Allergic Conjunctivitis - Bansal

whats teh first thing you think ab w allergic conjunctivitis

itching

what are the 3 types of allergic conjunctivitis

1. vernal

2. atopic

3. seasonal perennial

define allergy

A type of hypersensitivity reaction in which the immune system will overreact to normally harmless substances

seasonal allergic conjunctivitis

1. OUTDOOR env

   1. pollen

   2. tend to peak in the spring and summer of ea year

Perennial allergic Conjunctivitis

INDOOR allergens

• dust mites, pet or pest dander, feathers, fungi, and mold

seasonal/perenial conj pathophys

1. Type I Hypersensitivity rxn

   1. • After exposure- IgE forms in the body and binds to Mast Cells - these release histamine

   2. • Wait for activation when in contact with allergen present

the more you rub the more histamine you release

signs/symptoms of Seasonal/Perennial Conjunctivitis

1. • Generally Bilateral

2. • Itching - esp in medial canthus, redness, clear watery discharge, puffy eye lids,

1. inferior papillae

antihistamines/mast cell stabilizers moa

- inhibits histamine receptor and stabilizes mast cells

how do we treat seasonal/perennial conj

• Pataday 0.7% 1 gtt once a day

• Oral- Non sedating antihistamines such as Zyrtec, Claritin and Allegra

why do we use something cold w Seasonal/Perennial Conjunctivitis

slows the blood down

• so use a refridgerated artificial tear along w antihistamine

what do we use to treat severe Seasonal/Perennial Conjunctivitis

Add Loteprednol 0.2% QID x 1-2 weeks with taper after

• SHOULD monitor IOP to rule out steroid response

• MOA- binds to glucocorticoid receptors suppressing release of inflammatory mediators

whats the eye side effect w a steroid

inc IOP

if you catch a pt w a inc pressure from steroid …

they have over a 90% chance of getting primary open angle glaucoma

Vernal Keratoconjunctivitis epi

1. Generally, begin before the age of 10 and last 2-10 years

2. - resolves during puberty.

   1. usually affects more young males

3. SEASONAL

symptoms of Vernal Keratoconjunctivitis

Severe itching, redness, tearing, and photophobia

signs of Vernal Keratoconjunctivitis

1. thick ROPY mucous discharge

2. large papillary reaction = cobblestone

3. shield ulcer (convex)- epi erosion formed from superior tarsal inflammation

   1. if not reated will form a plaque fibrin and mucus

   2. you got to debride this

      1. shield ulcer blocks wound form healing

4. trantas dots - accumulated eosiniophil and epithelium toward the limbus

what this

trantas dots

1. accumulated eosiniophil and epithelium toward the limbus

whats pathaneumonic for Vernal Keratoconjunctivitis

trantas dots

how do we treat Vernal Keratoconjunctivitis

1. cool compress/ refridgerated artificial tears

2. • Antihistamine/Mast Cell Stabilizer

   1. • Pataday 0.7% 1 gtt QD

3. severe - steroid

   1. Loteprednol 0.2% QID x 1-2 weeks

how do you treat a shield ulcer from Vernal Keratoconjunctivitis

1. • May need to be removed/scraped prior to treatment,

2. • Add antibiotic gtt- ofloxacin QID or polytrim ung 3-4 times per day •

3. Could add cyclopentolate for pain

   1. dilates by paralyzing CB — most pain comes from CB

4. • Follow up every 2-3 days if present otherwise, every few weeks

Atopic Keratoconjunctivitis

Chronic BILATERAL conjunctival and lid inflammation due to allergic conditions

• Mass cell and eosinophil activation- Type I and Type IV hypersensitivity rxn

epi of Atopic Keratoconjunctivitis

Generally, between 2nd -5 th decade of age

symptoms of Atopic Keratoconjunctivitis

Severe itching, redness, tearing, and photophobia,

signs of atopic keratoconjunctivitis

Mucus/watery discharge, scaly lids/dermatitis, inf papillae, hyperemia

how do we treat Atopic Keratoconjunctivitis

1. • Antihistamine/Mast Cell Stabilizer

   1. • Pataday 0.7% 1 gtt once a day

2. • If severe- steroid treatment

   1. • Add Loteprednol 0.2% QID x 1-2 weeks

3. • Cool compresses/refrigerated artificial tears

4. • If there is atopic dermatitis of the lid

   1. • Consider tacrolimus .03% ung QHS or BID

   2. • Topical steroid ung- fluorometholone 0.1% QID to the affected area for 1- 2 weeks

what this

atopic dermatitis

giant papillary conjunctivitis

1. • Non-infectious inflammatory condition of the superior tarsal conjunctiva with the presence of “giant papillae” (papillae greater than 1 mm in diameter)

   1. Thought to be mechanical trauma and inflammatory in the presence of CL antigens

      1. if contact lens doesnt fit you get friction w superior palpebral conj

symptoms of giant papillary conjunctivitis

• FBS, itching,

signs of giant papillary conjunctivitis

• Large papillae superior palp conj greater than 1mm

treatment of giant papillary conjunctivitis

1. • Replace/refit lens- daily wear would be best

2. • If severe:

   1. • Discontinue lens wear

   2. • Loteprednol 0.2% QID x 1-2 weeks

   3. • Antihistamine/mast cell combo gtt

   4. • Refit lens once clear

3. • Follow up in 2-4 weeks

   1. • Can resume CLs once resolved

Toxic Conjunctivitis/ Medicamentosa signs/symptoms

1. • Hyperemia

2. chemosis

3. lid or periorbital swelling

4. mucous discharge

5. follicular palpebral conjunctival reaction

6. and itching

toxicity in Toxic Conjunctivitis/ Medicamentosa is

- Damage to tissues of ocular surface, could be due to the drug itself, preservatives within, or breakdown products of the drug

treatment of Toxic Conjunctivitis/ Medicamentosa

1. recognition is KEY

   1. • Cessation of offending agent

2. • Cool compresses/refrigerated Ats

3. • Can add a soft steroid such as Loteprednol 0.2% QID with a taper

what does he really hate bc it causes follicular palpebral conjunctival reaction, and itching due to a rebound reaction

Lumify (brimonidine)

what meds can cause potential toxic agents

1. Gentamycin

2. Brimonidine

3. neomycin

4. amphotericin B

5. atropine

6. pilocarpine

7. apraclonidine