Occular Allergy

Question 1

Red flags in occular allergy

Answer 1

1. Photophobia and pain with light
2. Pupillary abnormalities
3. Blurred vision
4. Ciliary flush

Question 2

List 5 threatening eye conditions

Answer 2

1. Iritis
2. Episcleritis
3. Scerlitis
4. Acute Glaucoma
5. HSV

Question 3

How is allergic conjunctivitis distinguished from infectious conjunctivitis

Answer 3

Infection is usually not pruritic or bilateral

Infection can have purulent discharge

Question 4

How is allergic conjunctivitis distinguished from toxic conjuc.

Answer 4

eyelids are more affected in toxic - edema, excoriations and thickening

Question 5

What time of year is VKC more common

Answer 5

Spring and young boys

Question 6

Name signs of VKC

Answer 6

1. Upper tarsal sign: papillae with cobblestone appearance and thick secretions
2. Limbal signs: dots (Horner Trantas dots) occurring at the junction of the cornea and conjunctiva. Shield ulcers

Question 7

Tx of VKC

Answer 7

1. Avoidance of eye rubbing and cold compresses
2. Topical anti histamines and mast cell stabilizers first line like Oloptadine and Ketotifen
3. Topical steroids can be considers by ophtho
4. AIT
5. May be role for cyclosporin or topical NSAIDs
6. Oral AH - Grade 2C observational studies only

Question 8

Atopic Keratoconjunctivitis: Name 3 features

Answer 8

1. Occurs in people with AD
2. Occular pruritus, eyelid dermatitis, and giant papillae on the lower tarsus and inferior fornix
3. thickening, induration, scaring, and can have cataracts

Question 9

Pathogenesis of AKC

Answer 9

Type 1 and Type 4 hypersensitivity

Question 10

Tx of AKC

Answer 10

1. Avoidance of triggers
2. Topical AH (Oloptadine), mast cell stabilizers (Ketotifen)
3. Topical steroids can be considered by ophtho
4. Eyelid dermatitis can be treated with topical calcineurin inhibitors
5. Can add oral AH
6. Systemic immunosuppression with cyclosporin

Question 11

What is GPC?

Answer 11

Giant cell conjunctivitis which is seen in soft contact lens wearers

Type 1 and Type 4 reaction to foreign substances on the contact lens surface

Question 12

Stages of GPC?

Answer 12

1. mild mucous discharge after sleeping and mild itching after lens removal
2. Increase in mucous production and itching and development of tarsal papillae
3. Severe mucous production, papillae increase in number and size. Contact lens is coated with debris
4. All signs and symptoms are severe and contact lens are worn only briefly

Question 13

Management of GPC

Answer 13

1. d/c lens use for 2 weeks, improve lens hygiene, replace lens regularly, use 3% hydrogen peroxide cleaner
2. Pharm: topical AH and mast cell stabilizers are first line (Oloptadine and Cromyln)

Question 14

Histology in SAR and PAR

Answer 14

mast cell and eos infiltration in conjuc. epithelium and subs. propria

mast cell activation
upregulation of ICAM-1 on epi cells

Tears: increase IgE, histamine, tryptase and TNFa

Question 15

Histology in Atopic KC

Answer 15

mast cells, eos in conjunc. epithelium and substantia propria
Epithelial and globlet cell hypertrophy
Increased collagen

Question 16

What is pathagnomnic for Vernal KC

Answer 16

horner-trantas dots (pathognomonic gelatinous, confluent, yellow-gray infiltrates at the juncture of the cornea and the sclera)

Question 17

Two signs of Vernal KC

Answer 17

1. Horner - trantas dots

2. Cobblestoning papillae

Question 18

Complication of VKC

Answer 18

Corneal ulcers