Ocular Allergy

Question 1

Allergic Conj S&S(5)

Answer 1

• Bilat itching, tearing + H20
• Conj mild inject + edema
• Papillae on palp conj
• mild mucous discharge
• periorbital venous congestion

Question 2

Allergic Conj Tx

Answer 2

• Artificial Tears
• Anti-histamines
• Anti-histamines + Decongestants
• Mast Cell Stabilizers (MCS)
• Anti-hisatmine + MCS
• NSAIDs
• Steroids

Question 3

Allergic Conj - Artificial Tears

Answer 3

• Dilutes allergen
• if allergy is assoc with Dry Eye
• Freq Dosing (use unpreserved or non-preserved perserved)

Question 4

Allergic Conj - Antihistamines

Answer 4

• use in Acute cases
• Livostin
• Emadine

Question 5

Allergic Conj - Anti H + Decong

Answer 5

• Acute Care
• QID
• rebound vasodilation adverse
• Pheniramine meleate 0.3 + Naphazoline HCL 0.025
• Pheniramine maleate 0.5 + Naphazolin HCL 0.05

Question 6

Allergic Conj - MCS

Answer 6

• Chronic Care
• no immediate relief - prophylactic
• Cromolyn Sodium 4%
• Lodoxamide trimethamine 0.1%

Question 7

Allergic Conj - Anti H + MCS

Answer 7

• best choice for acute + chronic
• Ketotifen 0.025% - BID
• Azelastine HCL - BID
• Olopatadine
• Patanol 0.1 - BID
• Pataday 0.2 - QD
• Pazeo 0.7 QD

Question 8

Allergic Conj - NSAIDs

Answer 8

• Acute

- Ketorolac (Acular) - QID

Question 9

Allergic Conj - Steroids

Answer 9

• Acute (for severe conj inflam only)
• not for chronic use
• Lotoprednol 0.2 - BID to QID

Question 10

Vernal Keratoconjunctivitis (VKC)

Answer 10

• Chronic conj inflammatory disorder
• primarily young males under 10
• resolves at puberty
• duration 2-10yrs
• most prev - Medit & West Africa
• Year round disease with seasonal flare ups

Question 11

VKC - signs

Answer 11

• Superior Tarsal cobble giant papillae
• Trantas’ dots (eosinophils & dead epith cells)
• may progress to pannus & superficial corneal neovasc
• Shield ulcers (usually superior)

Question 12

VKC - Tx

Answer 12

• usually self-limiting but should be treated
• Steroids - BID to QID to start
• Follow with MCS/Anti H for chronic
• NSAIDs?

Question 13

VKC shield ulcer Tx

Answer 13

• Strong steroid (Prednisolone Acetate 1% q3 to 4h
• Erythromycin ung QID
• Cycloplegia PRN

Question 14

Giant Papillary Conj (GPC) - causes

Answer 14

- chronic irritation from:
FB
Extruding scleral buckle
Exposed sutures
CLs

Question 15

GPC tx

Answer 15

• Steroids
• NSAIDs
• MCS + Anti H
• NB definitive Tx

Question 16

GPC definitive Tx

Answer 16

• Remove offending element (change CL material or CL sol)

Question 17

Atopic Dermatitis (contact) Signs

Answer 17

• sudden onset lid swelling
• mild H2O discharge
• Periorbital rash
• itching

Question 18

Contact Dermatitis Signs

Answer 18

• Chemosis out of proportion to injection

Question 19

Contact Dermatitis - Etiology

Answer 19

• Most common - eye drops (inc Steroids), cosmetics (inc nail polish)
• Autoimmune/idiopathic
• often Eczema

Question 20

Contact/Atopic Dermatitis Tx

Answer 20

• avoid offending agent(s)
• cool compress (4-6 QD)
• Presev neg art tears 4-8 QD
• topical anti H
• consider oral anti-H
• Consider mild steroid cream to lid (Atopic)
• Lotemax ung (fingertip rub on lids) BID - QID
• Hydrocortisone cream 1% TID for 5 days
• avoid ocular surface contact & skin thinning on chronic