Allergic Eye Disease

Question 1

How do Mast Cell Stabilisers Work?

Answer 1

• Prevents degranulation of mast cells which prevents further histamine release
• Has no effect on current histamine
• Has a 2 week delay before therapeutic effect

Question 2

Examples of Mast Cell Stabilisers

Answer 2

• Sodium cromoglicate
• Lodoxamide

Question 3

Sodium Cromoglicate in Allergic Eye Disease

Answer 3

• Topical mast cell stabiliser
• Dose is 4x daily
• No cautions in topical use
• Contraindications only allergy
• Drops sting upon instillation
• Use in pregnancy when benefits outweigh risks, safe in breastfeeding
• Can be GSL, P or PoM

Question 4

Sodium Cromoglicate GSL Preparations

Answer 4

• Entry level
• Opticrom
• Only licensed for seasonal conjunctivitis
• Not for use in those under 6 yrs
• Suggested to contact healthcare professional if symptoms do not resolve within 14 days

Question 5

Sodium Cromoglicate P Preparations

Answer 5

• Entry level
• Optrex
• Only licensed for seasonal and perennial conjunctivitis

Question 6

Sodium Cromoglicate PoM Preparations

Answer 6

• More scope for wider range of conditions
  
  • Allergic conjunctivitis (acute and chronic)
  • VKC
  • CLAPC

Question 7

Lodoxamide in Allergic Eye Disease

Answer 7

• IP Level
• 0.1% concentrations
• For all subtypes of allergic conjunctivitis
• Dose is 4x daily
• Contraindications are allergy
• Preferrable to avoid in pregnancy, caution in breastfeeding

Question 8

When are Systemic Antihistamines Indicated?

Answer 8

• Indicated for both seasonal and perennial allergic conjunctivitis
• Particularly recommended if other systemic symptoms
• Specialists can use for long term management of AKC

Question 9

Sedating Antihistamines

Answer 9

• Older class of drug
• Causes drowsiness
• No driving or operating heavy machinery
• Example drugs are chlorphenamine and clemastine

Question 10

Non-Sedating Antihistamines

Answer 10

• Newer class of drug
• Less likely to induce drowsiness
• Longer half life when compared to older generation of drugs
• Example drugs are loratadine and cetirizine

Question 11

Chlorpenamine in Allergic Eye Disease

Answer 11

• Indications: Hayfever, food allergy, drug reaction
• Dose 4mg every 4-6 hours (max 24mg in 24 hrs In adults)
• Cautions: Epilepsy, urinary retention, prostatic hypertrophy, ACG susceptibility
• Interact with other drugs with anticholinergic actions
• Contraindications: Hypersensitivity, use of MAOIs in previous 14 days

Question 12

Loratadine in Allergic Eye Disease

Answer 12

• 10mg daily dose in adults
• Interact with other drugs with anticholingeric effects and avoid in combination with antidepressants
• Contraindications: Allergy
• Avoid in pregnancy and breastfeeding

Question 13

Loratadine GSL/P Preparations Indications and Age

Answer 13

• Indicated for allergic rhinitis and hives
• Over age 2 yrs

Question 14

Loratadine PoM Preparations

Answer 14

• Indicated for hayfever and hives

Question 15

Chlorphenamine Side Effects

Answer 15

Drowsiness, HA, fatigue, dizziness

Question 16

Loratadine Side Effects

Answer 16

Common: Drowsiness, nervousness
Uncommon: Appetite increase, HA, insomnia
Rare: Alopecia, dry mouth, dizziness

Question 17

Topical Antihistamines

Answer 17

• IP Level
• Example is olopatidine

Question 18

Olopatidine in Allergic Eye Disease

Answer 18

• IP level
• Anti-histamine and mast cell stabiliser, provides a few hours of instant relief
• Indications: Seasonal allergic Conjunctivitis (and other off label uses)
• Dose: 2x daily for upto 4 months
• Interactions: Any drug with anticholinergic actions
• Contraindications: Hypersensitivity
• Not recommended for pregnancy and breastfeeding

Question 19

Topical Decongestants in Allergic Eye Disease

Answer 19

• Entry level
• Adrenergic alpha agonist to promote vasoconstriction and reduce eye irritation
• No effect on underlying cause
• Dose: 2x daily
• Naphazoline 0.1% (preserved)
• Contraindications: not used in under 12’s, not used for more than 7 days, excessive use (toxic reaction)
• Side Effects: Mydriasis
• Caution in those with CV disorders, arrhythmia, HBP and DM