23. Ocular Allergies II Flashcards
Giant Papillary Conjunctivitis (1)
Symptoms: ...
, ...
, ...
, ...
. In CL wearers, also ...
and ...
.
Signs:
* ...
on palpebral conjunctiva
* ...
discharge, especially when ...
* Associated with ...
to CL, lens ...
, ...
, ...
, and ...
* Less common with advent of ...
* Less common with ...
Giant Papillary Conjunctivitis (1)
Symptoms: redness
, burning
, itch
, foreign body sensation
. In CL wearers, also increase lens awareness
and symptoms exacerbated by lens wear
.
Signs:
* giant papillae
on palpebral conjunctiva
* mucous
discharge, especially when waking
* Associated with allergy
to CL, lens deposits
, solution preservatives
, ocular prostheses
, and protruding sutures
* Less common with advent of disposable CLs
* Less common with less-toxic solution preservatives
Giant Papillary Conjunctivitis grading
Grade 1/Pre-clinical: ...
, ...
papillae, ...
symptoms
Grade 2/Mild: ...
injection, ...
-...
mm papillae, ...
symptoms
Grade 3/Moderate: ...
injection, ...
mm papillae, ...
Grade 4/Severe: ...
injection, ...
mm papillae, ...
Most CL wearers will be Grade ...
and may ...
over time. As it progresses, some people might just ...
despite ...
as ...
.
Giant Papillary Conjunctivitis grading
Grade 1/Pre-clinical: slight conjunctival redness
, fine
papillae, no
symptoms
Grade 2/Mild: mild
injection, 0.3
-0.5
mm papillae, mild
symptoms
Grade 3/Moderate: moderate
injection, 0.5+
mm papillae, increasing CL awareness
Grade 4/Severe: severe
injection, 0.75+
mm papillae, contact lens intolerance
Most CL wearers will be Grade 1
and may progress
over time. As it progresses, some people might just tolerate it
despite the increase in CL awareness
as CLs are the only method to get good vision
.
Pathogenesis of Giant Papillary Conjunctivitis
Involves ...
and ...
mechanisms. It’s a combination of Types ...
and ...
hypersensitivities and is a response to ...
. There’s an increase in ...
, ...
, ...
, and ...
. Results in ...
, ...
, and ...
.
Pathogenesis of Giant Papillary Conjunctivitis
Involves mechanical
and immunologic
mechanisms. It’s a combination of Types I
and IV
hypersensitivities and is a response to foreign substance
. There’s an increase in mast cells
, eosinophils
, basophils
, and lymphocytes
. Results in fibroblast proliferation
, collagen growth
, and conjunctival papillae under eyelid
.
Giant Papillary Conjunctivitis (2)
Differential diagnosis: ...
, ...
, and ...
Assessment: ...
, ...
, ...
, ...
, ...
, ...
, ...
Treatment:
* Less severe: ...
for many months
* More severe: ...
for short term
* Review ...
, avoid ...
, modify lens ...
/...
/...
, change ...
* Long term management is ...
Giant Papillary Conjunctivitis (2)
Differential diagnosis: VKC
, SAC
, and SLK
Assessment: history
, slit lamp
, fluorescein
, eyelid eversion
, CL inspection
, sutures
, prosthesis
Treatment:
* Less severe: mast cell stabilisers
for many months
* More severe: topical steroid
for short term
* Review CL care
, avoid overnight wear
, modify lens design
/modality
/material
, change CL solution
* Long term management is often required
What is the effect of allergic eye disease on keratoconus?
Patients with allergic conjunctivitis are at increased risk of keratoconus, probably due to eye rubbing. Need intensive treatment to prevent keratoconus development.
Allergic conjunctivitis in children
Recommendations for treatment:
* ...
* Mild - ...
, ...
* Moderate - ...
/...
* Severe - ...
(caveat
), aggressive approach if ...
, refer if needs ...
, consider ...
and/or ...
Allergic conjunctivitis in children
Recommendations for treatment:
* Avoid allergen
* Mild - lubrication
, cold compresses
* Moderate - antihistamine
/mast cell stabilisers
* Severe - short burst steroids
(acceptable in children if at risk of shield ulcers and such
), aggressive approach if corneal involvement
, refer if needs multiple steroid burst
, consider allergy testing
and/or immunotherapy
Allergic contact dermatitis (1)
It’s a ...
, typically affecting ...
, ...
, and ...
.
Symptoms: ...
, ...
, ...
, ...
, and ...
.
Causes: ...
, ...
, ...
, ...
, ...
, and ...
/...
Allergic contact dermatitis (1)
It’s a skin reaction at site of exposure
, typically affecting eyelids
, periorbital skin
, and ocular surface
.
Symptoms: redness
, itching
, swelling
, scaling skin
, and vesicles
.
Causes: metals
, shellac
, preservatives
, topical antibiotics
, fragrances
, and acrylates
/surfactants
Allergic Contact Dermatitis (2)
Pathophysiology
It’s a Type ...
hypersensitivity and ...
lymphocyte mediated. There’s an ...
cycle.
Management...
and ...
of causative agent, ...
Allergic Contact Dermatitis (2)
Pathophysiology
It’s a Type IV
hypersensitivity and Th1
lymphocyte mediated. There’s an itch-scratch
cycle.
ManagementIdentification
and removal
of causative agent, ointment topical steroids
What is atopic dermatitis?
Definition: ...
, also known as ...
.
Management:
* ...
* ...
, which is a ...
and ...
. ADRs include: ...
, ...
, ...
, and ...
What is atopic dermatitis?
Definition: chronic inflammation, irritation, and redness of the skin
, also known as eczema
.
Management:
* allergen avoidance
* Dupilumab
, which is a mononucleotide antibody
and subcutaneous injection
. ADRs include: conjunctivitis
, ocular surface disease
, periorbital skin changes
, and conjunctival cicatrisation
What are the two autoimmune conjunctivitis?
- Ocular cicatricial pemphigold
- Stevens-Johnson Syndrome
Cicatricial Pemphigold
Definition: ...
that results in ...
Systemic features include:
* Affects ...
and ...
more than ...
* ...
affected in 80% of cases
* ...
and ...
* ...
in up to ...
% of cases within ...
yrs
Cicatricial Pemphigold
Definition: rare, progessive, chronic autoimmune disease
that results in recurrent sub-epithelial symptoms of the skin and mucous membranes with a tendency to scar formation
Systemic features include:
* Affects eldery
and females
more than males
* oral mucosa
affected in 80% of cases
* submucosal blisters
and scarring of mucosal membranes
* ocular signs
in up to 40
% of cases within 5
yrs
Ocular cicatricial pemphigold signs and symptoms
Ocular signs:
* Commonly ...
* Asymmetric ...
* ...
* Sub-conjunctival ...
, ...
, and ...
* Chronic ...
, ...
, ...
, and ...
Symptoms: ...
, ...
, and features of ...
Ocular cicatricial pemphigold signs and symptoms
Ocular signs:
* Commonly bilateral
* Asymmetric papillary conjunctivitis
* conjunctival hyperaemia
* Sub-conjunctival blisters
, ulceration
, and scarring
* Chronic conjunctival inflammation
, subepithelial scarring
, conjunctival shrinkage
, and entropion
Symptoms: burning
, watering
, and features of surface exposure disease
Ocular Cicatricial Pemphigold ocular complications
...
-
...
due to scarring over...
and destruction of...
-
...
which is adhesions between the...
and...
-
...
which is adhesions at the...
between...
and...
-
...
which is...
due to reduced tears and...
due to entropion
Ocular Cicatricial Pemphigold ocular complications
conjunctival disease
-
dry eye
due to scarring overlacrimal gland ducts
and destruction ofgoblet cells
-
symblepharon
which is adhesions between thepalpebral
andbulbar conjunctiva
-
ankyloblepharon
which is adhesions at theouter canthus
betweenupper
andlower lids
-
keratopathy
which isexposure
due to reduced tears andlagophthalmos
due to entropion
Treatment of ocular cicatricial pemphigold
-
...
as it must be treated by...
and...
specialists - Can give
...
and...
immunosuppresive agents -
...
cytotoxic drugs -
...
and...
steroids -
...
,...
, and manage...
- Surgical correction of
...
and maybe give...
Treatment of ocular cicatricial pemphigold
-
REFER
as it must be treated byophthalmological
andimmunological
specialists - Can give
topical
andoral
immunosuppresive agents -
systemic
cytotoxic drugs -
topical
andsystemic
steroids -
punctal occlusion
,artificial tears
, and manageblepharitis
- Surgical correction of
entropion
and maybe givemucous membrane grafts
Stevens-Johnson Syndrome (1)
Signs: ...
that is ...
, affects both the ...
and ...
. Tends to affect ...
, ...
...
, and ...
more than ...
.
Cause: generally a ...
to ...
, can be associated with ...
. Cause is only found in ...
% of cases.
Two types:
* Erythema Multiforme Minor - ...
involvement
* Erythema Multiforme Major - ...
, ...
, and ...
- ...
Stevens-Johnson Syndrome (1)
Signs: acute inflammation
that is self-limiting
, affects both the skin
and mucous membranes
. Tends to affect healthy
, young
individuals
, and males
more than females
.
Cause: generally a hypersensitivity reaction
to systemic or topical drugs
, can be associated with systemic infections
. Cause is only found in 50
% of cases.
Two types:
* Erythema Multiforme Minor - only skin
involvement
* Erythema Multiforme Major - skin
, two mucous membranes, typically the conj
, and systemic malaise
- SJS