L6 Conjunctival Allergies

Jessica

allergic conjunctivitis is type ___ immediate hypersensitivity reaction mediated by ____ mast cell activation

1, IgE

allergic conjunctivitis can be stimulated by direct exposure to _____ allergen

environmental

when histamine is released, where does it bind to ?

H1 receptors

t/f allergic conjunctivitis can be of family hx of atopy or genetic predisposition to allergic reaction

true

seasonal allergic conjunctivitis (SAC) is related to ..

seasonally circulating antigens

_______ allergic conjunctivitis persists throughout the year with some seasonal worsening. typical allergens consists of house dust mites, animal dander, mold spores, roaches, and rodents

perennial

what are 3 symptoms of seasonal/ perennial acute allergic conjunctivitis

itching, burning, water or mucoid

a patient comes in with complaining burning, itchy, watery eyes. you ask about any allergies. they mention they have allergies. with that in mind you look at bio microscopy. you see mild to moderate injection, chemosis, lid edema, and superior tarsal papillae. you diagnose it as allergic or perennial conjunctivitis. what is the 3 tx options

1. histamine blocker

2. mast cell stabilizer

3. vasoconstricters

what is vernal keratoconjunctivitis

chronic, bilateral, conjunctival inflammatory condition usually with seasonal recurrence

who does vernal keratoconjunctivitis affect the most or susceptible to (3)

those under 10 lasting 2-10 yrs

younger males in hot dry climates

family history of atopy

what are symptoms of vernal keratoconjunctivitis (4)

itching, redness, tearing, photophobia

FBS, ptosis, mucoid discharge, & blepharospasm are sx of

vernal keratoconjunctivitis

vernal keratoconjunctivitis has its signs confined to ____ and ____

conjunctiva and cornea

vernal keratoconjunctivitis has a _____ papillary response seen on ____ or upper tarsus

cobblestone, limbus

vernal keratoconjunctivitis (cobblestone papillae in picture)

T/F: vernal keratoconjunctivitis can have signs also like horner-trantas, thick ropy mucous, shield ulcer and pseudogerontoxon

true

horner trantas dots

horner trantas dots is a collection of ____ and ____ cells in the superior limbus or cornea

eosinophils and epithelial

you would diagnose VKC based on ____ and _____

hx and clinical exam

VKC has differentials such as ___ & ___

SAC and PAC

to avoid VKC its best to pretreat ____ weeks before allergy season

2-3

living in a cool drying environment as well as topical antihistimines/mast cell stabiliser for allergic conj is tx for

VKC

what is tx for severe VKC with dosing

short term high dose pulsed steroids

dexamethosone 0.1% or

prednisolone phosphate 1% or

difluprednate 0.05% 8x/daily x 1 week and then taper

if the pt has shield ulcer what is the tx

topical steroid

loteprednol 0.5% or pred acetate 1% or dexamthosone 0.1% 4-6 daily

topical antibiotic drop (polytrim qid) or ointment; ethryomycin qid, polysporin

cycloplegic agent--> cyclopentolate 1% tid

what is the manage for shield ulcer

follow up 1-3 days

what is management for VKC

taper steroids & monitor IOP

continue topical anti allergy drops through allergy season

_____ ____ is bilateral chronic inflammation of conjunctiva and lids

atopic keratoconjunctivitis

Atopic keratoconjunctivitis is susceptible in

20-50 yos

no racial or geographic predilectoin

how does atopic keratoconjunctivitis affect people

type I and type IV hypersensitivity

some sx of atopic keratoconjunctivitis is (7)

itching, watering, mucous discharge, redness, blurriness, photophobia, and pain

a 27 yo patient comes to you complaining about pain, light sensitivity, and reduced vision. this patient mentions they have allergies. in bio microscopy you see cicatricial ectropion, MG inflammation, papillae in the inferior fornix, and some corneal punctate epithelial keratopathy. what is the diagnoses of this pt

atopic keratoconjunctivitis

how does atopic keratoconjunctivitis manifest on the skin

flaking & dermatitis leading to cicatricial ectotropion and lagopthalmos

how does atopic keratoconjunctivitis affect the lash and lid margins

madarosis, MG inflammation, keratinazation, and punctal ectropion

how does atopic keratoconjunctivitis present

papillae in the inferior fornix, pale white edema, subepithelial fibrosis, fornix foreshortening, symblepharon, limbal gelatinous hyperplasia, may have horner trantas

how does atopic keratoconjunctivitis affect the cornea

punctate epithelial keratopathy, persisten epi defects, scarring, ulceration & neo

can be associated with keratoconus

atopic keratoconjunctivitis

atopic keratoconjunctivitis is diagnosed based on (3)

hx and clinical exam

fam hx of atopy

past hx and current eczema

what is the conservative tx for atopic keratoconjunctivitis

year round mast cell stabilizer if perrenial

topical steroids 8x/daily for 7-10 days and topical tacrolimus ointment 0.03-0.1% qhs/bid or topical steroid fluormetholone 0.1% qid to skin for 1-2 is tx for

atopic keratoconjunctivitis

______ ____ ___ is noninfectious inflammatory disorder involving superior tarsal conjunctiva

giant papillary conjunctivitis

is GPC associated with CL wearers?

yes

GPC can be from (2)

mechanical trauma & immune response to antigens

GPC sx (early)

irriation and mild itching

GPC sx (late)

lens surface debri, mucus in medial canthus, persisten FBS, itching w/o CL

signs of GPC early

mild hyperemia of upper tarsal conj and conj thickening... small mucous strands

late signs of GPC

conj thicken and opacification, ropy white strands, giant papillae

GPC tx (3)

mod. to CL wear or care

med. tx for allergic conj

topical steroid then taper

for GPC you should follow up in __-__ weeks

2-4

differential ddx of GPC (2)

VKC and AKC

_____ ___ is contact allergy of eyelids and conj

allergic dermatoconjunctivitis

allergic dermatoconjunctivitis is type ____ hypersensitivity

IV

eyedrops, costmetics, plastics, animal or vegetable products, and industrial chemicals all cause ___ ___

allergic dermatoconjunctivitis

which type of eyedrops cause allergic dermatoconjunctivitis (5)

neomycin, gentamicin, atropine, penicillin, thimerosal

allergic dermatoconjunctivitis

allergic dermatoconjunctivitis sx include (3)

severe itching, mucoid or mucopurulent discharge, lid swelling

a patient comes in complaining of swollen lids and really bad itching. at a closer look, you notice corneal erosions, keratinization of the lids, inferior papillae palpebral conj. what is your diagnosis

allergic dermatoconjunctivitis

the signs of ___ ___ include

papillae worse in inferior palpebral conj

ecsematous dermatitis of lower lid and lateral canthi

keratinization of lid

punctal edema and stenosis

and for the cornea: punctate epithelial keratitis, eriosions

allergic dermatoconjunctivitis

what is tx options for allergic dermatoconjunctivitis

conservative and medical tx of allergic conj

topical steroid

conservative tx for allergic conjunctivitis (3)

avoid allergen, artificial tears, no eye rubbing

medication options for allergic dermatoconjunctivitis (3)

histamine blockers, mast cell stabilizer, vasoconstrictor

why is vasoconstrictor an option of allergic conjunctivitis

a- agonists may be used to reduce redness

why is NSAIDs an option of allergic conjunctivitis

keterolac (pain??)

t/f steroid use for allergic conjunctivitis used short term due to potential for long term ses

true

___ ____ ____ is not allergic/immunologic conjunctivitis. its inflammation of the conjunctival epithelium due to self induced mechanical trauma

mucous fishing syndrome

mucous fishing syndrome is secondary to ____ ___ such as keratoconjunctivitis sicca, allergic conjunctivitis, bacterial conjunctivitis and blepharitis

ocular irriation

repeated mechanical removal of mucous from the conjunctiva leads to

papillary conjunctivitis which leads to more mucous production continuing the cycle of mucous fishing syndrome

mechanical stimulation of goblet cells increases the mucous production is the pathophysiology of

mucous fishing syndrome

mucous fishing syndrome has (4) sx

redness, FB sensation, epiphora, excess mucous

what is the tx for mucous fishing syndrome (2)

tx underlying cause and stop digital manipulation