anti allergics

Question 1

what does allergic eye disease take the form in

Answer 1

allergic eye disease affects between 15- 40% of the population and takes form of 2 main types , perennial allergic conjucitivits , and seasonal allergic conjuctivitis

as the name suggests perennial is not season dependent whereas seasonal is

Question 2

what is perennial allergic conjuctivits

Answer 2

perennial =it is not seasonal

happens any time of year

Question 3

what is sac also known as

Answer 3

seasonal allergic conjuctivitis would commonly be called hay fever and is due to an immunoglobulin e (lge) hypersensitivity reaction to pollen

most cases of allergic conjuctivittis are seasonal and present in spring or early summer

1st line in treatment - remove allergy

can be advised to wash eyes when they come back in to remove pollen or use artificial tear preparations

Question 4

what is perinial allergic conjuctivits due to

Answer 4

due to lge hypersensitivity reaction to a range of allergens such as animal dander , mould spores or house dust mites

Question 5

what type of drug is sodium clymograte

Answer 5

it is a mast cell stabiliser

Question 6

describe the meahchnism of allergic conjuctivitis

Answer 6

allergic conjuctivitis is caused by an immunoglobulin (lge) response to an allergen

allergens bind to mast cells in the conjuctiva causing them to degranulate which initiates an inflammatory cascade

histamine and other inflammatory mediators are then released- release of histamine causes the itching , causes blood vessels to dilate causing conjuctivial hyperaemia - blood vessels leak , leak water causing oedema and thickens conjuctiva and you get discharge so the tears thicken

Question 7

describe the mode of action of sodium crygolate

Answer 7

stabilises the mast cells and stops the degranulation and stops the inflammatory cascade of proteins which release histamine

SODIUM CRYGOLATE DOES NOT CAUSE DEGRANULATION THAT WOULD CAUSE AN ALLERGIC RESPONSE

Question 8

what are the symptoms of allergic conjuctivitis

Answer 8

activiation of hist mine h1 receptors in the conjuctiva leads to ocular itching (the predominant feature of ocular allergy =)

other allergic symptoms (such as redness and swelling) (chemises) of the conjucitiva and eyelid swelling) have been attributed to stimulation of h1 and h2 receptors on blood vessels

allergic conjuctivits can be made worse If there are problems with the lids, lashes or tear film as this could allow more exposure to the allergens

Question 8

how to differentiate between allergic conjucttivits and other types of conjuctivits

Answer 8

clinical presentation can be non specific but the hallmark symptom of allergic conuctivits is ocular itching (usually bilateral) if itching is no present an alternative should be considered

itching may also be described as burning or stinging

other features= water or mucoid discharge - sometimes referred to as ‘‘tearing’’ - discharge may be stringy or ropey due to the presence of a small amount of mucous

Question 9

where does the discharge produced by allergic conjuctivits usually sit

Answer 9

the ropey stringer mucous usually sits in the tarsal conjuctivia

Question 10

what are other presentations of allergic conjuctivits

Answer 10

conjucttival redness (hyperaemia) , injection

conjunctival swelling (chemossi) bulbar and tarsal conucitiva may budge over lid margin or limbus

conjunctival papillary reaction

eyelid oedema (swelling) periorbiarl oedema can occur in severe cases

Question 11

what are the two key features that are really characteristic of allergic conjuctivits

Answer 11

itchy

swelling on the conjuctiva

Question 12

what is the conjuctival papillary reaction

Answer 12

when looking under the lids there will be stringy mucoid discharge and also papillary response - typical appearance of tarsal conjuctiva should be smooth - if you see a papillary change i..e change to the papillae - suspect allergic conjucitivits

Question 13

what is viral conjuctivitis associated with

Answer 13

• a follicular response on the tarsal conjuctiva most forms of bacterial conuctivits we dont see a response on the tarsal conjuctivitis

Question 14

symptoms of allergic conjuctivits =

Answer 14

transient or subacute attacks of redness , watering , itching associated with sneezing and nasal discharge

conjunctival hyperaemia with relatively mild papillary reaction

Question 15

how would you describe a picture of red eye

Answer 15

conjuctival injection = redness

if its all over described as generalised

if it looks red all over it is called a generalised conjuctival injection

Question 16

what is the oedema of conjunctiva called

Answer 16

chemosis

Question 17

what is hypoyon

Answer 17

when cells accumulate in the anterior chamber

Question 18

in an exam what needs to be described to an examiner

Answer 18

• start with lids and lashes

then conjuctiva

then cornea

anterior chamber

iris

and crystalline lens

tear film

if they dont won’t you to avert lids - mention how you would normally avert the lids to see if there is a pupillary response or a follicular response

dont just talk about disease processes

Question 19

what are the different parts of the conjuctiva

Answer 19

bulbar conuctiva

tarsal conjcucitva

Question 20

if you see bumps on upper lid what is called

Answer 20

pupillae response of the tarsal conjuctiva

Question 21

what is red appearance of the eye with spread out vessels described as

Answer 21

diffuse conjuctival injection

Question 22

what are trantas dots a sign of

Answer 22

• • sign of severe allergy- accumulation of cells -wbcs and other cells- not ulceractions

Question 23

what might allergic conuctivits coexist with

Answer 23

rhinitis and rhinisunsuitis- nose and sinus

asthma

urticaria - general skin rashes

eczema

Question 24

what might symptoms be exacerbated by

Answer 24

symptoms may be exacerbated of other eye conditions such as belepharitis or dry eye

if there is corneal involvement then consider kertacoconuuctivis which has the potential for serious complications and should receive a doctors opinion

Question 25

what is sodium cromoglycate

Answer 25

a mast cell stabiliser - prevents them from degranulating and prevents the release of inflammatory mediators

Question 26

how is sodium cromyglycate available if more than 10ml

Answer 26

pom medicine

Question 27

how is sodium cromyglycate available if less than 10ml

Answer 27

p medicine

GSL if older than 6yrs and for not more than 14 days they have been classifies from p to gel for the relied and treatment of symptoms of hay fever , they are not to be used in children under 6 years for more than. 14 days

Question 28

what is the action of sodium cromoglicate

Answer 28

mast cell stabiliser for the relief and treatment of seasonal and perennial allergic conjunctivas , available in a variety of trade names e.g. opticrom (sanofi) or cromulox (bausch and lomb) multi use preparations so contains benzalkonium chloride

Question 29

is sodium cromoglicate available in the form of single use preperations

Answer 29

available in single use preparations

catacrom eeye drops - 2 percent sodium cromoglicate

opticrom
- allergy single does - eye drops - 2 percent sodium cromoglicate

Question 30

what are the contraindications for sodium cromglycate use

Answer 30

contrainidacted in pts with hypersensitivity to sodium cromolgycate or any component of the preparation - should only be used in pregnancy when there is a clear clinical need - contact lense weares should remove lenses during treatment - - no reported interactions with other meds but if other drops are being used should be spaced by 5-10 mins

Question 31

what is the dose of sodium crymoglycate

Answer 31

the dose is 1 or 2 drops to both eyes 4 times a day

store below 30 degrees and protect from direct sunlight

Question 32

what anti histamines can be used

Answer 32

antalonline sulfate is a antihistamine

available ion the uk as otrivine anntisin antonazone sulfate

0.05% xylometazoline hydrochloride

Question 33

what are contraindications to anti histamine use

Answer 33

hypersensitivity to antazoline

xynlometazonline

or any component oof the preparation

should not be used in pts who have taken monomania oxidase inhibits (MAOIS) within the previous 14 days

Question 34

what patients should the anti histamine not be given too

Answer 34

the only preparation available in the uk contains xylometazoline which is a symphatomimmentic and should be avoided in patients at risk of angle closure

use with caution in elderly patients with severe cardivacualr disease , hypertension , cardiac irregularities , hyperthyroidism , diabetes mellitus and pahemcohryomcyttomas and in patients with conditions causing urniary retention (such as prostatic hypertrophy) or patients who are currently receiving other sympathomimetic drugs

Question 35

what cautions should you be aware of when giving anti histamines

Answer 35

contact lenses should not be worn during treatnent, preparation contains benzalkonium chloride as a preservative , which may accumulate in soft lenses and cause irritation , contact lenses should bee removed prior to application and the patient should wait at least 15 mins before reinsertion

Question 35

if someone is pregnat should anatazoline be given

Answer 35

no

the safety in pregnancy has not been established , should be used with caution during pregnancy and only if the expected benefit to the patient is greater than any possible risk to the developing foetus , it is not known weather anttozoline is excreted in breast milk, its use during great feeding therefore requires that the benefits outweigh the potential risk to the infant

Question 36

what are the drug interactions of anatazoline

Answer 36

should not be used in pts receiving monomaime oxidase inhibitors (MAOIS) within 14 days of stopping such treatment (there is a risk of hypertensive crisis)

should be used with caution in pts receiving other medications such as digitalis (heart drug) , beta adrenergic blockers, guanethisdine , reesperine , methyldopoa or antihypertensive agents

Question 37

what can sedating antihistamines enhance the effects of

Answer 37

sedating antihistamines can enhance the sedating effects of CNS, depressants , including alcohol , hypnotics , opioid analgesics , anxiolytic sedatives and antipsychotics , they also have an additive antimuscarnic action when taken with other antimuscarinic drugs such as atropine and some antidepressants

in the case of concomitant use of another topical eye preparation allow 5-10 minutes between each application of each preparation.

Question 38

what is rebound hyerpermia

Answer 38

check angle status with van heroic test as the sympathomimetic effects of xylomeettazoline can lead to drug induced angle closure

rebound hyperaemia may occur following prolonged or frequent use

ocular side effects are uncommon and typically transient

there have been recent case reports of severe follicular conjuctivitis