First Aid, Chapter 7 Hypersensitivity Disorders, Conjunctivitis

Question 1

What is allergic conjunctivitis?

Answer 1

AC is a self-limited, bilateral inflammation of the conjunctiva with limbal sparing (lack of or less injection around the limbus, where the cornea fuses with the conjunctiva)

Question 2

What are allergic shiners? What causes allergic shiners?

Answer 2

Allergic shiners are a transient increase in periorbital pigmentation from decreased venous return to skin and tissue.

Question 3

What is the prevalence of allergic conjunctivitis?

Answer 3

20% of the general population being affected, 60% of whom present with allergic rhinitis.

Question 4

What is the best treatment for AC?

Answer 4

Dual-acting topical medications with combination of H1-receptor antagonist and mast cell stabilizers (e.g., olopatadine, ketotifen, and azelastine).

Question 5

What is vernal keratoconjunctivitis? What population does it occur in?

Answer 5

Vernal keratoconjunctivitis (VKC) is a sight-threatening, bilateral chronic inflammation of the conjunctiva. It occurs more in young atopic males (ages 3–20 years) residing in warm and dry climates.

Question 6

What is ciliary flushing, and in which conditions is it found?

Answer 6

Ciliary flushing is an injection of the deep episcleral vessels, causing redness around the cornea. It is seen in corneal inflammation, iridocyclitis, and acute glaucoma.

Question 7

What is the pathology of vernal keratoconjunctivitis?

Answer 7

The exact mechanism is incompletely understood, but mast cells and eosinophils are increased in conjunctival epithelium and substantia propria.

Question 8

What are symptoms and features of vernal keratoconjunctivitis?

Answer 8

VKC presents with a severe photophobia and intense ocular itching. Key features include papillary hypertrophy (>1 mm), resulting in possible ptosis of the upper eyelid, thick, ropey discharge, and Horner-Trantas dots.

Question 9

What is the differential diagnosis of vernal keratoconjunctivitis?

Answer 9

• Atopic keratoconjunctivitis (AKC) -Giant papillary conjunctivitis (GPC)
• AC
• Infective conjunctivitis
• Blepharitis

Question 10

What is the treatment for vernal keratoconjunctivitis?

Answer 10

Allergen avoidance (i.e., alternate occlusive eye therapy) and high-dose pulse topical corticosteroids. Mast cell stabilizers (i.e., cromolyn) have shown to be effective. Other treatments include dual-acting medications (i.e., H1-receptor antagonist and mast cell stabilizers) oral antihistamines, and antibiotic and steroid ointments (for shield ulcers).

Question 11

What is atopic keratoconjunctivitis?

Answer 11

Atopic keratoconjunctivitis (AKC) is a sight-threatening, bilateral chronic inflammation of the conjunctiva and eyelids. It occurs mostly in teenagers or young adults in their twenties with a personal or family history of atopic dermatitis. The conjunctival activity parallels the skin involvement and can occur perennially (no seasonal predisposition).

Question 12

What is the pathology of atopic keratoconjunctivitis?

Answer 12

Similarly to AC, AKC involves IgE, mast cells, and eosinophils.

Question 13

What is the key feature/symptoms of atopic keratoconjunctivitis?

Answer 13

The key feature of AKC is chronic ocular pruritus/burning with findings of atopic dermatitis.

Question 14

How can loss of vision occur in atopic keratoconjunctivitis?

Answer 14

From corneal pathology which includes:

• Superficial punctuate keratitis
• Corneal infiltrates
• Scarring
• Keratoconus
• Anterior subcapsular cataracts (Figure 7-4)

Question 15

What is the differential diagnosis of atopic keratoconjunctivitis?

Answer 15

 Contact dermatitis  Infective conjunctivitis  Blepharitis  Pemphigoid  VKC  AC  GPC

Question 16

What eye problem does steroid administration cause?

Answer 16

Steroid administration results in formation of posterior subcapsular cataracts. (Prednisone = posterior)

Question 17

What is the treatment of atopic keratoconjunctivitis?

Answer 17

Treatment of AKC usually involves environmental allergen controls and a transient topical corticosteroid. Mast cells stabilizers (i.e., cromolyn) or dualacting medications (e.g., H1-receptor antagonist and mast-cell stabilizers) are effective. Other treatments include systemic antihistamines, cyclosporine A (oral or topical), and topical tacrolimus.

Question 18

What is giant papillary conjunctivitis?

Answer 18

GPC is accompanied by a chronic, bilateral inflammation associated with foreign body intolerance (e.g., ocular prostheses, sutures). May be aggravated by concominant allergy.

Question 19

What percentage of contact lens wearers does GPC affect? What types of contacts are most affected?

Answer 19

may affect 20% of contact-lens wearers (Figure 7-5). Extended-wear soft contact lens > hard contact lens > soft contact lens (daily disposables).

Question 20

What is the pathology of giant papillary conjunctivitis?

Answer 20

Mechanical trauma with irritation of the upper lid and protein buildup on the lens causes an allergic reaction. Tear deficiency may also be a contributing factor of GPC.

Question 21

What are clinical features of GPC?

Answer 21

Key features of GPC are:  
-Ocular itching after lens removal 
-Morning mucus discharge
-Photophobia or blurred vision 
-Contact lens intolerance 
Tarsal papillary hypertrophy is smaller than in VKC (i.e., >0.3mm).

Question 22

What is the differential diagnosis of GPC?

Answer 22

• Infective conjunctivitis
• Irritant or toxin conjunctivitis
• AC
• AKC
• VKC

Question 23

What is the treatment of GPC?

Answer 23

Reduction in contact lens wearing and/or a change in lens style, plus “artificial tears.”

Question 24

What are sight-treatening conditions in pts with eye issues? What are the red eye danger signs?

Answer 24

Acute glaucoma, scleritis, iritis, uveitis, herpes simplex keratitis.

Photophobia, blurred vision, severe pain, seeing colored halos, abnormal pupil size (sluggish or fixed), ciliary flush.