OCULAR ALLERGY THERAPEUTIC PERSPECTIVES
by DR PRIYA BASAIAWMOIT
presentation about ocular allergy & therapeutic perspectives
and there management for ophthalmologist and eye care professionals
The document discusses the anatomy and disorders of the eye. It describes the three layers of the eyeball - outer fibrous layer, middle vascular layer, and inner nerve tissue layer. It then explains several common eye disorders in detail, including refractive errors like myopia and hyperopia, muscular disorders like strabismus, eyelid disorders like hordeolum and blepharitis, and globe disorders of the eye like cataracts, glaucoma, and retinal detachment. Treatment options are provided for each condition.
This document provides a differential diagnosis for red eye and lists the most common causes. It discusses four important causes in more detail: acute adenoviral conjunctivitis, acute bacterial corneal ulcer/keratitis, acute anterior uveitis, and acute congestive glaucoma. For each cause, it outlines characteristics of vision, eyelid swelling, discharge, congestion, cornea appearance, anterior chamber reaction, pupil appearance, intraocular pressure, and whether referral is required.
This document discusses various causes of red eye and provides guidance on differential diagnosis and treatment recommendations. It addresses conditions such as iritis, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, allergic conjunctivitis, and complications after cataract surgery such as endophthalmitis. Clinical signs and symptoms are outlined to help distinguish between infectious, inflammatory, allergic, and other causes of red eye. Management typically involves topical medications, with referrals made for refractory cases or potential sight-threatening conditions.
This document discusses the approach to evaluating and treating a red and painful eye. It covers key aspects of history and physical exam, including common etiologies like caustic injuries, subconjunctival hemorrhages, acute angle closure glaucoma, hyphema, and penetrating injuries. Management depends on the underlying cause but may include irrigation, medications, imaging, or ophthalmology consultation for conditions like perforations or retrobulbar hematomas that require surgical intervention. The goal is to quickly diagnose the problem and prevent vision loss or complications.
- Ocular allergy affects approximately one-third of the population and manifests as forms including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis and contact dermatoconjunctivitis.
- These forms are mediated by type I and type IV hypersensitivity reactions and have symptoms of itching, redness, burning and watery discharge.
- Treatment involves identifying allergens, avoiding triggers, using antihistamines, mast cell stabilizers, NSAIDs and corticosteroids, with immunotherapy and anti-IgE therapy for more severe cases
Infectious and inflammatory conditions of eyesRRamya10
Conjunctivitis, also known as pink eye, is an inflammation of the conjunctiva that causes redness, tearing, and discharge from the eye. It is often caused by bacterial or viral infections that enter the eye through contact with infected objects. Common bacterial causes include Hemophilus influenzae, Streptococcus pneumoniae, and Chlamydia. Viruses such as Adenovirus and Herpes virus also frequently cause conjunctivitis. Management involves antibiotic eye drops or ointments for bacterial infections and supportive care like cold compresses for viral infections.
This workshop focuses on evaluating patients presenting with red eye. The top 10 causes of red eye are discussed, including conjunctivitis, uveitis, acute angle closure glaucoma, episcleritis, subconjunctival hemorrhage, dry eye, blepharitis, injury, corneal ulcer, and frequent eye drops. Management strategies are provided for various conditions like conjunctivitis, blepharitis, dry eye, corneal ulcer, and drug-induced allergic conjunctivitis. The workshop emphasizes examining for corneal lesions when evaluating red eye and avoiding steroid eye drops.
This document summarizes several common eye conditions including conjunctivitis, ophthalmia neonatorum, retinitis, styes, and cataracts. Conjunctivitis, or pink eye, is an inflammation of the conjunctiva that is usually caused by bacterial or viral infections. Ophthalmia neonatorum is a purulent eye discharge in newborns caused by pathogens like Neisseria gonorrhoeae. Retinitis is an inflammation of the retina that can be caused by infection, toxins, or tuberculosis. Styes are infections of the eyelid sebaceous glands caused by bacteria like Staphylococcus. Cataracts are opacities in the lens
The document discusses the anatomy and disorders of the eye. It describes the three layers of the eyeball - outer fibrous layer, middle vascular layer, and inner nerve tissue layer. It then explains several common eye disorders in detail, including refractive errors like myopia and hyperopia, muscular disorders like strabismus, eyelid disorders like hordeolum and blepharitis, and globe disorders of the eye like cataracts, glaucoma, and retinal detachment. Treatment options are provided for each condition.
This document provides a differential diagnosis for red eye and lists the most common causes. It discusses four important causes in more detail: acute adenoviral conjunctivitis, acute bacterial corneal ulcer/keratitis, acute anterior uveitis, and acute congestive glaucoma. For each cause, it outlines characteristics of vision, eyelid swelling, discharge, congestion, cornea appearance, anterior chamber reaction, pupil appearance, intraocular pressure, and whether referral is required.
This document discusses various causes of red eye and provides guidance on differential diagnosis and treatment recommendations. It addresses conditions such as iritis, dry eye, subconjunctival hemorrhage, bacterial conjunctivitis, allergic conjunctivitis, and complications after cataract surgery such as endophthalmitis. Clinical signs and symptoms are outlined to help distinguish between infectious, inflammatory, allergic, and other causes of red eye. Management typically involves topical medications, with referrals made for refractory cases or potential sight-threatening conditions.
This document discusses the approach to evaluating and treating a red and painful eye. It covers key aspects of history and physical exam, including common etiologies like caustic injuries, subconjunctival hemorrhages, acute angle closure glaucoma, hyphema, and penetrating injuries. Management depends on the underlying cause but may include irrigation, medications, imaging, or ophthalmology consultation for conditions like perforations or retrobulbar hematomas that require surgical intervention. The goal is to quickly diagnose the problem and prevent vision loss or complications.
- Ocular allergy affects approximately one-third of the population and manifests as forms including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis and contact dermatoconjunctivitis.
- These forms are mediated by type I and type IV hypersensitivity reactions and have symptoms of itching, redness, burning and watery discharge.
- Treatment involves identifying allergens, avoiding triggers, using antihistamines, mast cell stabilizers, NSAIDs and corticosteroids, with immunotherapy and anti-IgE therapy for more severe cases
Infectious and inflammatory conditions of eyesRRamya10
Conjunctivitis, also known as pink eye, is an inflammation of the conjunctiva that causes redness, tearing, and discharge from the eye. It is often caused by bacterial or viral infections that enter the eye through contact with infected objects. Common bacterial causes include Hemophilus influenzae, Streptococcus pneumoniae, and Chlamydia. Viruses such as Adenovirus and Herpes virus also frequently cause conjunctivitis. Management involves antibiotic eye drops or ointments for bacterial infections and supportive care like cold compresses for viral infections.
This workshop focuses on evaluating patients presenting with red eye. The top 10 causes of red eye are discussed, including conjunctivitis, uveitis, acute angle closure glaucoma, episcleritis, subconjunctival hemorrhage, dry eye, blepharitis, injury, corneal ulcer, and frequent eye drops. Management strategies are provided for various conditions like conjunctivitis, blepharitis, dry eye, corneal ulcer, and drug-induced allergic conjunctivitis. The workshop emphasizes examining for corneal lesions when evaluating red eye and avoiding steroid eye drops.
This document summarizes several common eye conditions including conjunctivitis, ophthalmia neonatorum, retinitis, styes, and cataracts. Conjunctivitis, or pink eye, is an inflammation of the conjunctiva that is usually caused by bacterial or viral infections. Ophthalmia neonatorum is a purulent eye discharge in newborns caused by pathogens like Neisseria gonorrhoeae. Retinitis is an inflammation of the retina that can be caused by infection, toxins, or tuberculosis. Styes are infections of the eyelid sebaceous glands caused by bacteria like Staphylococcus. Cataracts are opacities in the lens
Sat 1540-clinical-approach-to-red-eye- -parkIhsaan Peer
This document provides an overview of red eye (conjunctivitis) for clinical practice. It begins with learning objectives and then covers topics such as ocular anatomy, causes of red eye, evaluation of red eye, differential diagnosis, treatment recommendations, and when to refer to an ophthalmologist. Key points include differentiating conditions that cause red eye based on symptoms and signs, describing ideal treatments for various conjunctivitis types, and discussing recommendations for returning to activities with infectious conjunctivitis. The document provides guidance on evaluating and diagnosing different red eye conditions.
This document summarizes several common pediatric eye conditions seen by Dr. Mona Hussein. It discusses conditions such as conjunctivitis (bacterial, viral, allergic), refractive errors, amblyopia, strabismus, and others. For each condition, it provides details on symptoms, signs, investigations, and treatment approaches. The document is intended to inform specialists about evaluating and managing these common eye issues in children.
Defects and disease of different sense organasSayak Chowdhury
The document discusses several defects and diseases that can affect different sense organs. It provides information on cataracts of the eye, describing the various types and their symptoms. It also discusses conjunctivitis of the eye, explaining its causes and treatment options. For the nose, it covers nosebleeds, describing common causes like trauma, risk factors like high blood pressure, and prevention methods. It also discusses non-allergic rhinitis and its environmental triggers. Regarding the skin, it provides information on skin cancer symptoms and prevention through sun protection and avoiding indoor tanning. It also discusses acne symptoms and prevention strategies. For the ear, it covers tinnitus symptoms and potential causes, as well as symptoms and treatment
This presentation summarizes a case of scleritis. A 41-year-old male presented with gradual decreased vision in his left eye associated with redness, watering and pain for 2 months. Examination found conjunctival congestion in the left eye with scleral elevation, bluish appearance, and adherent conjunctiva. Intraocular pressure was elevated in the left eye. Based on the clinical features, a diagnosis of diffuse scleritis was made. Scleritis most commonly occurs in adults aged 40-60 years and has a high rate of recurrence over several years despite treatment. Early diagnosis and proper management are important to control inflammation and prevent complications.
Ophthalmology is the branch of medicine dealing with the eyes and vision. It includes diagnosis and treatment of eye disorders. Ophthalmologists are medical doctors who provide full eye care including exams, prescribing corrective lenses, diagnosing and treating diseases, and performing eye surgery. Optometrists provide similar services but cannot perform surgery. Opticians fill prescriptions for eyeglasses. Blepharitis is a common inflammation of the eyelids that occurs when oil glands near the eyelashes become clogged. It can cause red, irritated eyes and crusty eyelashes. Treatment focuses on eyelid scrubs and warm compresses to remove bacteria and debris from the eyelids.
This slide contains information regarding conjunctivitis, pterygium and pinguecula. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
This document contains notes from an ophthalmology OSCE revision covering various eye conditions and treatments. It discusses dermatochalasis and entropion treatment, styes and chalazion differential diagnosis and treatments, ptosis grades and treatments, dacryocystitis management, conjunctivitis causes and treatments, pterygium and pinguecula, hyphema management, and removing a corneal foreign body. The notes provide concise descriptions of common eye issues with their presentations, differential diagnoses, and treatment plans.
The document outlines learning objectives and guidelines for examining patients presenting with red eye conditions. The objectives are to recognize common red eye conditions, accurately diagnose and treat the causes, and identify patients needing referral. The document provides guidance on taking a history, performing an examination of the eyes and surrounding areas, diagnosing common etiologies like conjunctivitis, styes, and trauma-related injuries, and identifying "red flags" requiring prompt referral.
Most common opthalmology slides with anwers in uhs ospeVerdah Sabih
This document contains information about common ophthalmology cases including diagnoses, treatments, and complications. It discusses various conditions such as entropion, ectropion, styes, ophthalmia neonatorum, phlyctenular conjunctivitis, bulbar conjunctivitis, ptosis, pterygium, hyphema, and keratic precipitates. For each case it provides the diagnosis, relevant clinical findings, and management approaches. The document appears to be a study guide or reference material for ophthalmology examinations.
This document provides an overview of common eye conditions and examination techniques. It covers topics such as red eye conditions (conjunctivitis, episcleritis, corneal ulcers), anterior uveitis, glaucoma, lid conditions (chalazions, styes, blepharitis), tearing issues, sudden vision loss, slow vision loss, eye trauma, and squints. Examination tips are provided for visual acuity testing, fields of vision, pupils, movements, and opthalmoscopy. Conditions are classified into categories like red eye, lids and tears, slow vision loss, trauma, and squints.
Eye injuries can occur from direct trauma, chemical contamination, infection, allergies, or other medical conditions. Some common signs of eye injuries include pain, redness, blurred vision, swelling and watering. The treatment for an eye injury depends on its cause but generally involves flushing the injured eye with water and seeking immediate medical attention to prevent further damage.
conjunctivitis is an eye disorder .this is all so known as pink eye .in the India south side people it is called as madras eye ..in this slide mentioned about .definition, review anatomy and physiology, types including causes , pathophysiology, signs and symptoms, treatment, nursing management, and prevention are there. the client who is affected with this use separate towels, wash your hands daily, eat eye healthy foods like vitamin a , e,omega 3 fatty acid, this will help the eyes verywell.eye exercise very helpful for eye health.if eye sensitive is there use sun glass that is very help full for the eye , eye staraning should be avioded.if the school student is affected means student should not go to the school for one week.
This document discusses various disorders of the eyelids and conditions that cause red eye. It describes several conditions including blepharitis, styes, chalazions, entropion, trichiasis, lagophthalmos, ptosis, dacryocystitis, orbital cellulitis, conjunctivitis, hemorrhagic conjunctivitis, allergic conjunctivitis, phlyctenular conjunctivitis, vernal conjunctivitis, pterygium, and corneal ulcers. Treatment options focus on antibiotic ointments, compress, referral for surgical correction if needed, and systemic antibiotics in more severe cases.
This document discusses a case of a 65-year-old man presenting with decreased vision, pain, photophobia, and whiteness and discharge from his eye due to a suspected dust injury. Upon examination, he was found to have lid swelling, conjunctival congestion, ciliary congestion, a poorly-defined ulcer with slough and hypopyon in the floor. Testing found pseudomonas pyocyanea infection. The stages and complications of corneal ulcers are outlined. Treatment involves antibiotic drops, cycloplegics, and managing complications like perforation which may require gluing, grafting or surgery. Causes of non-healing ulcers and fungal and acanthamoeba infections are also
This document discusses various disorders and conditions of the eye. It begins by covering conditions of the eyelids and conjunctiva, such as blepharitis, hordeolum, entropion, ectropion, and ptosis. It then discusses disorders of the cornea and uveal tract, focusing on keratitis (inflammation and ulceration of the cornea), which can be caused by viruses, bacteria, fungi, or trauma. The document also covers conjunctivitis, pterygium, trachoma, and errors of refraction like myopia, hyperopia, and astigmatism as well as other disorders such as cataracts, glaucoma, retinal problems, and eye
This document summarizes several pediatric ocular diseases and their systemic associations. It describes the clinical features and treatments of Alport's syndrome, Alstrom syndrome, CHARGE association syndrome, Stevens-Johnson syndrome, cat scratch disease, herpes simplex virus, rubella, varicella-zoster virus, and references for further information. For each condition, it outlines ocular findings such as lenticonus, flecks, uveitis, conjunctivitis and keratitis as well as associated systemic symptoms and recommended treatment approaches.
This document discusses conjunctivitis, also known as pink eye. It defines conjunctivitis as an inflammation or infection of the conjunctiva, the transparent membrane that lines the eyelids and covers the white part of the eyeball. Conjunctivitis can be caused by viruses, bacteria, allergens, chemicals, or other irritants. Common symptoms include eye redness, discharge, itching, and tearing. Treatment depends on the cause but may involve antibiotic or antiviral eye drops, allergy medication, or simply allowing a viral infection to run its course. Good hygiene practices can help prevent the spread of contagious conjunctivitis.
Atopic keratoconjunctivitis (AKC) is a chronic allergic eye condition that results from atopy, a genetic predisposition to allergic responses. It typically appears during late adolescence/early adulthood and affects the lower eyelids more than the upper eyelids, causing redness, swelling, itching and tearing. If left untreated, it can lead to complications like scarring, cataracts and corneal damage that impair vision. Treatment involves identifying allergens, using antihistamines and mast cell stabilizers, with corticosteroids or immunosuppressants in severe cases. Optometrists can manage mild AKC through lid hygiene, cold compresses, pharmaceuticals and referral
This document discusses ocular allergy, classifying it into different types including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. It describes symptoms, pathogenesis, clinical features, and treatment options for each type. Seasonal allergic conjunctivitis is caused by seasonal allergens and affects mostly those under 30. Vernal keratoconjunctivitis mostly affects young boys and is associated with atopy in 50% of cases. Atopic keratoconjunctivitis is associated with atopic eczema and strong family history of allergy. Giant
Sat 1540-clinical-approach-to-red-eye- -parkIhsaan Peer
This document provides an overview of red eye (conjunctivitis) for clinical practice. It begins with learning objectives and then covers topics such as ocular anatomy, causes of red eye, evaluation of red eye, differential diagnosis, treatment recommendations, and when to refer to an ophthalmologist. Key points include differentiating conditions that cause red eye based on symptoms and signs, describing ideal treatments for various conjunctivitis types, and discussing recommendations for returning to activities with infectious conjunctivitis. The document provides guidance on evaluating and diagnosing different red eye conditions.
This document summarizes several common pediatric eye conditions seen by Dr. Mona Hussein. It discusses conditions such as conjunctivitis (bacterial, viral, allergic), refractive errors, amblyopia, strabismus, and others. For each condition, it provides details on symptoms, signs, investigations, and treatment approaches. The document is intended to inform specialists about evaluating and managing these common eye issues in children.
Defects and disease of different sense organasSayak Chowdhury
The document discusses several defects and diseases that can affect different sense organs. It provides information on cataracts of the eye, describing the various types and their symptoms. It also discusses conjunctivitis of the eye, explaining its causes and treatment options. For the nose, it covers nosebleeds, describing common causes like trauma, risk factors like high blood pressure, and prevention methods. It also discusses non-allergic rhinitis and its environmental triggers. Regarding the skin, it provides information on skin cancer symptoms and prevention through sun protection and avoiding indoor tanning. It also discusses acne symptoms and prevention strategies. For the ear, it covers tinnitus symptoms and potential causes, as well as symptoms and treatment
This presentation summarizes a case of scleritis. A 41-year-old male presented with gradual decreased vision in his left eye associated with redness, watering and pain for 2 months. Examination found conjunctival congestion in the left eye with scleral elevation, bluish appearance, and adherent conjunctiva. Intraocular pressure was elevated in the left eye. Based on the clinical features, a diagnosis of diffuse scleritis was made. Scleritis most commonly occurs in adults aged 40-60 years and has a high rate of recurrence over several years despite treatment. Early diagnosis and proper management are important to control inflammation and prevent complications.
Ophthalmology is the branch of medicine dealing with the eyes and vision. It includes diagnosis and treatment of eye disorders. Ophthalmologists are medical doctors who provide full eye care including exams, prescribing corrective lenses, diagnosing and treating diseases, and performing eye surgery. Optometrists provide similar services but cannot perform surgery. Opticians fill prescriptions for eyeglasses. Blepharitis is a common inflammation of the eyelids that occurs when oil glands near the eyelashes become clogged. It can cause red, irritated eyes and crusty eyelashes. Treatment focuses on eyelid scrubs and warm compresses to remove bacteria and debris from the eyelids.
This slide contains information regarding conjunctivitis, pterygium and pinguecula. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
This document contains notes from an ophthalmology OSCE revision covering various eye conditions and treatments. It discusses dermatochalasis and entropion treatment, styes and chalazion differential diagnosis and treatments, ptosis grades and treatments, dacryocystitis management, conjunctivitis causes and treatments, pterygium and pinguecula, hyphema management, and removing a corneal foreign body. The notes provide concise descriptions of common eye issues with their presentations, differential diagnoses, and treatment plans.
The document outlines learning objectives and guidelines for examining patients presenting with red eye conditions. The objectives are to recognize common red eye conditions, accurately diagnose and treat the causes, and identify patients needing referral. The document provides guidance on taking a history, performing an examination of the eyes and surrounding areas, diagnosing common etiologies like conjunctivitis, styes, and trauma-related injuries, and identifying "red flags" requiring prompt referral.
Most common opthalmology slides with anwers in uhs ospeVerdah Sabih
This document contains information about common ophthalmology cases including diagnoses, treatments, and complications. It discusses various conditions such as entropion, ectropion, styes, ophthalmia neonatorum, phlyctenular conjunctivitis, bulbar conjunctivitis, ptosis, pterygium, hyphema, and keratic precipitates. For each case it provides the diagnosis, relevant clinical findings, and management approaches. The document appears to be a study guide or reference material for ophthalmology examinations.
This document provides an overview of common eye conditions and examination techniques. It covers topics such as red eye conditions (conjunctivitis, episcleritis, corneal ulcers), anterior uveitis, glaucoma, lid conditions (chalazions, styes, blepharitis), tearing issues, sudden vision loss, slow vision loss, eye trauma, and squints. Examination tips are provided for visual acuity testing, fields of vision, pupils, movements, and opthalmoscopy. Conditions are classified into categories like red eye, lids and tears, slow vision loss, trauma, and squints.
Eye injuries can occur from direct trauma, chemical contamination, infection, allergies, or other medical conditions. Some common signs of eye injuries include pain, redness, blurred vision, swelling and watering. The treatment for an eye injury depends on its cause but generally involves flushing the injured eye with water and seeking immediate medical attention to prevent further damage.
conjunctivitis is an eye disorder .this is all so known as pink eye .in the India south side people it is called as madras eye ..in this slide mentioned about .definition, review anatomy and physiology, types including causes , pathophysiology, signs and symptoms, treatment, nursing management, and prevention are there. the client who is affected with this use separate towels, wash your hands daily, eat eye healthy foods like vitamin a , e,omega 3 fatty acid, this will help the eyes verywell.eye exercise very helpful for eye health.if eye sensitive is there use sun glass that is very help full for the eye , eye staraning should be avioded.if the school student is affected means student should not go to the school for one week.
This document discusses various disorders of the eyelids and conditions that cause red eye. It describes several conditions including blepharitis, styes, chalazions, entropion, trichiasis, lagophthalmos, ptosis, dacryocystitis, orbital cellulitis, conjunctivitis, hemorrhagic conjunctivitis, allergic conjunctivitis, phlyctenular conjunctivitis, vernal conjunctivitis, pterygium, and corneal ulcers. Treatment options focus on antibiotic ointments, compress, referral for surgical correction if needed, and systemic antibiotics in more severe cases.
This document discusses a case of a 65-year-old man presenting with decreased vision, pain, photophobia, and whiteness and discharge from his eye due to a suspected dust injury. Upon examination, he was found to have lid swelling, conjunctival congestion, ciliary congestion, a poorly-defined ulcer with slough and hypopyon in the floor. Testing found pseudomonas pyocyanea infection. The stages and complications of corneal ulcers are outlined. Treatment involves antibiotic drops, cycloplegics, and managing complications like perforation which may require gluing, grafting or surgery. Causes of non-healing ulcers and fungal and acanthamoeba infections are also
This document discusses various disorders and conditions of the eye. It begins by covering conditions of the eyelids and conjunctiva, such as blepharitis, hordeolum, entropion, ectropion, and ptosis. It then discusses disorders of the cornea and uveal tract, focusing on keratitis (inflammation and ulceration of the cornea), which can be caused by viruses, bacteria, fungi, or trauma. The document also covers conjunctivitis, pterygium, trachoma, and errors of refraction like myopia, hyperopia, and astigmatism as well as other disorders such as cataracts, glaucoma, retinal problems, and eye
This document summarizes several pediatric ocular diseases and their systemic associations. It describes the clinical features and treatments of Alport's syndrome, Alstrom syndrome, CHARGE association syndrome, Stevens-Johnson syndrome, cat scratch disease, herpes simplex virus, rubella, varicella-zoster virus, and references for further information. For each condition, it outlines ocular findings such as lenticonus, flecks, uveitis, conjunctivitis and keratitis as well as associated systemic symptoms and recommended treatment approaches.
This document discusses conjunctivitis, also known as pink eye. It defines conjunctivitis as an inflammation or infection of the conjunctiva, the transparent membrane that lines the eyelids and covers the white part of the eyeball. Conjunctivitis can be caused by viruses, bacteria, allergens, chemicals, or other irritants. Common symptoms include eye redness, discharge, itching, and tearing. Treatment depends on the cause but may involve antibiotic or antiviral eye drops, allergy medication, or simply allowing a viral infection to run its course. Good hygiene practices can help prevent the spread of contagious conjunctivitis.
Atopic keratoconjunctivitis (AKC) is a chronic allergic eye condition that results from atopy, a genetic predisposition to allergic responses. It typically appears during late adolescence/early adulthood and affects the lower eyelids more than the upper eyelids, causing redness, swelling, itching and tearing. If left untreated, it can lead to complications like scarring, cataracts and corneal damage that impair vision. Treatment involves identifying allergens, using antihistamines and mast cell stabilizers, with corticosteroids or immunosuppressants in severe cases. Optometrists can manage mild AKC through lid hygiene, cold compresses, pharmaceuticals and referral
This document discusses ocular allergy, classifying it into different types including seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. It describes symptoms, pathogenesis, clinical features, and treatment options for each type. Seasonal allergic conjunctivitis is caused by seasonal allergens and affects mostly those under 30. Vernal keratoconjunctivitis mostly affects young boys and is associated with atopy in 50% of cases. Atopic keratoconjunctivitis is associated with atopic eczema and strong family history of allergy. Giant
This document summarizes different types of allergic conjunctivitis. It describes a case of a 32-year-old woman presenting with itchy, red eyes and ropy discharge who was diagnosed with acute allergic conjunctivitis. It then discusses the different types of allergic conjunctivitis including simple allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis, and phlyctenular keratoconjunctivitis. For each type, it provides details on symptoms, signs, clinical features, and treatment options.
This document discusses uveitic glaucoma, including:
1. It affects around 10% of patients with uveitis and can occur in various types of uveitis, most commonly anterior uveitis.
2. Elevated intraocular pressure in uveitis can be temporary or long-lasting, causing optic nerve damage described as uveitic glaucoma.
3. Treatment aims to control intraocular inflammation and lower intraocular pressure through medications and surgery if needed. Managing the underlying uveitic condition is also important to control glaucoma.
Allergic conjunctivitis is inflammation of the conjunctiva caused by an allergic reaction. Common allergens that trigger this condition include pollen, perfumes, cosmetics, smoke, and dust mites. There are several types including seasonal allergic conjunctivitis caused by seasonal allergens like pollen, perennial allergic conjunctivitis caused by perennial allergens like dust, and vernal keratoconjunctivitis and atopic keratoconjunctivitis which are chronic forms more common in males. Treatment involves avoiding allergens, using cold compresses, artificial tears, mast cell stabilizers, antihistamines, and topical steroids depending on severity
The document summarizes diseases of the eye. It discusses diseases affecting different parts of the eye, including the orbit, lacrimal apparatus, eyelids, conjunctiva, cornea, sclera, uveal tract, lens, retina, optic nerve and glaucoma. Specific conditions covered include orbital cellulitis, blepharitis, conjunctivitis, trachoma, pterygium, neonatal conjunctivitis and vernal keratoconjunctivitis. Diagnostic features and treatment approaches are provided for many of the discussed diseases.
This document discusses the treatment of allergic eyes. It begins by explaining that allergic conjunctivitis is a very common cause of eye issues in India. It can be acute (seasonal or perennial) or chronic (vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis). The pathophysiology involves mast cell degranulation and inflammatory mediator release causing symptoms like itching. Chronic types involve constant inflammation from eosinophils and cytokines. The document then outlines treatment options for different severity levels based on a grading system from 0-30 of symptoms like itching, discomfort and chemosis. Mild cases use antihistamines, mast cell
This document defines and classifies conjunctivitis, discussing its various causes including viral, bacterial, allergic, and other non-infectious origins. It describes the signs and symptoms, treatment, and when referral is necessary for different types of conjunctivitis such as viral, bacterial, hyperacute, chronic, and allergic conjunctivitis. It also briefly discusses other eye lesions including keratitis, uveitis, episcleritis, scleritis, hordeolum, chalazion, and pterygium.
This document discusses various disorders of the eye and their management. It covers functional disorders like myopia, hyperopia, astigmatism and presbyopia. It also discusses eyelid infections such as blepharitis, hordeolum, chalazion, conjunctivitis, blepharoptosis, entropion and ectropion. Disorders of the cornea and uveal tract including ulceration, corneal abrasion and uveitis are examined. Other disorders mentioned are cataract, glaucoma and ptregium. The document also reviews disorders of the retina like retinal detachment, muscular disorders including strabismus and nystagmus, as well as blindness.
This document discusses various corneal diseases including herpes zoster ophthalmicus, syphilitic interstitial keratitis, acanthamoeba keratitis, onchocerciasis, and xerophthalmia. It describes the mechanisms, risk factors, signs, symptoms, investigations, and treatments for each condition. Key points include that herpes zoster ophthalmicus can cause acute or chronic eye involvement including epithelial keratitis, conjunctivitis, and neurotrophic keratitis. Syphilitic interstitial keratitis presents with limbitis, salmon patch vessels, and scarring. Acanthamoeba keratitis causes pseudodendrites, stromal infiltration,
Allergic Conjunctivitis - Dr Arnav SaroyaDrArnavSaroya
The document discusses ocular allergy and the various types of allergic conjunctivitis, describing their clinical manifestations, pathophysiology, diagnosis, and treatment approaches. The most common types are seasonal allergic conjunctivitis and perennial allergic conjunctivitis, both of which present with itching, tearing, and redness. The treatment involves anti-allergic medications, avoidance of allergens, and occasionally surgery for severe cases.
This document provides information about different types of allergic eye conditions. It discusses the pathophysiology of Type I hypersensitivity reactions and the key cells and mediators involved like mast cells, histamine, leukotrienes. It describes common allergic conjunctivitis conditions like seasonal allergic conjunctivitis and perennial allergic conjunctivitis. It also discusses more severe forms like vernal keratoconjunctivitis and atopic keratoconjunctivitis that can involve the cornea. Giant papillary conjunctivitis caused by contact lens use is also summarized. The document outlines the signs, symptoms and treatment approaches for these different ocular allergy conditions.
This document provides an overview of causes and symptoms of red eye. It discusses various conditions that can cause redness of the eye including conjunctivitis, pterygium, subconjunctival hemorrhage, corneal abrasion, keratitis, iritis, episcleritis, trichiasis, entropion, orbital cellulitis, acute dacryocystitis, hyphaema, and corneal ulcer. Signs and symptoms of red eye such as pain, discharge, photophobia, and visual changes are described for different conditions. Evaluation of red eye involves characterizing symptoms and performing an examination of the conjunctiva, cornea, anterior chamber, eyelids, and orbit.
Red eye can be caused by conditions affecting the conjunctiva, cornea, sclera, anterior chamber, or eyelids. Common causes include conjunctivitis (bacterial, viral, allergic), keratitis (infectious or non-infectious), corneal abrasion or ulcer, subconjunctival hemorrhage, episcleritis, iritis, hyphaema, glaucoma, entropion, ectropion, and orbital cellulitis. A thorough history and physical exam is needed to determine the cause and guide treatment.
Contact Lens Peripheral Ulcer - Case Reportpaymaun19
Contact lens peripheral ulcer (CLPU) is a corneal ulcer that is stimulated from contact lens wear. Despite advancement in contact lens properties, patients are still at risk of developing contact lens-related complications. Even for the most hygienic and compliant contact lens patients, complications can still occur. Although the nature of CLPU is typically not sight-threatening, understanding the pathophysiology of CLPU is important and requires immediate management and monitoring. This case will outline a discussion involving the treatment and management for contact lens peripheral ulcer (CLPU).
This document presents a case study of a 10-year-old male student presenting with redness and itching in both eyes for 15 days. On examination, the patient was found to have mild eyelid edema, conjunctival congestion and papillae in both eyes. Based on the signs and symptoms, the patient was diagnosed with vernal keratoconjunctivitis (VKC). Treatment included topical medications which improved the symptoms over subsequent follow-ups. The document concludes with a discussion of VKC including its prevalence, symptoms, signs, classification, treatment options and management.
This document presents a case study of a 10-year-old male student presenting with redness and itching in both eyes for 15 days. On examination, the patient was found to have mild eyelid edema, conjunctival congestion and papillae in both eyes. Based on the signs and symptoms, the patient was diagnosed with vernal keratoconjunctivitis (VKC). Treatment included topical medications which improved the symptoms over subsequent follow-ups. The document concludes with a discussion of VKC including its prevalence, symptoms, signs, classification, treatment options and management.
This document discusses conjunctival disorders and conjunctivitis. It begins by defining the conjunctiva and its functions. Common symptoms of conjunctival problems include redness, irritation, tearing, itching and pain. Assessment of the conjunctiva involves visual examination of redness, discharge, papillae and follicles. Conjunctivitis is inflammation of the conjunctiva and can be caused by bacterial, viral, allergic or other inflammatory processes. Common types discussed are acute bacterial conjunctivitis, viral follicular conjunctivitis and pharyngio-conjunctival fever caused by adenovirus. Treatment depends on cause but may include antibiotics, cold compresses and artificial tears.
This document discusses conjunctival disorders and conjunctivitis. It begins by defining the conjunctiva and its functions. Common symptoms of conjunctival problems include redness, irritation, tearing, itching and pain. Assessment of the conjunctiva involves visual examination of redness, discharge, papillae and follicles. Conjunctivitis is inflammation of the conjunctiva and can be caused by bacterial, viral, allergic or other inflammatory processes. Common types discussed are acute bacterial conjunctivitis, viral follicular conjunctivitis and pharyngio-conjunctival fever caused by adenovirus. Treatment depends on cause but may include antibiotics, cold compresses and artificial tears.
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2. Category Question for patients
Ocular symptoms What are your symptoms? How severe are they?
Are your eyes itchy? Do they burn? sting? Are they painful?
Is there discharge from your eyes? If so, is it watery or mucoid?
Does it feel like there is a foreign body in your eyes?
Do you rub your eyes?
Are your eyes dry?
When did your symptoms start?
What is your worst season, if any?
Have you had any previous episodes?
Are your symptoms in one eye or both?
Are there any exacerbating or relieving factors?
Is your vision affected?
Are you sensitive to lights?
Do you wear contact lenses? Are they comfortable?
Is there any history of trauma to your eyes?
Health history Is there associated atopy? Or a family history of atopy?
Is there a diagnosis of ADHD?
Are you on any medications?
Are there any other past medical and surgical concerns (tonsillectomy, sinus surgery)?
Exposures/Environment Do you live with pets?
Is the home carpeted? Forced-air heating? Air conditioning? Humidity level?
Is there exposure to smoke (first- or second-hand)?
Have there been any new exposures (e.g., new pet, renovations, new personal or home hygiene products)?
Are there any potential occupational exposures?
Infectious contacts (possibility of infectious cause of red eye)?
Treatment HaveOTC topical products been used? If so, which product(s)?
HaveOTC oral agents been used? If so, which product(s)?
Have prescription medications, including immunotherapy, been tried?
How often were the therapies used and for how long?
Has there been any relief of symptoms?
Quality of Life Are the symptoms interfering with school/work, activities of daily living or sleep?
Has school/work been missed due to symptoms?
4. INTRODUCTION
■ Ocular allergy – an inflammatory response of the
conjunctival mucosa, that also affects cornea & eye lids
■ In recent years advancement in the understanding &
pathophysiology of ocular allergies has paved way for
the development of newer drug candidates
5. EPIDEMIOLOGY
The diagnosis of allergic conjunctivitis is on the
increase
SAC (Seasonal AC) & PAC (Perennial AC) –15-20 % of
cases of allergic conjunctivitis
VKC – reported from many Asian countries e.g. Nepal,
Pakistan & India
VKC & AKC may cause corneal & ocular surface
involvement leading to severe visual loss
04
03
02
01
9. PATHOPHYSIOLOGY
Conjunctiva – vascularized
tissue consisting of
dendritic cells &
macrophages
Most common
site of allergic
reactions
TYPE I HYPERSENSITIVITY REACTION
TYPE IV HYPERSENSITIVITY
REACTION
SAC &
PAC
VKC
+ AKC
16. SAC
01
Common among all ages accounting for more than
half the cases of AC
02
Occurs seasonally when pollen is released in
May & June
03 Itching followed by watering is seen
04
Sometimes associated with allergic rhinitis
or rhino conjunctivitis
17. PAC
Corneal
involvement in
SAC and PAC is rare
Itching, redness &
conjunctival swelling
Similar signs
& symptoms to SAC
Allergy to
animal dander,
feathers, mites
Frequency
of occurrence
increases as the age
increases
As the name
suggests it occurs
throughout the
year
18. 01 Skin Prick test 04 Nonspecific provocation test
02 Patch test 05 Tear film evaluations
03 Conjunctival provocation test 06
Ocular surface staining
procedures
EVALUATION & DIAGNOSTIC
TESTS
21. VKC
Warm tropical
climates
Limbal form in Africans
Boys affected
3.2:1
50% patients
have other
atopic
manifestations
50% family h/o
Atopy
<10 years,
outgrow the disease
after puberty
25. SHIELD ULCER
01
02
03
Grade I ulcer having a transparent base
Grade II – with a translucent base or with white /yellowish
deposits
Grade III – elevated plaque which is above the level of the adjacent
normal epithelium
Chronic VKC – limbal stem cell deficiency leading to corneal vascularization, pannus
formation, poor ocular surface & persistent epithelial defects
29. Right and left eyes with
periocular eczema and corneal
haze. C and D: Right and left
eyes with progression of the
disease; dense pannus
entering visual axis. E:
symblepharon. F: posterior
subcapsular cataract, which
can be associated with atopic
keratoconjunctivitis.
AKC
31. GPC
Preservatives
in medicine
Drug induced
Trauma to upper tarsal
conjunctiva by CL,
ocular prosthesis
or sutures
Toxic allergic
reactions
Giant Papillae
formation
Removal of
external agents
reduce papillae
34. CONTACT
HYPERSENSITIVITY
01
02
03
The pattern of involvement depends upon severity of the reaction &
the site of contacts
Patients may have lid swelling, redness, chemosis, follicular reaction
& later sometimes cicatrization
corneal involvement – superficial punctate keratitis, pseudodendrites
or grayish stromal infiltrates
37. AC is not a single disease &
is not exclusive of
conditions such as tear film
dysfunction
1. SAC & PAC are the
most common allergic
disorders
2. Accurate clinical
history & evaluation of
signs and symptoms
3.
IgE-mediated hypersensitivity &
mast cell degranulation are the
initial pathophysiological
mechanisms
4.
Identification of
specific sensitizing
allergens is useful for
avoidance
5. Prick test is the
primary recommended
allergy test
6.
The cornea may be involved
in VKC, AKC, or contact
blepharo-conjunctivitis but
not in SAC or PAC
7.
AC can occur even if skin
prick test is negative or
IgE is negative 8. Conjunctival allergen
provocation can prove
local hypersensitivity
9.
DIAGNOSIS – SUMMARY
40. ALLERGEN AVOIDANCE
1ST LINE
APPROACH –
ACCOMPANY MEDICAL MANAGEMENT
Complete allergen
avoidance
CL associated, CL solution,
switch to disposalble
Punctal occlusion
mechanical barrier gels
In all types of conjunctivitis
In GPC
Allergic rhino conjunctivitis.
41. NON PHARMACOLOGIC
TREATMENTS
NON PHARMACOLOGIC
TREATMENTS
Cold compress, Saline
Cold artificial tears &
ointments
Probiotics
Prostaglandin D2
receptor anrtagonist
Useful, as they help allevate the symptoms
– acute AC
Dilution of allergens
Clinical trails – Rhino conjunctivitis
Clinical trials – Rhino conjunctivitis
42. Drug MOA Effects Approved for Side effects Contraindications
Vasoconstrictors &
Decongestants
Alpha
adrenergic
(alpha 1)
Immediate
vasoconstriction
Conjunctival
hyperemia
Rebound
hyperemia,
follicular
reaction,
mydriasis,
blepharitis,
conjunctivitis
Narrow angle
glaucoma, MAO
inhibitors, Children
under 14
1
Naphazoline/Oxymetazoline/Xylometazoline
1. Over the counter medications
2. Inappropriate use by patients
3. Used in cases of episodic itching
4. Short duration with many side
effects
1. Seldom indicated
in our practice
2. Sparingly used
for short term
solution
43. Drug MOA Effects Approved for Side effects Contraindications
Antihistamine
s
H1
antagonist
Antagonize
venular
permeability &
chemotaxis of
lymphocytes &
eosinophils
Early phase
symptomatology
First generation
crosses BBB,
sedation,
possible
stinging,
keratitis
Nil
2
Emedastine/Levocabastine/Epinastine
1. Most preferred option for treatment
2. Relief of itching & redness
3. Most effective in acute phase
4. Rarely sufficient as monotherapy
1. Antazoline &
Pheneramine –
1st generation
2. Available in
combination with
Naphazoline
44. Drug MOA Effects Approved for Side effects Contraindications
Mast cell
stabilizers
Inhibit mast
cell
degranulation
5-14 days
onset of
action
Prevents release of
histamine & other
preformed
mediators
Prophylaxis Headaches,
Burning,
Irritation
Nil
3
Cromolyn Sodium/Permirolast Pottasium/Lodoxamide/Nedocromil Sodium
1. Takes several weeks to attain max
efficacy
2. Do not relieve existing symptoms
3. Not effective on mediators once its
released
1. Not useful for acute symptoms
2. Dosing 3-4 times a day may limit
patient compliance
3. Combination with steroid/oral
antihistamine – more potent
45. Drug MOA Effects Approved for Side effects Contraindications
Dual activity
agents
H1
antagonist +
Inhibit mast
cell
degranulation
Histamine
inhibition and
prevention of
release
Itch
Olapatadine
approved for all
signs & symptoms
Nil Children under 3
years of age
4
Ketotifen/Olapatadine/Bepostatine/Alcaftidine/Azelastine
1. 1st line agents & most commonly
prescribed
2. Provide rapid symptom relief as well
as tolerability
3. Act in early & late phase reaction
1. Once daily administration for
Olapatadine & Alcaftadine
2. Improving patient compliance
3. Combination with steroid can
be done if severe symptoms
46.
47. Drug MOA Effects Approved for Side effects Contraindications
Topical
NSAIDs
Cyclooxygenase
inhibition
interrupting
prostaglandin
formation
Pain
Short term use
only
Stinging,
Keratitis,
Ocular
hypertension
Asthma, Nasal
polyps
5
Ketorolac/Flurbiprofen/Nepafenac
1. Temporary reduction of severe
symptoms of discomfort
2. Not often used in AC
3. Useful when symptoms continue to
be inadequately controlled
1. Can also be used if
prescription of steroid not
optimal for a patient
48. Drug MOA Effects Approved for Side effects Contraindications
Topical
Corticosteroids
Block
phospholipase
A2, inhibits
proliferation of
mast cells,
reduces
histamine,
inhibits T-cell
activation
Prevention of
prostaglandin
and leukotriene
synthesis,
reduced
permeability of
vascular walls
All signs and
symptoms
Short term use only
Cataracts, ocular
hypertension,
delayed healing,
infection,
immunosuppressi
on
General
contraindications for
corticosteroids
6
Prednisolone/Dexamethasone/Fluromethalone/Loteprednol
1. Preferable to use low strength steroids
2. 2 treatment types – Pulsed or Prolonged
3. Pulse – 3-4 drops/day for 3-5 days - AKC &
VKC
4. Prolonged – 3-4 drops per day for 1-3 weeks
then taper – chronic disease
1. PAC & SAC rarely require
steroids
2. Loteprednol – metabolized
efficiently – ocular surface
inflammation
3. Used in seasonal AC
50. IMMUNOMODULATORS
CYCLOSPORINE
• T cell & mast cell inhibitor effective
in controlling ocular inflammation
by blocking Th2 lymphocyte
proliferation & IL2 production
• Also inhibits histamine release
from mast cell & basophils & by
reducing IL5 production
• Concentration: 0.05-2%
• GPC, VKC, AKC
TACROLIMUS
• Similar/Superior effectivity as
compared to cyclosporine
• Ointment preparation
• Concentration: 0.03-0.1%
• Used when unresponsive to
cyclosporine
• Lid Eczema in AKC
• Severe AKC & VKC
Calcineurin inhibitors
Side effects – stinging/burning sensation & the possibility of molluscum contagiosum virus, papillomavirus, or
herpesvirus infection
51.
52. ORAL ANTIHISTAMINES
2nd generation considered
2nd generation does not cross
BBB
Slower onset of action, not
much effective in VKC
Associated with drying of
mucosal membranes &
reduced tear production
LEUKOTRINE ANTAGONISTS
Decreases symptoms of PAC
& SAC
Not as effective as oral
antihistamines
Combination therapy can be
used
Cetrizine,
Fexofenadine,Azelastine
01.
03.
04.
01.
02.
03.
05.
ORAL MEDICATIONS
02.
53. IMMUNOTHERAPY
01 Goal – to diminish symptoms of rhinitis & conjunctivitis
triggered by known allergens & to prevent recurrence
02
03
04
Administering gradually increasing amounts of the allergen to induce
an immunological tolerance
Allergen administered subcutaneously (SCIT) – Induction phase &
maintenance phase
Considered in Allergic conjunctivitis IgE & non IgE mediated
54. BIOLOGICALS
01 Goal – Binding to specific biological molecules thereby
blocking inflammatory pathway
02
03
04
Clinical trials on Omalizumab for asthma & Dupilumab
for dermatitis inVKC
Not yet approved for allergic conjunctivitis
Insunakinra – IL1 receptor antagonist, documented to diminish
ocular surface symptoms
56. SURGERY
Conjunctival resection
with bulbar conjunctival
autograft or amniotic
membrane graft inVKC
Superficial keratectomy
for shield ulcer inVKC
Complex surgery in AKC,
of lids, ocular surface and
Boston K-PRO
57. SPECIAL CONSIDERATIONS
ELDERLY ATHLETES PREGNANCY
• Similar causes as in other age
groups
• Age related changes
• Oral antihistamines closely
monitored
• Tear film dysfunction to be
considered
• Athletic performance can be
affected
• Appropriate management of
symptoms with safe, effective
medications is needed
• Ability to compete should not
be affected
• Limited data that ocular
medications are found in
breast milk
• Oral decongestants are
avoided
• Cromolyn Na is safe
• Intranasal steroids safe &
effective
58. OTHER CONSIDERATIONS
CONTACT LENSES OCULAR SURFACE
• Avoided in patients with
seasonal allergy
• Bandage contact lenses can be
used
• Daily disposable lenses better
than Extended wear in AC
• Soft silicone with
increased gas permeability
contact lenses have a higher
satisfaction of comfort (56%) than
RGP lenses (14%), with 63% of
Non atopic & 47% of atopic
subjects describing their lenses as
very comfortable to wear
• Recommendation is for 1 drop at a time,
with closure of the eyelids for a few
seconds after drug instillation
• When multiple eye drops are to be used,
allow time between individual
medications (3-5 minutes) to permit
proper absorption of the medication into
the ocular tissue and to prevent washout
59. TREATMENT SUMMARY
Identification & avoidance of
irritants and sensitizing agents
is the most effective way to
prevent ocular allergy
Cold compresses & refrigerated
topical medications
Lubricants help to remove &
dilute allergens that come in
contact with the ocular surface
Oral 2nd gen antihistamines
preferred over 1st gen
In cases of dry eye oral
antihistamines are to be
discontinued
Topical antihistamines are
effective in the treatment of
AC
Topical decongestants should
not be used long term because
of a potential “paradoxical
effect.”
Topical cromolyn Na has
been the prototypic
compound among mast cell
stabilizer
60. TREATMENT SUMMARY
Topical dual or multiple actions
newer drugs are widely &
effectively used
Topical NSAIDs, although
effective in treating ocular
allergy, may cause ocular &
systemic side effects
Topical steroids should be
restricted to brief courses for
the most severe forms of ocular
allergies
Topical cyclosporin A & other
immunomodulators used in
severe chronic disease
Allergen immunotherapy
should be considered for
patients with AC & AR
Safety profile of drugs
considered during
pregnancy
Evidence accumulated that
intranasal corticosteroids
reduce ocular symptoms
associated with allergic rhinitis
Stepwise approach utilized
for treatment of AC
ADHD-allergic decongestants should NOT be taken alongside prescription medications for ADHD.
ANTIHISTAMINES increase ADHD symptoms in children with ATOPIC DERMATITIS
Treating allergies can improve their ability to finish their work and concentrate .
Attention deficit hyperactivity disorder
Immunopriviledged means ability to tolerate introuduction of antigens without eliciting inflammatory immune response
Eg of immunoprivilidged organs eyes,placenta,foetus,CNS,
Role of mast cell and T lymphocyte in allergic conjunctivitis
Pain if corneal involvement,
Mediterranean, the Middle East, Central and West Africa, South America, and Asian countries, such as Japan, Thailand, and India
Other atopic manifestations such as allergic rhinitris and asthma
Skin prick test- Epicutaneous tests (“prick,” intradermal) (SPT) remain the most simple, rapid, and inexpensive procedure for the diagnosis of allergen sensitivity in patients with ocular allergy. Skin tests provide evidence of specific sensitivity to external environmental allergens within 20 minutes after placement on the skin. A positive wheal-and-flare reaction reinforces the concept of specific allergen sensitization to the patient. The test is highly sensitive for systemic allergies, such as allergic rhinitis and allergic asthma, but it does not always correlate with allergic sensitization of the ocular surface.
PATCH TEST: presence of eczematous blepharitis or blepharo-conjunctivitis may suggest the possibility of a delayed-type reaction, and patch testing may be necessary to delineate the specific antigen. This involves applying a series of potential chemical sensitizers in aluminum or cellulose disks to the skin of the back; these are removed after 48 hours and the patches examined at multiple time points. Benzalkonium chloride and thimerosal, preservatives present in ophthalmic and contact lens solutions, are common culprits. Periorbital skin is quite different from other sites such as that of the back, not only for the depth of epithelial and dermal layers, but also for the limited number of mast cells present and for its limited exposure to the external environment compared with the eyelid. For example, possibly sun exposure exacerbates specific and nonspecific hyperreactivity reactions only on the lid skin.
Conjunctival provocation test :can be likened to “skin testing” of the eye, because known quantities of specific allergen are instilled onto the ocular surface, and the resulting allergic response is measured at 15 to 30 minutes, similar to skin testing. Mediator release and cellular infiltration are relatively easily measured in tear samples. This technique is primarily used in the assessment of new drugs for ocular allergies, but it can sometimes be used to define suspected sensitizing allergens that appear to be limited to the ocular surface.26
,27
The immediate positive response is characterized by the same signs (redness, chemosis, and lid swelling) and symptoms (itching and tearing) as those the patients experience after natural exposure to the antigen. The positive reaction usually subsides gradually, within 20 minutes. A late-phase inflammatory reaction also may occur, depending on allergen dose and patient sensitivity. The CPT is a safe and simple procedure that provides valuable clinical information with limited systemic side effects (generalized itching, bronchospasm, anaphylaxis) that are rarely seen.
Nonspecific provocation test: Ocular challenge with histamine or hyperosmolar solutions has been used to verify a nonspecific hyperresponsiveness of the conjunctiva in allergic patients.29
Vernal keratoconjunctivitis patients were shown to respond with lower concentrations of histamine, although this remains experimental at this point
Tear film evaluations:Measurement of total IgE in tears
Normal values of IgE in tears are normally very low, less than 2.5 kUI/L (3 ng/mL), because of the blood–tear barrier. Detectable tear IgE levels indicate local production of antibodies and suggest a diagnosis of allergic conjunctivitis.
Tear osmolarity
Tear osmolarity should be evaluated for supporting the diagnosis of tear film dysfunction (previously known as dry eye syndrome).31
,32
Hyperosmolarity suggests a form of dry eye.
Schirmer test
The Schirmer tear test is the most commonly used and easily performed test for tear production by the lacrimal gland in the evaluation of dry eye. The Schirmer I test (without anesthesia) measures both basal and reflex tearing (abnormal, ≤5 mm of wetting after 5 minutes). The Schirmer II test (with anesthesia) measures only the basal secretion of tearing (abnormal, ≤3 mm of wetting after a 5-minute interval)
Ocular surface staining procedures :
Fluorescein
Fluorescein is a water-soluble dye used to examine the cornea, conjunctiva, and the precorneal tear film by staining denuded areas of corneal epithelium and pooling into surface irregularities
Mediterranean, the Middle East, Central and West Africa, South America, and Asian countries, such as Japan, Thailand, and India
Other atopic manifestations such as allergic rhinitris and asthma
KC is named as such because severe symptoms most commonly occur in the spring (hence "vernal")
Bilateral disease
ROPY DISCHARGE
Subepithelial fibrosis resulting from papillae hypertrophy can cause increased eyelid thickening and ptosis. Thick, ropy mucus secretions are usually present and associated with tarsal papillae. The skin or lid margins are rarely involved, and the cornea is also typically not involved.
These dots are seen when the disease is active and indicate severity of the disease
Corneal involvement in VKC may occur as corneal epithelial punctate keratitis, and where the epithelial erosions may coalesce and form a vernal or Shield ulcer.(TOGBYS ULCER)
Presence of shield ulcer will worsen patients symptoms and affect vision .
These ulcers are oval and usually present in the upper part of cornea
The shield ulcers are classified based on the presence of white material at the base of the ulcer
Turkish journal pic
to drugs as neomycin,atropine,epinephrine
Toxic allergic reactions may also be due or preservatives in medicines such as thiomersol.
The corneal involvement may be in the form of superficial punctate keratitis, pseudodendrites or grayish stromal infiltrates
Poor compliance to treatment on the part of the patient or inadequate control of disease when it presents in its severe form
Common complications -
Dry eye, infection and corneal scar
Chronicity of untreated disease may lead to vision threatening problems like limbal stem cell deficiency(LSCD) and secondary keratoconus due to rubbing of eyes
Steroid induced raised IOP and cataract have been reported in these patients
3. Accurate clinical history & evaluation of signs and symptoms allow the diagnosis of ocular allergy & the definition of possible sensitizing antigens
Patients often self-medicate with purchased over-the-counter (OTC) medications and fail to seek help even when those therapies are ineffective [22, 23]. In one study, 56% of patients diagnosed with AC started with self-treatment measures as first action. Washing the eyes with water or saline were the most commonly chosen therapies [23]. Many OTC drugs have limited efficacy for AC (e.g., topical vasoconstrictors) and can lead to undesirable side effects (e.g., rebound vasodilation from topical vasoconstrictors; mucosal dryness or drowsiness from oral antihistamines).
Cold compresses, saline, and cold artificial tears or ointments are useful because they alleviate the symptoms and dilute the allergen, especially in acute allergic conjunctivitis.6,7,9 Recent studies demonstrate the additive effect on the pharmacology of topical agents when combined with cold compresses and artificial tears.7 Other treatments such as ingestion of probiotics like mandarin orange yogurt or antagonists of the prostaglandin D2 receptor 2 have shown promising results in clinical trials, decreasing the symptoms of patients with rhino-conjunctivitis.
They have a rapid onset of action and may be used in cases of episodic itching and redness but have a potential for inappropriate use by patients.6 They have a short duration and have many side effects such as tachyphylaxis, ocular irritation, and hypersensitivity.6,7 In our practice they are seldom indicated, should be used sparingly, and only as a short-term solution.
Available either alone or in conjunction with antihistamine
Short term relief of vascular injection and redness
Problem of REBOUND INJECTION on stoppage
Not effective against AKC & VKC
topical antihistamines have no effect on other mediators of the allergic response like leukotrienes and prostaglandins. Therefore, they are best used in the acute phase reaction and are rarely sufficient as monotherapy.
Other antihistamines such as cetirizine eye drops are available in the U.S. only. As a rule, topical antihistamines have been usurped by the topical dual-activity agents.
Permirolast Potassium 0.1%(Alamast) Pemirolast potassium is a more potent mast cell stabilizer than cromolyn sodium and tranilast. It acts by inhibiting type-1 immediate hypersensitivity reaction. Pemirolast inhibits eosinophil chemotaxis and blocks the antigen induced release of inflammatory agents such as histamine, leukotrienes C4, D4 and E4.it blocks Ag mediated calcium ion influx into mast cells.
topical dual-activity agents are generally clinically superior due to both symptom/sign relief and tolerability
Ketotifen, Olopatidine,Bepotastine and Alcaftidine have a dual action of antihistaminic effect and prevention of mast cell degranulation
These dual action topical agents act during both ocular early and late phase reactions providing rapid and sustained relief
In addition, alcaftadine and olopatadine eye drops are approved for once daily administration which may improve patients compliance
Anti-inflammatory ophthalmic solutions are not often used in AC, but may be useful when symptoms continue to be inadequately controlled despite the use of dual-activity agents or when the prescription of a steroid is not optimal for a particular patient. By blocking the cyclooxygenase pathway, these agents inhibit production of prostaglandins, one of the newly formed mediators of inflammation in IgE mediated allergic responses
LOTEPREDNOL ETABONATE –
ester-based steroid
rapidly metabolized on entering AC
Extremely useful in treating ocular surface inflammation
This steroid is metabolized more efficiently therefore reducing the risk of adverse side effects [63]. The 0.2% concentration of loteprednol etabonate is indicated for the treatment of seasonal AC. Only 1% of patients showed a significant IOP rise of ≥ 10 mmHg with this concentration, and its long-term use did not correlate with cataract development
These agents need to be used under close supervision owing to the chance of secondary glaucoma, cataract and secondary infections
Shield ulcers esp those who are opaque base respond well to corticosteroids and mechanical debridement
Side effects usually with tacrolimus
This side effect can usually be countered with the liberal application of artificial tears. Cetirizine causes sedation in a subset of patients, despite its categorization as nonsedating.
Changes involve downregulation of Th2 response and upregulation of regulatory T-cells.5 It is carried out by administering gradually increasing amounts of the allergen to induce an immunological tolerance
it is indicated in patients with a documented IgE-mediated hypersensitivity to airborne agents, with severe forms of rhinoconjunctivitis that affect their quality of life in spite of allergen avoidance and pharmacotherapy
biological treatments could have superior results because they block the underlying inflammation pathways by bonding with specific biological molecules, whereas the above-mentioned treatments use unspecific ways of decreasing conjunctival inflammation
Omalizumab shows generally good results, though it has not yet been approved for allergic conjunctivitis, while dupilumab may increase the risk of blepharoconjunctivitis, which is tacrolimus-responsive in patients with severe atopic disease or previous AKC
Oral decongestants should be
avoided during the first trimester. Sodium cromolyn is a safe
treatment for allergic rhino-conjunctivitis during pregnancy.
Intranasal corticosteroids may be used in the treatment of nasal
symptoms during pregnancy because of their safety and efficacy
profile, and they have a potential positive impact on ocular allergy.
1-day disposable lenses may be an effective strategy for managing
OA in contact lens wearers