22. Ocular Allergies I Flashcards
What is allergy?
Definition: ... and is pure ....
Allergens: ..., ..., ..., ..., etc.
Atopy is the ....
What is allergy?
Definition: reaction to a substance in the environment that is harmless to most people and is pure inflammation.
Allergens: dust mites, pollen, food, medication, etc.
Atopy is the genetic tendence to develop allergy.
Who treats the following inflammatory conditions?
Inflammatory conditions of skin and eyelids - ...
Dermatological, conjunctival, and corneal inflammation - ...
Anterior ocular inflammation - ...
Everything above? - ...
Who treats the following inflammatory conditions?
Inflammatory conditions of skin and eyelids - dermatologists
Dermatological, conjunctival, and corneal inflammation - GP
Anterior ocular inflammation - optometrists
Everything above? - ophthalmologists
What is the difference between Type I, Type IV, and non-immune-mediated inflammation?
Type I and Types IV are immune mediated. Type I have mast cells, histamine, and eosinophils as main mediators (chemical) and Type IV have lymphocytes and macrophages as main cell mediators.
Non-immune-mediated inflammation is based around direct injury and/or pharmacological.
What is the main inflammatory mediator and what does it do?
Mast cells are the main mediator and they activate other cells.
Seasonal Allergic Conjunctivitis (SAC) (1)
It is common and affects up to ...% of the population. It is a ... and not a ....
Seasonal meaning active from ... to ..., mostly known as .... It is a ... hypersensitivity and therefore ...-mediated.
Seasonal Allergic Conjunctivitis (SAC) (1)
It is common and affects up to 20% of the population. It is a minor annoyance and not a significant health crisis.
Seasonal meaning active from spring to early summer, mostly known as hayfever. It is a Type I hypersensitivity and therefore IgE-mediated.
Seasonal Allergic Conjunctivitis (SAC) (2) and Perennial AC (1)
Signs: ..., ..., ..., and .... The lids may also be ... and ... with ... and no ... damage.
Differential diagnoses: ..., ..., other mechanisms of ....
Assessed via ..., ..., ..., and ....
Seasonal Allergic Conjunctivitis (SAC) (2) and Perennial AC (1)
Signs: bilateral, conjunctival papillae, hyperaemia, and oedema. The lids may also be oedematous and serous with mucoid discharge and no corneal damage.
Differential diagnoses: allergic conjunctivitis, dry eye-related surface disease, other mechanisms of conjunctivitis.
Assessed via history, slit lamp, fluorescein, and lid eversion.
Seasonal Allergic Conjunctivitis (SAC) (3) and Perennial AC (2)
Treatment
* ..., we’re not trying to ... but instead ...
* Non-pharmacological: ... and ...
* Pharmacological: ..., ..., ... or combinations which include ... and ...
Follow up
* ... as ...
Seasonal Allergic Conjunctivitis (SAC) (3) and Perennial AC (2)
Treatment
* allergen avoidance, we’re not trying to save tissue but instead relieve symptoms
* Non-pharmacological: cold compresses and lubricants
* Pharmacological: oral anti-histamines, topical antihistamines, mast cell stabilisers or combinations which include vasoconstrictors and astringents
Follow up
* patient driven as season starts
What is the difference between Seasonal Allergic Conjunctivitis and Perennial Allergic Conjunctivitis?
SAC is acute and often during spring time. PAC persists all year due to a perennial allergen.
Non-pharmacological treatment for SAC and PAC
Allergen avoidance - ..., ..., ...
Cold compresses - reduces ... and ...
Artificial tears - ... to antigen, ... of antigen, ... antigen, ... is preferable
Non-pharmacological treatment for SAC and PAC
Allergen avoidance - change environment, air filter, cleaning
Cold compresses - reduces chemosis and hyperemia
Artificial tears - barrier to antigen, dilution of antigen, flushes antigen, preservative-free is preferable
Patanol vs Zaditen
Both combinations of ... and .... Patanol (...) is more ... and ... with quicker ..., improved ..., better ..., and fewer .... However, it is S... so potentially less available, costs ... and does not have a ....
Patanol vs Zaditen
Both combinations of antihistamines and mast cell stabilisers. Patanol (olopatadine) is more efficacious and comfortable with quicker relief, improved symptoms, better QoL, and fewer side effects. However, it is S4 so potentially less available, costs more and does not have a preservative-free option.
Combination pharmaceutical treatments for SAC and PAC
... and ... - S... - one to two drops a day to avoid ....
... and ... - olopatadine S... and ketotifen S... - first line therapy for AC. Dual effect is better since one drug with two actions and far fewer ....
... and .../... or ... to aggressively treat inflammation, and while ..., the other drug kicks in.
Combination pharmaceutical treatments for SAC and PAC
Topical vasoconstrictors and antihistamines - S3 - one to two drops a day to avoid rebound redness.
Topical antihistamines and mast cell stabilisers - olopatadine S4 and Ketotifen S3 - first line therapy for AC. Dual effect is better since one drug with two actions and far fewer side effects.
Topical steroid and MCS/AH or NSAID to aggressively treat inflammation, and while steroid is tapering, the other drug kicks in.
Single pharmaceutical treatments for SAC and PAC
... - levocabastine HCL - available as eyedrop or nasal spray, S...
... - phenylephrine HCl, naphazoline HCl, and tetrahydrozoline, S.... Chronic use can result in ..., ..., and/or ... as they downregulate the receptors over time and become less effective.
... - sodium cromoglycate - available as eyedrop, S....
... - ketorolac and diclofenac - S...
... - used to reduce itch an inflammation
Single pharmaceutical treatments for SAC and PAC
Topical antihistamines - levocabastine HCL - available as eyedrop or nasal spray, S3
Topical vasoconstrictors - phenylephrine HCl, naphazoline HCl, and tetrahydrozoline, S3. Chronic use can result in follicular reactions, contact dermatitis, and/or rebound redness as they downregulate the receptors over time and become less effective.
Topical mast cell stabilisers - sodium cromoglycate - available as eyedrop, S3.
Topical NSAIDs - ketorolac and diclofenac - S4
Topical steroids - used to reduce itch an inflammation
Oral antihistamines for SAC and PAC
Can work for ocular conditions but ...? Targets ... receptors but is body wide and therefore has ... side-effects.
Topical antihistamines are more ..., with less ... and higher ... whereas oral antihistamines are best used for ... or ....
Oral antihistamines for SAC and PAC
Can work for ocular conditions but are they safe? Targets H1 receptors but is body wide and therefore has body wide side-effects.
Topical antihistamines are more rapid, with less side effects and higher efficacy whereas oral antihistamines are best used for non-ocular or multisystem disease.
Vernal Keratoconjunctivitis (1)
Defined as ... conjunctivitis
Symptoms include: intense .../..., ..., ..., ..., ..., ..., ..., ...
Vernal Keratoconjunctivitis (1)
Defined as recurrent, bilateral, self-limiting conjunctivitis
Symptoms include: intense itching/burning, watering, photophobia, foreign body sensation, puffy lids, mucoid discharge, blurred vision, eye rubbing
Vernal Keratoconjunctivitis (2)
Conjunctival signs
* Worse in .../...
* ... and affects ... more
* Most commonly manifests between ... and ... years and runs its course by ...
* Can develop into ...
* Most suffers are ...
* Usually affects ... conjunctiva and may involve ...; two forms can coexist
* Conjunctival ... and ...
* Large palpebral ...
* Discharge is ...
* ...
Vernal Keratoconjunctivitis (2)
Conjunctival signs
* Worse in spring/early summer
* bilateral and affects men more
* Most commonly manifests between 5 and 25 years and runs its course by early adulthood
* Can develop into atopic keratoconjunctivitis
* Most suffers are atopic
* Usually affects superior tarsal conjunctiva and may involve limbal area; two forms can coexist
* Conjunctival hyperaemia and chemosis
* Large palpebral papillae
* Discharge is stringy mucous
* ptosis
