Transcript
Allergic eye disease Presented by: khoy sothearith
2nd year resident
Outline
• Acute allergic conjunctivitis
• Seasonal and perennial allergic conjunctivitis
• Vernal keratoconjunctivitis
• Atopic keratoconjunctivitis
Acute allergic conjunctivitis – presentation
• Younger children( spring or summer)
• acute itching and watering, associated with severe chemosis
Acute allergic conjunctivitis – treatment
• Usually not require – Chemosis settle within hours
• Cool compress
• Single drop of adrenaline 1%
Seasonal and perennial allergic conjunctivitis
Seasonal”hay fever eye “
• Spring and summer • Allergen: tree and grass
polen • Specific allergen varies
with geographic location • Common
Perennial
• Through the year, worst in automm
• Allegen: house dust mite, animal dander, fungal allergen
• Less common
Diagnosis
• Presentation: transient acute or subacute redness, watering and itching, associated with sneezing or nasal discharge
• Signs: – completely resolve within episode
– Conjunctival hyperemia
– Mild papillary reaction
– Chemosis and eyelid edema
• Investigation – Not require
– Conjunctival scrapping -> eosinophilia
Treatment • Artificial tear • Mast cell stabilizer( sodium cromoglycate, nedocromil
sodium, lodoxamide) • Antihistamines( emedastine, epinastine, levocabastine,
bepotastine) • Combined preparation( antihistamine + vasoconstrictor): Otrivin-Antistin®
• Dual action of antihistamine + mast cell stabilizer(azelastine, ketotifen, olopatadine)
• Topical steroid • Oral antihistamine
– Severe case
Vernal keratoconjunctivitis
• Affects children and young adults• More common in males and in warm climates• Itching, mucoid discharge and lacrimation
• Palpebral
Types
• Limbal• Mixed
• Recurrent, bilateral
Frequently associated with atopy: asthma, hay fever and dermatitis
Progression of vernal conjunctivitis Diffuse papillary hypertrophy, most marked on superior tarsus
Formation of cobblestone papillae Rupture of septae - giant papillae
Limbal vernal
Trantas dotsMucoid nodule
Progression of vernal keratopathy
Punctate epitheliopathy Epithelial macroerosions
Plaque formation (shield ulcer) Subepithelial scarring
Atopic kertoconjunctivitis
similar to VKC, more severe and unremitting
Rare bilateral
Typically develop in adulthood
No gender preponderance
Tend to be perennial, worst in winter
Atopic keratoconjunctivitis
Typically affects young patients with atopic dermatitis
Eyelids are red, thickened, macerated and fissured
Progression of atopic conjunctivitisInfiltration of tarsal conjunctiva causing featureless appearance
Inferior forniceal papillae Mild symblepharon formation
Progression of atopic keratopathy
Punctate epitheliopathy Persistent epithelial defects
Subepithelial scarring Peripheral vascularization
Treatment of VKC and AKC
management of VKC does not differ substantially from that of AKC• less responsive and requires more intensive and
prolonged treatment
General measure
• Allergens avoidance
• Cool compress
• Lid hygiene
Local treatment
• Mast cell stabilizer
• Antihistamine
• Combine preparation
• Steroid
• Immune modulator – Cyclosporine 0.05%: if steroid ineffective– Tacrolimus 0.03%
Systemic treatment
• Antihistamine • Antibiotic(doxycycline 50–100 mg daily for 6 weeks or
azithromycin 500 mg once daily for 3 days) – to reduce blepharitis
• Immunosuppressive agents(e.g. steroids, ciclosporin, tacrolimus, azathioprine)
• Aspirin
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