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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Allergy - Week 3 > Flashcards

AED - Allergy - Week 3 Flashcards

1
Q

Is type I inflammation immediate or delayed? What about type IV?

A

Type I is immediate

Type IV is delayed

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2
Q

What are the main causes of type I inflammation in the eyes (3)? Are drugs a common cause?

A

Usually pollen, dust mites, and SCLs

Very rarely caused by drugs

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3
Q

What typically forms with type I inflammation in the eye?

A

Papillae

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4
Q

What typically forms with type IV inflammation in the eye (3)?

A

Follicles, papillae, phlyctenules

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5
Q

What are the main causes of type IV inflammation in the eye (4)?

A

Cosmetics
Drugs
Biological foreign bodies
Autoantigens

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6
Q

What are the main causes of non-immune mediated inflammation in the eye (2)?

A

Drugs

Chemicals

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7
Q

What typically forms with non-immune mediated inflammation in the eye (3)?

A

Papillae

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8
Q

List the four kinds of allergic conjunctivitis.

A

Seasonal/perennial conjunctivitis (hayfever)
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Giant papillary conjunctivitis

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9
Q

What is seasonal conjunctivitis often associated with?

A

Allergic rhinitis

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10
Q

How long do symptoms persist if an individual is allergic to perennial allergen?

A

All year

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11
Q

What type of imflammation is seasonal conjunctivitis?

A

Purely type I

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12
Q

What percentage of the population is affected by seasonal conunctivitis?

A

5-20%

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13
Q

Is seasonal conjunctivitis uni- or bilateral?

A

Bilateral

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14
Q

Define chemosis.

A

Conjunctival oedema

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15
Q

List 5 signs of conjunctivitis.

A 
Conjunctival papillae
Hyperaemia
Chemosis
Possible lid oedema
Serous and mucous discharge
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16
Q

Is the cornea affected in seasonal conjunctivitis?

A

No

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17
Q

List 3 symptoms of seasonal conjunctivitis. Which of these is the hallmark?

A

Itchy eyes - hallmark
Watery eyes
Associated sneezing

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18
Q

List three differential diagnoses for seasonal conjunctivitis.

A

Other allergic conjunctivitis
Dry eye related surface disease
Other mechanism of conjunctivitis

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19
Q

What four things must be done to assess a suspected seasonal conjunctivitis?

A

History
Slit lamp
Fluorescein
Lid eversion

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20
Q

List 5 treatment options for seasonal conjunctivitis.

A 
Allergic avoidance
Topical antihistamine
Oral antihistamine
Cold compresses
Topical steroids
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21
Q

What can chronic use of topical vasoconstrictors result in (2)?

A

Follicular reactions

Contact dermatitis

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22
Q

What is the likely cellular cause if mast cell stabilisers do not work with seasonal conjunctivitis? What action should be taken and how long?

A

Eosinophilic activity

Use steroids concurrently with mast cell stabiliser/antihistamine for 2 weeks.

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23
Q

List 8 symptoms of vernal keratoconjunctivitis.

A 
Intense burning/itching
Watery eyes
Photophobia
Foreign body sensation
Puffy lids
Mucoid discharge
Blurred vision
Eye rubbing
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24
Q

What is vernal keratoconjunctivitis also known as and why?

A

Spring catarrh, symptoms may become worse in spring and early summer

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25
Q

What type of inflammation is vernal keratoconjunctivitis? Does it account for all its mechanisms?

A

Part of the mechanism os type I hypersensitivity

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26
Q

Is vernal keratoconjunctivitis common?

A

Uncommon

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27
Q

Is keratoconjunctivitis uni- or bilateral? Which gender does it affect more?

A

Bilateral, males>females

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28
Q

Between what ages does vernal keratoconjunctivitis most commonly manifest? What usually happens and what can it develop into? Is this common or rare?

A

Between 5 and 25 years, usually runs its course by early adulthood
Ocassionally develops into AKC

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29
Q

Define atopy.

A

Individuals with other allergies

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30
Q

What do most individuals with vernal keratoconjunctivitis have?

A

Atopy or family history of atopy

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31
Q

Which conjunctival region is most commonly affected by vernal keratoconjunctivitis? What else may it affect andin which race is this more common in? Can these two forms coexist?

A

Usually affects the superior tarsal conjunctiva
May also affect the limal area, more common in African descent
Limbal and tarsal forms can coexist

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32
Q

List 5 signs of vernal keratoconjunctivitis.

A 
Conjunctival hymeraemia
Chemosis
Large palpebral papillae (up to 5mm)
Stringy mucous discharge (may sit between papillae)
Ptosis
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33
Q

List 4 corneal changes that can occur with vernal keratoconjunctivitis.

A

Superficial punctate keratitis
Shield ulcers
Subepithelial scarring
Eosinophilic plaques

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34
Q

What happens to the limbus with vernal keratoconjunctivitis (4)? What cells is responsible for one of these?

A

Limbitis with limbal papillae and Horner-Trantas’ dots (eosinophils)
Pseudogerontoxon

35
Q

How does a pseudogerontoxon appear?

A

Whitish band around the peripheral cornea in an area of previously inflammed limbus. Also called cupid’s bow.

36
Q

List two differential diagnoses for vernal keratoconjunctivitis.

A

Atopic keratoconjunctivitis

Giant papillary conjunctivitis

37
Q

List the four components to assessing vernal keratoconjunctivitis.

A

History
Slit lamp
Fluorescein
Lid eversion

38
Q

Describe the pathophysiology of vernal keratoconjunctivitis (2).

A

Th2 lymphocytes mediate hypoproduction of IgE via II4.

They also mediate differentiation and activation of mast cells and eosinophils.

39
Q

Explain why venral keratoconjunctivitis may improve with the onset of puberty.

A

Overexpression of oestrogen and progesterone receptors in the conjunctiva

40
Q

Hypersensitivity to what 3 things may have a role in vernal keratoconjunctivitis?

A

Wind
Dust
Sunlight (UV)

41
Q

Is there a genetic component to vernal keratoconjunctivitis? Explain.

A

Probable

Reduced levels of tear film histamine has been found

42
Q

List 5 treatment options for vernal keratoconjunctivitis.

A 
Allergen avoidance
Topical mast cell inhibitors
Corticosteroids
Topical NSAIDs
Topical cyclosporin
43
Q

How can shield ulcer resolution be improved in vernal keratoconjunctivitis?

A

Referral for superficial keratectomy

44
Q

How often should vernal keratoconjunctivitis be followed up (3)?

A

Every 1-3 days with shield ulcers
Every few weeks during exacerbations
Less frequently between exacerbations

45
Q

Describe why shield ulcers form.

A

When superficial punctate keratitis-associated vernal keratoconjunctivitis leads to a break in the corneal epithelium

46
Q

Describe the mechanical hypothesis for shield ulcer formation in vernal keratoconjunctivitis.

A

Giant papillae on the upper tarsal conjunctiva are responsible for corneal abrasion

47
Q

Describe the toxin hypothesis for shield ulcer formation in vernal keratoconjunctivitis. What does this additionally explain?

A

Eosinophil granules found in the inflammatory debris covering the ulcers is cytotoxic and inhibits would healing. Explains ulcer re-epithelialisation after inflammatory debris is removed.

48
Q

List 7 symptoms of atopic keratoconjunctivitis.

A 
The same as for vernal keratoconjunctivitis
Intense itching/burning
Watery eyes
Photophobia
Foreign body sensation
Puffy lids
Mucoid discharge
Blurred vision
49
Q

When is the typical onset of atopic keratoconjunctivitis?

Is it common?

A

Early adulthood

Uncommon

50
Q

Is atopic keratoconjunctivitis uni- or bilateral? Which gender does it affect more?

A

Bilateral, males = females

51
Q

What are individuals with atopic keratoconjunctivitis more prone to (2)?

A

Staph. blepharitis and HSV

52
Q

What three conditions is there an increased incidence of with atopic keratoconjunctivitis? Give a reason, if possible.

A

Keratoconus and retinal detachment - possibly due to eye rubbing
Also higher incidence of anterior subcapsular cataract

53
Q

What type of inflammation is atopic keratoconjunctivitis?

A

Part of mechanism is type I hypersensitivity

54
Q

List 7 signs of atopic keratoconjunctivitis.

A 
Atopic dermatitis
Stringy mucous discharge
Thickened eyelids, crusty
Ptosis
Papillary hypertrophy
Fibrosis/scarring
Limbal cysts or papillae
55
Q

List 3 changes to the cornea with atopic keratoconjunctivitis.

A

SPK
Shield ulcers
Horner-Trantas’ dots

56
Q

List two differentia diagnoses for atopic keratoconjunctivitis.

A

Vernal keratoconjunctivitis

GPC

57
Q

List 9 components to assessing atopic keratoconjunctivitis.

A 
History
Slit lamp
Fluorescein
Lid eversion
Lid margins
Lens
Corneal topography
DFE
Skin - referral to an allergist via a GP
58
Q

List 5 treatment options for atopic keratoconjunctivitis.

A 
Allergen avoidance
Topical antihistamines/MCS/NSAIDs
Corticosteroids
Topical cyclosporin
Avoid rubbing eyes
59
Q

What treatment should be avoided with atopic keratoconjunctivitis? Explain why.

A

Long term topical steroids due to possible glaucoma, cataracts and increased susceptibility to infection

60
Q 
Distinguish veral and atopic keratoconjunctivitis via the following characteristics:
Age of onset
Sex
Seasonal variation
Discharge
Conjunctival scarring
Eosinophils in conjunctival scraping
A

Age of onset - atopic occurs much earlier (first decade) than vernal (second/third decade)
Sex - vernal affects males more than females, atopic is equal
Seasonal variation - vernal occurs in spring months typically, atopic is perennial
Discharge - vernal is thick mucoid, atopic is watery/clear
Scarring - vernal is moderate incidence of scarring, atopic has higher indicence of scarring
Eosinophils - vernal is mmore likely to have eosinophils presnt in scrapings

61
Q

Is the presence of Horner-Trantas’ dots common or rare with atopic keratoconjunctivitis?

A

Rare

62
Q

Does corneal neovascularisation occur with vernal keratoconjunctivitis? What about atopic?

A

Vernal - not present unless secondary to infectious keratitis
Atopic - deep neovascularisation tends to develop

63
Q

List 6 symptoms of giant papillary conjunctivitis.

A 
Redness
Burning
Itch
Foreign body sensation
In CL wearers, increased lens aareness and exacerbated symptoms
64
Q

What is giant papillary conjunctivitis associated with (5)?

A

Allergy to contact lens, CL deposits, solution preservatives, ocular prostheses, protruding sutures

65
Q

Describe the four gradings for giant papillary conjunctivitis.

A

1 - slight conjunctival redness with fine papillae and no symptoms
2 - mild injection, 0.3-0.5mm papillae and mild symptoms
3 - moderate injection, +0.5mm papillae with increased contact lens awareness
4 - severe injection, +0.75mm papillae with lens intolerance

66
Q

List three differential diagnoses for giant papillary conjunctivitis.

A

Vernal keratoconjunctivitis, limbic keratoconjunctivitis, and seasonal allergic conjunctivitis

67
Q

List the 5 components for assessing giant papillary conjunctivitis.

A 
History
Slit lamp
Fluorescein
Lid eversion
Inspection of CLs/prosthesis
68
Q

List 5 treatment options for giant papillary conjunctivitis.

A 
Mast cell stabilisers
Topical steroids
Advise on CL wear
Fit new CLs
Removal of sutures
69
Q

List two examples of autoimmune conjunctivitis.

A

Cicatricial pemphigoid

Stevens-Johnson syndrome

70
Q

Is cicatricial pemphigoid common or rare?

A

Rare

71
Q

What is cicatricial pemphigoid characterised by?

A

Recurrent sub-epithelial blister of the skin and mucous membranes with a tendency to form scar tissue

72
Q

What age population does cicatricial pemphigoid affect? What gender?

A

Affects the elderly, females > males

73
Q

List four clinical signs of cicatricial pemphigoid.

A

Conjunctival hyperaemia
Sub-conjunctival blisters, ulceration, and scarring
Chronic sub-epithelial conjunctival scarring and shrinkage
Entropion

74
Q

List three symptoms of cicatricial pemphigoid.

A

Burning
Watery eyes
All features of surface exposure disease

75
Q

List 4 complications of cicatricial pemphigoid and why they occur.

A

Dry eye - lacrimal gland scarring and goblet cell desctruction
Symblepharon - adhesions between palpebral and bulbar conj.
Ankyloblepharon - adhesions at the outer canthus between upper and lower lids
Keratopahy - exposure, reduced tears, and lagophthalmos

76
Q

How is cicatricial pemphigoid managed?

A

Referral to ophthalmological and immunological specialists

77
Q

What is Stevens-Johnson syndrom characterised by?

A

An acute inflammation affecting both skin and mucous membranes

78
Q

Which gender and age population does Stevens-Johnson syndrome affect more?

A

Healthy young individuals, male > female

79
Q

What is the most important cause of Stevens-Johnson syndrome?

A

Often a hypersensitivity reaction to systemic or topical drugs

80
Q

In what percentage of Stevens-Johnson syndrome cases is the cause found?

A

50%

81
Q

List 6 symptoms of Stevens-Johnson syndrome.

A 
Fever
Malaise
Sore throat
Cough (up to 14 days)
Headache
Skin lesions developing every 2-3 weeks for 1-2 months
82
Q

What is an ocular feature of acute phase Stevens-Johnson syndrome?

A

Papillary conjunctivitis

83
Q

What is the treatment option for Stevens-Johnson syndrome (2)?

A

Elimination of the causative agent

Refer - hospitalisation is often needed

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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