAL FEATURES - SIGNS CONJ- papillae Chemosis Mild redness
- 9. Complications CORNEAL INVOLVEMENT – shield ulcer , keratoconus DRY EYES
- 10. MANAGEMENT GENERAL MEASURES Avoid exposure to allergens - DARK GOGGLES Cold compress Not to rub the eyes
- 11. TREATMENT To control the present attack Topical steroids - FML , loteprednal Topical antihistamine – CPM, epinastine To prevent further attacks Mast cell stabilizers – sodium cromoglycate, olopatidine
- 12. ACUTE ALLERGIC RHINO CONJUNCTIVITIS SEASONAL ALLERGIC CONJUNCTIVITIS Spring & summer Commonest form Tree and grass pollen PERENNIAL ALLERGIC CONJUNCTIVITIS ↑ Autumn Milder & less common House dust mites, animal dander & fungal allergen
- 13. ACUTE ALLERGIC RHINO CONJUNCTIVITIS TREATMENT Mast cell stabilisers – sodium cromoglycate q.i.d Antihistamines Combined therapy Steroids – rarely indicated
- 14. VERNAL CONJUNCTIVITIS VERNAL KERATOCONJUNCTIVITIS SPRING CATARRH Bilateral recurrent allergic conjunctivitis Ig E & cell mediated immune mechanisms
- 15. VERNAL KERATOCONJUNCTIVITIS RISK FACTORS Boys ≥ girls , mean age – 7 yrs Family history of atopy Peak incidence in spring & summer
- 16. SYMPTOMS ITCHING ROPY DISCHARGE Frequent blinking
- 17. VKC – SIGNS Palpebral Upper tarsal conjunctiva Cornea Limbal Mixed
- 18. VERNAL KERATOCONJUNCTIVITIS DIFFUSE PAPILLARY HYPERTROPY OF UPPER TARSUS MACROPAILLAE / COBBLE STONES - ≥ 1MM PALPEBRAL FORM
- 20. VERNAL KERATOCONJUNCTIVITIS LIMBAL FORM Limbal papillae White spots at apices – Horner Trantas dots
- 21. VERNAL KERATOCONJUNCTIVITIS KERATOPATHY Punctate epithelial erosions Macroerosions Shield ulcers & plaques
- 22. VERNAL KERATOCONJUNCTIVITIS KERATOPATHY Pseudogerontoxon – resembles arcus senilis Peripheral superficial vascularisation HSV keratitis & keratoconus
- 23. VERNAL KERATOCONJUNCTIVITIS TREATMENT TOPICAL Mast cell stabilisers - ↓ need for steroids Antihistamines Steroids – mainstay Fluromethalone 0.1 % Cyclosporin – qid in steroid resistant cases
- 24. MUST KNOW Other names IgE mediated & cell mediated allergic Itching & ROPY DISCHARGE Papillae – COBBLE STONE APPEARANCE limbus – HORNER TRANTA’S SPOT TREATMENT – antihistamine steroid mast cell stabilizer
- 25. ATOPIC KERATOCONJUNCTIVITIS Associated with atopic dermatitis , asthma, allergic rhinitis . Chronic, unremitting , extremely severe form of allergic conjunctivitis → significant visual morbidity
- 26. GIANT PAPILLARY CONJUNCTIVITIS Giant papilla- > 1 mm Soft CL wear, ocular prosthesis , exposed sutures, filtering blebs FB sensation , redness, itching, CL intolerance TREATMENT: Remove the cause Lubricating eye drops Same as allergic conjunctivitis
- 28. ASSIGNMENT ocular side effects of using steroids (topical / systemic) Name four ocular diseases in which steroids are used for treatment
- 29. Immune mediated - PHYLCTENULAR CONJUNCTIVITIS Hypersensitivity reaction to endogenous bacterial protein (tuberculosis, adenoiditis/tonsillitis) TYPES : Conjunctival Limbal Corneal
- 31. CLINICAL FEATURES SYMPTOMS : Mild irritation Redness SIGNS : SMALL NODULE necrosis ulcer
- 32. TREATMENT Short course of topical steroids
- 33. XEROPHTHALMIA
- 34. XEROPHTHALMIA Spectrum of ocular disease ranging caused by vitamin A deficiency. Nutritional blindness CAUSES: malnutrition, malabsorption, chronic alcoholics, diseases which precipitate malnutrition like measles, malaria, diarrhoea , acute illness in children.
- 35. HOW ? VITAMIN A is essential for the synthesis of retinal photo pigments & conjunctival glycoproteins. RHODOPSIN Visual cycle delayed dark adaptation / Night Blindness Conjunctival epithelial dysfunction ocular surface dryness
- 36. XEROPHTHALMIA
- 37. XEROPHTHALMIA XN: NIGHT BLINDNESS EARLIEST SYMPTOM responds rapidly to vitamin A therapy [ within 24-48 hours]
- 38. CONJUNCTIVAL XEROSIS X1 A : - the conjunctival epithelium undergoes KERATANISING METAPLASIA. i.e. the normal columnar epithelium is transformed into stratified squamous epithelium. Goblet cells will be lost & keratinization occurs. - conjunctival xerosis – starts at the temporal side
- 40. BITOT’S SPOT - keratin + saprophytic bacilli [ CORYNEBACTERIUM XEROSIS] accumulate on the xerotic surface FOAMY APPEARANCE== BITOT’S SPOT - Begin to resolve within 2-5 days & disappear by 2 weeks of treatment -In Chronic cases, the spots will not disappear
- 41. BITOT’S SPOT
- 42. CORNEAL XEROSIS – X2 Lustreless dry appearance , in the inferior limbus Responds within 2-5 days, disappear within 2 weeks of treatment
- 43. CORNEAL XEROSIS
- 44. X3A & X3B : KERATOMALACIA COLLIQUATIVE NECROSIS/ LIQUAFACTIVE NECROSIS sterile corneal melting Round or oval punched out ulcers involving the inferonasal quadrant Perforation adherent leucoma, anterior staphyloma, phthisis bulbi
- 45. KERATOMALACIA
- 46. XEROPHTHALMIA- XS &XF XS: CORNEAL SCARRING -Nebula, macula , leucoma XF: XEROPHTHALMIC FUNDUS /UYEMURA’S FUNDUS -Small white lesions in the retina
- 48. TREATMENT - MEDICAL EMERGENCY VITAMIN A: ( 3 DOSES) 2 LAKH I.U - ORALLY OR 1 LAKH I.U – I.M 1ST DAY, 2ND DAY & WITHIN 1-4 WEEKS CHILDREN BETWEEN 6-11 MONTHS: HALF THE DOSE CHIDREN < 6 MONTHS : QUARTER THE DOSE
- 49. TREATMENT OCULAR LESIONS: Lubricants Broadspectrum antibiotics Cycloplegics FORTIFIED DIET
- 50. QUESTIONS VKC / SPRING CATARRAH XEROPHTHALMIA Causes of night blindness Treatment of xerophthalmia Treatment of allergic conjunctivitis What is Bitot’s spot ? Difference between papillae & follicle.
- 51. 24.2.16 - symposium Causes of Limbal nodule Acute red eye – enumerate the causes. How to differentiate between them. Ophthalmia neonatorum Trachoma – clinical features & management
Editor's Notes
- MOST common form of ocular & nasal allergy. Affects 20% of population . 2 clinical forms have been described based on pattern of exacerbations and likely allergen
- Olapatidine,ketotifen , azelastine
- Bilateral recurrent disorder . Ig E & cell mediated immune mechanisms p;ay an important role. 95% remit by late teens and remainder 5% develop atopic keratoconjunctivitis . Sub – Saharan regions of Africa - significant public health problem VKC may occur in seasonal basis, with peak incidence in spring & summer
- Plaques – bowman,s layer becomes coated with mucous and calcium phosphate – poor wetting & delayed re- epithelialization
- Plaques – bowman,s layer becomes coated with mucous and calcium phosphate – poor wetting & delayed re- epithelialization
- 0.1 ml of dexamethasone 4m / ml or triamcinolone 40 mg / ml
- 0.1 ml of dexamethasone 4m / ml or triamcinolone 40 mg / ml
- Rare b/l ,symmetrical disease that develops in young men associated with atopic dermatitis Diagnosis is clinical and no single laboratory test to distinguish AKC from VKC