HEENT 15: Allergic Conjunctivitis

Question 1

Describe the clinical presentation of allergic conjunctivitis.

Answer 1

• redness – diffuse, bilateral
• vesicles
• itching
• other allergy symptoms
• light sensitivity
• nasal discharge
• no corneal involvement
• cobblestone papillae under upper eyelid
• blistered conjunctiva
• painless tearing

Question 2

What is the pharmacological treatment for conjunctivitis?

Answer 2

OTC products:

• artificial tears or saline solution
• oral antihistamine
• ophthalmic antihistamine and decongestants/vasoconstrictors
• decongestants – short-term use only to prevent rebound hyperemia (redness)
• ophthalmic mast cell stabilizers – slow onset (2-3 days)

Rx if OTC ineffective:

• ophthalmic antihistamines
• ophthalmic mast cell stabilizers

Question 3

Topical Antihistamines (4)

Answer 3

• antazoline/naphazoline (albalon A) – 1-2 drops q3-4h
• pheniramine/naphazoline (diopticon A, naphcon A) – 1-2 drops up to QID
• ketotifen (zaditor) – 1 drop q8-12h
• olopatadine (patanol) – 1-2 drops q6-8h

Question 4

Mast Cell Stabilizers (3)

Answer 4

• sodium cromoglycate (opticrom) – 1-2 drops 4-6 times/day
• nedocromil (alocril) – 1-2 drops BID
• lodoxamide (alomide) – 1-2 drops QID

Question 5

Ocular Lubricants (4)

Answer 5

1-2 drops TID-QID

• carboxymethylcellulose (refresh tears, celluvisc)
• dextran 70/hypromellose (bion tears, tears naturale)
• polysorbate (dioptears, tears encore)
• polyvinyl alcohol (hypotears, liquifilm tears)