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BOARDS2: conjuntiva/cornea > Allergies > Flashcards

Allergies Flashcards

1
Q

Main signs of allergies in the eyes

A

Papilla and chemosis

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2
Q

AKC

A

Rare keratoconjunctivitis that classical occurs in young to middle aged adults (teens to 40s) with a history of atopic conditions. It is not seasonal. Type 1 and 4 HS. Requires chronic treatment and Evals

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3
Q

What type of HS is AKC

A

1 and 4

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4
Q

What is AKC assocaited with

A

Atopic dermatitis

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5
Q

Eyelid/adnexal signs

A

Scaly, thickened, and/or swollen outer eyelid margins, Dennie’s lines (additional crease under the eyelid due to periorbital edema), and “atopy shiners”

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6
Q

Conjunctival signs of AKC

A

Commonly involve the INFERIOR fornices and tarsal conjunctiva
Small papillae
Milky, pale, edematous conjunctival appearance (can be described as “featureless” appearance)
Symblepharon formation in the inferior fornices may occur in severe cases and could mimic OCP

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7
Q

Corneal/lenticular findings of AKC

A

Neo
Kone
Cataracts

More common in AKC than VKC

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8
Q

Which is more associated with asthma, AKC or VKC

A

VKC

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9
Q

VKC

A

Seasonal, more in warm months
Strong Association with atopic conditions (asthma, eczema, etc)
Extremely rare
Young males under the age of 10 who live in hot/dry climates
5-10 years before resolving around puberty

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10
Q

Symptoms of VKC

A 
Intense itching
Photophobia 
Thick mucus discharge 
Lacrimation
FB sensation
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11
Q

Signs of VKC

A 
Prominent papillae (usually bilateral) on SUPERIOR conj (cobblestone papillae) or superior limbus, and trantas dots 
Corneal involvement may develop due to friction between the superior papillae and the corneal epithelium leading to a shield ulcer
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12
Q

Superior papillae causes

A

GPC

VKC

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13
Q

Inferior papillae causes

A

AKC

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14
Q

Treating a shield ulcer in AKC

A

Topical steroid 4-6x/day

  • loteprednol
  • pred acetate
  • dexamethasone

Topical abx drops/ointment QID

  • polytrim
  • erythromycin

Cyclopentolate 1% TID

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15
Q

Seasonal allergic conjunctivitis

A

Type 1 HS

Airborne allergens

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16
Q

Perennial allergic conjunctivitis

A

Type 1 HS (IgE)

Household allergens

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17
Q

Symptoms/signs of allergic conjunctivitis

A 
Ocular itching 
Hyperemia 
Tearing 
Rhinitis and sneezing 
Papillae
Conj chemosis
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18
Q

GPC

A

Chronic inflammatory condition associated with an immune response against CL deposits (protein) or mechanical trauma
Classically associated with CL wear, but may be secondary to exposed sutures, filtering blebs, scleral buckles, and ocular prosthetics

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19
Q

What CL wearers are at greatest risk of GPC

A

Increased modulus
SiHy
Extended wear

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20
Q

Symptoms of GPC

A 
Decreased CL wear time
Ropy discharge
Itching 
Photophobia
Worse after removing CL
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21
Q

Signs of GPC

A 
Papillae (>0.3mm) of the upper tarsal conj
Giant papillae (>1mm) form when neighboring [a[illae break down septa’s and coalesce together after prolonged inflammation
22
Q

Treatment of GPC

A 
Daily wear (disposable)
Clear care 
DC wear until clear (1-4m)
Combo drop
Steroid drop-severe cases 
F/U 2-4 weeks
23
Q

Average length of time for development of GPC associated with CL wear is

A

8 months

0may occur as early as 3 weeks depending on type of CL and wear schedule

24
Q

Risk factors for GPC

A

Extended wear hydrogel CL
High water-ionic lenses
Higher modulus
Poor replacement compliance

25
Q

Atopic dermatitis

A

Common, chronic, relapsing disorder that results from a type 1 HS (85% of patients have elevated IgE during active AD
60% of patients dx within the first year of life
One of several types of eczema and associated with a family Hx of AD, allergic rhinitis, and asthma

26
Q

Signs of atopic dermatitis

A

Pruritis
Skin rash
Itch-scratch-rash-itch
Chronic steroids needed

27
Q

Ocular problems with atopic dermatitis

A

Cataracts (between age 15-30)

  • shield cataract
  • PSC

Chronic staph blepharitis, causing a thickened, fissured appearance of the eyelids (atopy shiners) due to constant eye rubbing

28
Q

How many patients with atopic dermatitis have ocular involvement

A

25-42%

29
Q

Causes of presenile cataracts

A

Wilson is MAD

  • Wilson’s disease
  • myotonic dystrophy
  • atopic dermatitis
  • DM
30
Q

Which is AKC more associated with, asthma or AD

A

AD

Can be both, but more commonly AD

31
Q

Ocular problems from AKC

A

Keratoconnus
Corneal neo
Cataracts
Symblepharon

32
Q

Causes of papillae

A

Allergy: VKC, AKC, allergic conj (IgE)
Bacterial: bacterial conjunctivitis, gonorrhea
Non specific: floppy eyelid, chlamydia (mixed)

33
Q

Outer eyelid involvement and inferior issues

A

AKC

34
Q

8yo boy in the spring with asthma, superior issues, shield ulcer, cobblestone papillae

A

VKC

35
Q

What type of vision is affected most by a PSC cataract

A

Near

36
Q

Most common cause of visual impairment in AKC is

A

SPK

37
Q

Treatment of AKC

A

Determine the etiologies cause and remove the offending antigen
Cool compresses
Tropical ophthalmic MCS/antihistamine combo for acute
Short term topical ophthalmic steroids
Topical ophthalmic MCS for long term therapy
Cataract surgery
Kones treated with GPCLs, CXL, corneal transplant
Treatment of associated atopic dermatitis

38
Q

Allergy treatment pearls

A
  • cool compresses, alo, ala, crom, BEZPOP, topical steroids

- lotEmax (ester-safer)

39
Q

GPC treatment

A

SiHy change to Hy, go daily
Clear care
Topical steroids (FML/lotemax) and/or combo drop (BEZPOP)
Lotemax Q12hrs x 2 weeks then combo x 4 weeks

40
Q

What do mast cell stabilizers do

A

Prevent future degranulation of mast cells, but they do not block actions of histamine that has already been released

No indicated for acute cases

41
Q

What are the MSC/antihistamine combo drops

A

BEZPOP

  • bepreve
  • elestat
  • zaditor
  • patanol
  • optivar
  • pataday
42
Q

Treatment for mild allergic conjunctivitis

A

AT 4-8x day

43
Q

Treatment for moderate allergic conjunctivitis

A

Combo drop QD/BID

44
Q

Treatment for severe allergic conjunctivitis

A

Mild topical steroid with combo drops

-loteprednol 0.2% or FML 0.1% QID x 1-2 weeks

45
Q

FU schedule for allergic conjunctivitis

A

2 weeks

46
Q

Things that can help all stages of allergic conjunctivis

A

Cool compresses
Eliminate allergen
Oral antihistamine

47
Q

Treatment of VKC

A

Similar to AKC and allergic conjunctivitis

48
Q

Treatment for GPC

A

Temporarily DC CL wear
Refit CL with greater frequency of replacement
PF CL solution
Cool compresses
Topical ophthalmic mast cell stabilizers/antihistamine combo
Short term topical steroids

49
Q

What are papillae

A

Inflamed areas of elevated conjunctiva that contain a central vessel, which serves as the source for infiltration of eosinophils, mast cells, neutrophils, and lymphocytes

  • range from very small to very large
  • nonspecific to any condition, but common in allergic and bacterial
50
Q

What are follicles

A

Avascular, white Gray nodules that are typically located in the tarsal and fornix conjunctiva

  • immature lymphocytes and macrophages concentrate in the center of the nodule
  • associated with chlamydia, toxic, viral, toxic

BOARDS2: conjuntiva/cornea (7 decks)

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