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od2 semester 2 - applied clinical training > wk6: AED - Allergy 2 [DG] > Flashcards

wk6: AED - Allergy 2 [DG] Flashcards

1
Q

List the symptoms of VKC (8)

A 
intense itching/burning
watery
photophobia
FB sensation
puffy lids
mucoid discharge
blurred vision
eye rubbing
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2
Q

List the signs of VKC (7)

A

symptoms may worsen in spring + early summer
type 1 hypersensitivity
uncommon, bilateral, males>females
most common age @5-25yrs
most sufferers atopic (people with other allergies) or have family hx of atopy
usually affects superior tarsal conjunctiva but may affect limbal area (or could affect both)

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3
Q

List the clinical features of VKC (8)

A

bilateral
conjunctival hyperaemia + chemosis
large palpebral papillae (up to 5mm)
stringy mucus dicharge (may sit b/w papillae)
ptosis
Corneal changes: SPK, shield ulcers, subepithelial scarring, eosinophil plaques
Limbus: limbitis with limbal papillae + Horner-Trantas’ dots, and pseudogerontoxon

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4
Q

How does VKC present in the cornea? (4)

A

SPK, shield ulcers, subepithelial scarring, eosinophil plaques

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5
Q

How does VKC present at the limbus? (3)

A

limbitis with limbal papillae + Horner-Trantas’ dots, and pseudogerontoxon in area of previously inflamed limbus

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6
Q

What DDx exist for VKC? (2)

A

atopic keratoconjunctivitis

giant papillary conjunctivitis

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7
Q

How do you assess VKC? (4)

A

hx, slit lamp, fluoroscein, lid eversion

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8
Q

Describe the pathophysiology of VKC, in relation to Th2 lymphocytes and what they mediate (2)

A

Th2 lymphocytes mediate:

  • reduced IgE via IL-4
  • differentiation + activation of mast cells & eosinophils via IL-3 and IL-5 respectively
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9
Q

What might explain improvement in VKC with onset of puberty?

A

over expression of oestrogen and progesterone receptors in the conjunctiva of VKC patients

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10
Q

What might VKC patients have a hypersensitivity to? (3)

A

wind, dust, sun

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11
Q

is their a genetic component behind VKC?

A

Possibly, research has found reduced level of tear film histamine

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12
Q

List tx options for VKC (6)

A

allergen avoidance (if identifiable, role for allergist)
topical MC inhibitors
corticosteroids
topical NSAIDs
topical cyclosporin
referral for superficial keratectomy to improve resolution of shield ulcer

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13
Q

Name 2 topical MC inhibitors that can tx VKC

A

Olapatidine (patanol iBD), Ketoifen (zatiden iBD)

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14
Q

Name a corticosteroid that can tx VKC, when would you schedule follow up after using it?

A

Fluorometholone (FML/Flarex iBD - iQID) - follow up one week after starting therapy

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15
Q

Name 2 topical NSAIDs that can tx VKC

A

Ketorolac (acular iQID), Diclofenac (voltaren iTDS-iQ3h)

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16
Q

How often should you follow up a VKC px if they have a shield ulcer?

A

every 1-3 days

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17
Q

How often should you follow up a VKC px during exacerbations?

A

every few weeks

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18
Q

How often should you follow up a VKC px between exacerbations? (i.e when exacerbations not happening)

A

less frequently (less frequently than every few weeks)

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19
Q

What type of IOP measurement would be best for VKC patients? Why?

A

Non-contact tonometry, b/c thin cornea

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20
Q

When do shield ulcers form?

A

when superficial punctate keratitis (SPK) associated VKC leads to a break in the corneal epithelium

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21
Q

Name the mechanisms that have been proposed to explain the pathogenesis of VKC-associated shield ulcers? (2)

A

Mechanical and toxin hypotheses

22
Q

Explain the mechanical hypothesis for VKC associated shield ulcer pathogenesis

A

Mechanical: suggests giant papillae on upper tarsal conjunctiva are responsible for corneal abrasion

23
Q

Explain the toxin hypothesis for VKC associated shield ulcer pathogenesis

A

Toxin: suggests that eosinophil granule major basic protein found in the inflammatory debris covering VKC shield ulcers is cytotoxic and inhibits wound healing of the corneal epithelium

24
Q

Which hypothesis of VKC associated shield ulcer pathogenesis might explain ulcer re-epithelialization after the inflammatory debris is removed?

A

Toxin hypothesis

25
Q

Which hypothesis explains the more common shield ulcers?

A

Mechanical hypothesis

26
Q

Are VKC and AKC often misdiagnosed as each other? Does it matter?

A

yes, often. DDx usually doesn’t matter at the start

27
Q

Compare the incidence of VKC with AKC in terms of ages (2)

A

VKC: 5-25yrs
AKC: early adulthood, post-puberty

28
Q

How do the symptoms of atopic keratoconjunctivitis (AKC) compare with VKC?

A

Basically the same

29
Q

In regards to AKC:

  • What type of hypersensitivity is AKC?
  • how common, unilateral or bilateral, which sex affect more?
A

type 1

uncommon, bilateral, affects males>females

30
Q

How many AKC px are atopic with associated skin disease?

A

Most

31
Q

What organisms/conditions are AKC patients prone to? (3)

A

Staph. blepharitis and HSV disease

32
Q

How does AKC affect incidence of keratoconus and retinal detachment?

A

Increases

33
Q

How common can AKC patients experience anterior subcapsular cataract?

A

rare (is usually due to these patients using strong steroids)

34
Q

What signs of AKC can present in the skin? (1)

A

atopic dermatitis (e.g. in wrists, neck, eyelids)

35
Q

What signs of AKC can present in the lids? (3)

A

eyelids thickened, crusty, ptosis

36
Q

What signs of AKC can present in the conjunctiva? (3)

A

mainly inferior involvement
papillary hypertrophy, fibrosis, scarring
limbal cystic lesions or papillae

37
Q

What signs of AKC can present in the cornea? (3)

A

SPK
shield ulcers
horner-trantas’ dot

38
Q

What DDx exists for AKC? (2)

A

VKC, GPC

39
Q

How can we assess AKC? (10)

A 
hx
slit lamp
fluoroscein
lid eversion
lid margins
lens
corneal topography
DFE
skin
referral to allergist
40
Q

List the tx options for AKC (6)

A

allergen avoidance, flushing of conj, hypoallergenic bed
topical AH, MCS, NSAIDs as per VKC
corticosteroids [aggressive]
topical cyclosporin
avoid eye rubbing
follow up regularly and as tx mode dictates (see VKC)

41
Q

What corticosteroid can be used to tx AKC?

A

Flarex/Maxidex iTDS to Q2h with aggressive taper

42
Q

Why should you not undertreat with steroids?

A

because if you do undertreat, you’ll get long term accumulation of steroid exposure, which can lead to cataract, etc.

43
Q 
Compare VKC with AKC for the following:
A: age onset
B: sex
C: seasonal variation
D; discharge
E: conj scarring
F; horner trantas dots
G; corneal neovascularisation
H:  presence of eosinophils in conj scraping
A 
VKC                AKC
A: younger    2nd-3rd decade
B: males         no sex favorite
C: spring         perennial
D: thick mucoid watery/clear
E: moderate       higher incidence
F: common          rare
G: no                    yes, generally
H: more                 less
44
Q

List the symptoms of GPC (5)

A 
redness
burning
itch
FB sensation
increased lens awareness in CL wearers
45
Q

What type of allergies is GPC associated with? (5)

A 
allergies to:
CLs
CL deposits
solution preservatives
ocular prosthesis
protruding sutures
46
Q

What advancement in tech has made GPC perhaps less common?

A

perhaps less common since advent of disposable CLs and kinder preservatives in solutions

47
Q

Describe the features of:

  • grade 1 GPC (3)
  • grade 2 GPC (3)
  • grade 3 GPC (3)
  • grade 4 GPC (3)
A

Grade 1: slight conjunctival redness with fine papillae and no symptoms
Grade 2: mild injection, 0.3mm-0.5mm papillae, mild symptoms
Grade 3: moderate injection, 0.5mm+ papillae with increasing CL awareness
Grade 4: severe injection, 0.75mm+ papillae with lens intolerance

48
Q

How can we assess GPC? (5)

A 
hx
slit lamp
fluoroscein
lid eversion
inspection of CLs/prosthesis
49
Q

List tx options for GPC (5)

A

MCS for several months (if less severe)
Topical steroid shorter term (more severe)
Advise px re CL care + overwear, non preserved sol.s
New contact lenses (refit) - daily lenses?
Removal of sutures

50
Q

Name 2 conditions that fall under the category of autoimmune conjunctivitis. How common are they?

A

Cicatricial pemphigold
Steven-Johnson syndrome

These are rare

51
Q

Continue later

A

Oh man oh man

od2 semester 2 - applied clinical training (63 decks)

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