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Eye disease Term 2 > Allergic eye disease > Flashcards

Allergic eye disease Flashcards

1
Q

what is an ocular allergic response a result from

A

from exposure to foreign substances (allergens)

allergic response of the ocular surface to extraneous antigens = antigens that are in the outside e.g. hay fever as a response to grass pollen

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2
Q

which parts of the eye does a hypersensitivity reaction mainly affect and which parts may in also involve

A

conjunctiva but may also involve the lids and cornea

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3
Q

what 4 conditions of ocular allergies are there

A
  • allergic conjunctivitis
  • giant papillary conjunctivitis GPC
  • contact dermatoconjunctivitis
  • keratoconjunctivitis
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4
Q

what 3 conditions is allergic conjunctivitis classified into

A
  • acute allergic conjunctivitis
  • seasonal allergic conjunctivitis SAC
  • perennial allergic conjunctivitis PAC
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5
Q

what is the ocular manifestation of hay fever

A

seasonal allergic conjunctivitis SAC

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6
Q

what 2 conditions is keratoconjunctivitis classified into
what structures are affected
what action should be taken if this is seen and why

A
  • atopic keratoconjucntivitis AKC
  • vernal keratoconjucntivitis VKC
  • as well as the conjunctiva, the cornea is also affected
  • refer these patient to HES
  • as its a sight threatening condition and frequently needs steroid control
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7
Q

why is giant papillary conjunctivitis GPC not as common as it used to be

A

as it used to happen when people wore soft CLs for years, this accumulated deposits and there was an allergic response to the deposits

also common in prosthetic eyes

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8
Q

what structures are affected in contact dermatoconjunctivitis and what is it a response to

A
  • affects the conjunctiva and the skin adjacent

- as a response to drugs or cosmetics i.e. something put in/around the eye

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9
Q

what 5 reactions will show signs of an allergic eye disease with the conjunctiva
describe how each one occurs and what they look like

A
  • Oedema (chemosis)
    can over lap the cornea, but cornea will still be clear
  • Hyperaemia
  • Papillae
    inflammatory spots, tiny elevations of the conjunctiva surface
  • Follicles
    collections of lymphoid tissue just under the surface of the conjunctiva (more common in toxic reactions)
  • Mucus discharge
    from conjunctiva goblet cells that are stimulated to produce more mucous
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10
Q

what 4 reactions will show signs of an allergic eye disease with the lids

A
  • Oedema
  • Hyperaemia
  • Blepharitis
  • Ptosis
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11
Q

what 6 reactions will show signs of an allergic eye disease with the cornea/limbus

A
  • Keratitis
  • Infiltrates
  • Ulceration
  • Plaques
  • Scarring
  • Trantas dots: follicles around the limbus
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12
Q

what are Trantas dots

A

follicles around the limbus

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13
Q

list 6 symptoms that occur in an allergic eye disease

A
  • Itching
  • Irritation
  • Burning
  • Epiphora
  • Photophobia
  • Blurred vision
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14
Q

what is the strongest symptom that someone with allergic eye disease will complain about

A

itching

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15
Q

what type of photophobia will someone with an allergic eye disease have

A

mild

not as bad as something like uveitis

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16
Q

when may a patient with an allergic eye disease complain about blurred vision

A

if the cornea is involved, which is rare

or it may be because the eyes are watering a lot

17
Q

what is the aetiology of an acute allergic conjunctivitis and give 2 examples of allergens that can cause this

what is a predisposing factor

what is the main symptom

what are the 3 signs

what is your management (name 3 things)

A

Aetiology:
- Urticarial reaction to an allergen that comes in contact with the lid or conjunctiva
reaction is very quick, within minutes, can be bilateral if the allergen connected both eyes
- Type I hypersensitivity reaction
- Allergens include grass pollen, animal dander

Predisposing factor:
- History of atopy

Main symptom:
- Itching
May be unilateral if contact response

Signs:

  • Lid oedema and erythema
  • Chemosis
  • Epiphora

Management:

  • Usually resolves after a few hours
  • Cool compress
  • Allergen avoidance
18
Q

when does Perennial Allergic conjunctivitis cause symptoms and in response to what

A
  • causes symptoms throughout the year

- in response to allergens such as house dust mite or animal dander

19
Q

what is the same for seasonal allergic conjunctivitis SAC

and perennial allergic conjunctivitis PAC

A

the symptoms experienced

20
Q

what is the prevalence on hay fever in the UK
what do 40% of those affected have
when is the peak hayfever season
symptoms in which part of the body predominate
what can hay fever affect in children

A
  • 15.5% of the UK population suffered from hay fever (7.2 million)
  • 40% had symptoms so severe as to affect their work
  • Peak hayfever season May/June
  • Eye and nasal symptoms predominate
  • Hay fever can have an adverse effect on children’s learning ability (as symptomatic during school days)
21
Q

what are people who have hay fever symptoms in the spring allergic to
and what are people who have hay fever symptoms in the summer allergic to

A
  • spring = tree pollen

- summer = grass pollen

22
Q

what is the aetiology of Seasonal and Perennial allergic conjunctivitis and examples of what can cause this

what is a predisposing factor

what is the 2 main symptoms

what are the 5 signs

what 4 things can you do for management

A

Aetiology:
Type I
- Seasonal: seasonal allergens
- Perennial: allergens such as house dust mite, symptoms throughout the year

Predisposing factor:
- Family history

Symptoms:

  • Itching
  • Epiphora

Signs:

  • Hyperaemia
  • Chemosis
  • Lid oedema
  • Diffuse papillary reaction
  • No corneal involvement

Management:

  • Allergen avoidance
  • Cool compresses
  • Sodium chromoglicate
  • Topical and systemic antihistamines
23
Q

explain how family history is a predisposing factor for seasonal/perennial conjunctivitis

A

genetics determines how your immune system responds to the allergens

they produce a IGe response = an antibody response

IGe binds to the surface of the mast cells and the pollen then causes cross linking and subsequent degranulation

the mast cell mediators cause the symptoms and signs e.g. redness, swelling, oedema etc

24
Q

list 6 non-pharmacological management options for allergic conjunctivitis

A
  • Allergen avoidance
  • Allergen exclusion (difficult to do)
  • Cold compresses
  • Lid-hygiene (not relevant to hay fever)
  • Artificial tears (will wash out some allergens that was in contact with the ocular surface)
  • Contact lens fit and hygiene (to allow px to wear CLs)
25
Q

list 6 ways of allergen avoidance

and 2 ways on allergen exclusion

A

Avoidance

  • Limit outdoor activities
  • Use air conditioning
  • Reduce humidity (to reduce house dust)
  • Protective eyewear
  • Barrier cover for mattress and pillows
  • Remove reservoirs for allergen e.g. carpets (harbour lots of dust, wooden floors are better)

Exclusion

  • Occlusive glasses (prevents allergen to contact ocular surface)
  • Induced ptosis
26
Q

list the 3 pharmacological management options for allergic conjunctivitis

A
  • Antihistamines (oral and topical)
  • Mast cell stabilisers
  • Combination AH/MCS
27
Q

how often does someone with allergic conjunctivitis usually have to instil topical antihistamines and when can this not be used

A
  • 4x a day

- cannot use with CLs as contains preservatives

28
Q

how do mast cell stabilisers work for allergic conjunctivitis

A

it stabilises mast cell membrane and reduces degranulation

29
Q

what pharmacological drug can be used for allergic conjunctivitis with CLs and why

A
  • Combination AH/MCS
  • because you only need to put it in twice a day, so once before inserting CLs and once after removing CLs
  • only available on prescription
30
Q

what is the 3 possible aetiologies of Giant papillary conjunctivitis GPC

what are 2 possible predisposing factors

what is the 3 main symptoms

what are the 4 signs

what is a ddx

what 3 things can you do for management

A

Aetiology

  • Contact lens wear (trauma and deposits)
  • Exposed sutures
  • Filtration bleb

Predisposing factors

  • History of atopy
  • Poor lens hygiene (deposits)

Symptoms

  • Mild irritation
  • Itching
  • Increased lens awareness (leading to intolerance)

Signs

  • Papillae, variable in size (> 1mm), variable in position
  • Tops of papillae may stain with fluorescein
  • Palpebral conjunctival hyperaemia
  • Increased mucus discharge

Differential diagnosis
- Vernal keratoconjuntivitis

Management

  • Lens hygiene (if wear lenses for more than 1 day)
  • Disposable lenses
  • Mast cell stabilisers
31
Q

how does RGP lenses cause GPC

A

it is seen in every RGP wearer, bit because or deposits, but because to mechanical structure of the lens

32
Q

how does exposed sutures cause GPC

A

in the old days, during the time of standard cataract surgery when IOLs were big and couldn’t be folded up, so had to make incision in cornea, so the sutures caused a mechanical GPC

33
Q

how does a filtration bleb cause GPC

A

from surgery for glaucoma
it is the consequence of a trabeculectomy procedure = the creation of a new channel for aqueous drainage
this produces a little vesicle of aqueous on the surface called a bleb = a raised bit

34
Q

what will you need to do if the management options e.g. mast cell stabilisers don’t work on a px with GPC

A

px to be referred to take topical steroids

35
Q

what is another name for contact dermatoconjunctivitis

A

Conjunctivitis Medicamentosa

36
Q

what is the 2 possible aetiologies of contact dermatoconjunctivitis/Conjunctivitis Medicamentosa

what are the 3 signs

what is the 3 main symptoms

what 2 things can you do for management

A

Aetiology

  • Eyedrops
  • Cosmetics applied to the eyelids

Signs

  • Lid oedema and erythema
  • Chemosis
  • Follicular conjunctivitis

Symptoms

  • Burning
  • Stinging
  • Epiphora

Management

  • Identify and withdraw allergen (if its eyedrops, then use different one)
  • Systemic anti-histamines
37
Q

what is the possible aetiology of Atopic keratoconjunctivitis

what is a possible predisposing factor and give 2 examples of this

what is the 4 main symptoms

what are the 4 signs

what is a ddx

what things can you do for management, for mild, for severe and 2 other general options for both types

A

Aetiology

  • Adult equivalent of vernal keratoconjunctivitis
  • Young adult males
  • Perennial with exacerbations (all year round)

Predisposing factors

  • Atopic history
    e. g. eczema, asthma

Symptoms

  • Itching
  • Epiphora
  • Blurred vision
  • Mucus discharge

Signs

  • Eyelids thickened, crusted and fissured
  • Blepharitis
  • Conjunctival hyperaemia
  • Corneal involvement

Differential diagnosis
- Vernal keratoconjunctivitis

Management

  • Mild: sodium chromoglicate
  • Severe: with corneal involvment, steroids/immunosuppressants
  • Lid hygiene
  • Antibiotics (if risk of concurrent infection)
38
Q

what is the possible aetiology of vernal keratoconjunctivitis

what 3 possible predisposing factors

what is the 4 main symptoms

what are the 8 signs

what 5 management options are there

A

Aetiology
- Uncommon allergic disorder of children

Predisposing factors

  • Onset below 10 years
  • Exacerbations during spring (but can be all year round)
  • Atopic history

Symptoms

  • Itching
  • Epiphora
  • Blurred vision
  • Photophobia

Signs

  • Mucus discharge
  • Giant papillae
  • Hyperaemia
  • Trantas dots
  • Punctate corneal staining
  • Erosion
  • Plaque
  • Scarring
Management	
- Cold compresses
- Mast cell stabilisers
- Corticosteroids
- Mucolytics
- Ciclosporin
need strong systemic immunosuppresent drug
difficult condition to treat, so needs referring to specialist ophthalmologist to treat
39
Q

why is vernal keratoconjunctivitis a serious condition and what does it require if seen in practice

A
  • cornea is involved so is sight threatening

- needs referring to specialist ophthalmologist to treat

Eye disease Term 2 (23 decks)

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