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Flashcards in Allergic eye disease Deck (39)
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what is an ocular allergic response a result from

from exposure to foreign substances (allergens)

allergic response of the ocular surface to extraneous antigens = antigens that are in the outside e.g. hay fever as a response to grass pollen


which parts of the eye does a hypersensitivity reaction mainly affect and which parts may in also involve

conjunctiva but may also involve the lids and cornea


what 4 conditions of ocular allergies are there

- allergic conjunctivitis
- giant papillary conjunctivitis GPC
- contact dermatoconjunctivitis
- keratoconjunctivitis


what 3 conditions is allergic conjunctivitis classified into

- acute allergic conjunctivitis
- seasonal allergic conjunctivitis SAC
- perennial allergic conjunctivitis PAC


what is the ocular manifestation of hay fever

seasonal allergic conjunctivitis SAC


what 2 conditions is keratoconjunctivitis classified into
what structures are affected
what action should be taken if this is seen and why

- atopic keratoconjucntivitis AKC
- vernal keratoconjucntivitis VKC

- as well as the conjunctiva, the cornea is also affected

- refer these patient to HES
- as its a sight threatening condition and frequently needs steroid control


why is giant papillary conjunctivitis GPC not as common as it used to be

as it used to happen when people wore soft CLs for years, this accumulated deposits and there was an allergic response to the deposits

also common in prosthetic eyes


what structures are affected in contact dermatoconjunctivitis and what is it a response to

- affects the conjunctiva and the skin adjacent

- as a response to drugs or cosmetics i.e. something put in/around the eye


what 5 reactions will show signs of an allergic eye disease with the conjunctiva
describe how each one occurs and what they look like

- Oedema (chemosis)
can over lap the cornea, but cornea will still be clear

- Hyperaemia

- Papillae
inflammatory spots, tiny elevations of the conjunctiva surface

- Follicles
collections of lymphoid tissue just under the surface of the conjunctiva (more common in toxic reactions)

- Mucus discharge
from conjunctiva goblet cells that are stimulated to produce more mucous


what 4 reactions will show signs of an allergic eye disease with the lids

- Oedema
- Hyperaemia
- Blepharitis
- Ptosis


what 6 reactions will show signs of an allergic eye disease with the cornea/limbus

- Keratitis
- Infiltrates
- Ulceration
- Plaques
- Scarring
- Trantas dots: follicles around the limbus


what are Trantas dots

follicles around the limbus


list 6 symptoms that occur in an allergic eye disease

- Itching
- Irritation
- Burning
- Epiphora
- Photophobia
- Blurred vision


what is the strongest symptom that someone with allergic eye disease will complain about



what type of photophobia will someone with an allergic eye disease have

not as bad as something like uveitis


when may a patient with an allergic eye disease complain about blurred vision

if the cornea is involved, which is rare
or it may be because the eyes are watering a lot


what is the aetiology of an acute allergic conjunctivitis and give 2 examples of allergens that can cause this

what is a predisposing factor

what is the main symptom

what are the 3 signs

what is your management (name 3 things)

- Urticarial reaction to an allergen that comes in contact with the lid or conjunctiva
reaction is very quick, within minutes, can be bilateral if the allergen connected both eyes
- Type I hypersensitivity reaction
- Allergens include grass pollen, animal dander

Predisposing factor:
- History of atopy

Main symptom:
- Itching
May be unilateral if contact response

- Lid oedema and erythema
- Chemosis
- Epiphora

- Usually resolves after a few hours
- Cool compress
- Allergen avoidance


when does Perennial Allergic conjunctivitis cause symptoms and in response to what

- causes symptoms throughout the year
- in response to allergens such as house dust mite or animal dander


what is the same for seasonal allergic conjunctivitis SAC
and perennial allergic conjunctivitis PAC

the symptoms experienced


what is the prevalence on hay fever in the UK
what do 40% of those affected have
when is the peak hayfever season
symptoms in which part of the body predominate
what can hay fever affect in children

- 15.5% of the UK population suffered from hay fever (7.2 million)

- 40% had symptoms so severe as to affect their work

- Peak hayfever season May/June

- Eye and nasal symptoms predominate

- Hay fever can have an adverse effect on children’s learning ability (as symptomatic during school days)


what are people who have hay fever symptoms in the spring allergic to
and what are people who have hay fever symptoms in the summer allergic to

- spring = tree pollen
- summer = grass pollen


what is the aetiology of Seasonal and Perennial allergic conjunctivitis and examples of what can cause this

what is a predisposing factor

what is the 2 main symptoms

what are the 5 signs

what 4 things can you do for management

Type I
- Seasonal: seasonal allergens
- Perennial: allergens such as house dust mite, symptoms throughout the year

Predisposing factor:
- Family history

- Itching
- Epiphora

- Hyperaemia
- Chemosis
- Lid oedema
- Diffuse papillary reaction
- No corneal involvement

- Allergen avoidance
- Cool compresses
- Sodium chromoglicate
- Topical and systemic antihistamines


explain how family history is a predisposing factor for seasonal/perennial conjunctivitis

genetics determines how your immune system responds to the allergens

they produce a IGe response = an antibody response

IGe binds to the surface of the mast cells and the pollen then causes cross linking and subsequent degranulation

the mast cell mediators cause the symptoms and signs e.g. redness, swelling, oedema etc


list 6 non-pharmacological management options for allergic conjunctivitis

- Allergen avoidance

- Allergen exclusion (difficult to do)

- Cold compresses

- Lid-hygiene (not relevant to hay fever)

- Artificial tears (will wash out some allergens that was in contact with the ocular surface)

- Contact lens fit and hygiene (to allow px to wear CLs)


list 6 ways of allergen avoidance
and 2 ways on allergen exclusion

- Limit outdoor activities
- Use air conditioning
- Reduce humidity (to reduce house dust)
- Protective eyewear
- Barrier cover for mattress and pillows
- Remove reservoirs for allergen e.g. carpets (harbour lots of dust, wooden floors are better)

- Occlusive glasses (prevents allergen to contact ocular surface)
- Induced ptosis


list the 3 pharmacological management options for allergic conjunctivitis

- Antihistamines (oral and topical)
- Mast cell stabilisers
- Combination AH/MCS


how often does someone with allergic conjunctivitis usually have to instil topical antihistamines and when can this not be used

- 4x a day
- cannot use with CLs as contains preservatives


how do mast cell stabilisers work for allergic conjunctivitis

it stabilises mast cell membrane and reduces degranulation


what pharmacological drug can be used for allergic conjunctivitis with CLs and why

- Combination AH/MCS
- because you only need to put it in twice a day, so once before inserting CLs and once after removing CLs

- only available on prescription


what is the 3 possible aetiologies of Giant papillary conjunctivitis GPC

what are 2 possible predisposing factors

what is the 3 main symptoms

what are the 4 signs

what is a ddx

what 3 things can you do for management

- Contact lens wear (trauma and deposits)
- Exposed sutures
- Filtration bleb

Predisposing factors
- History of atopy
- Poor lens hygiene (deposits)

- Mild irritation
- Itching
- Increased lens awareness (leading to intolerance)

- Papillae, variable in size (> 1mm), variable in position
- Tops of papillae may stain with fluorescein
- Palpebral conjunctival hyperaemia
- Increased mucus discharge

Differential diagnosis
- Vernal keratoconjuntivitis

- Lens hygiene (if wear lenses for more than 1 day)
- Disposable lenses
- Mast cell stabilisers


how does RGP lenses cause GPC

it is seen in every RGP wearer, bit because or deposits, but because to mechanical structure of the lens


how does exposed sutures cause GPC

in the old days, during the time of standard cataract surgery when IOLs were big and couldn't be folded up, so had to make incision in cornea, so the sutures caused a mechanical GPC


how does a filtration bleb cause GPC

from surgery for glaucoma
it is the consequence of a trabeculectomy procedure = the creation of a new channel for aqueous drainage
this produces a little vesicle of aqueous on the surface called a bleb = a raised bit


what will you need to do if the management options e.g. mast cell stabilisers don't work on a px with GPC

px to be referred to take topical steroids


what is another name for contact dermatoconjunctivitis

Conjunctivitis Medicamentosa


what is the 2 possible aetiologies of contact dermatoconjunctivitis/Conjunctivitis Medicamentosa

what are the 3 signs

what is the 3 main symptoms

what 2 things can you do for management

- Eyedrops
- Cosmetics applied to the eyelids

- Lid oedema and erythema
- Chemosis
- Follicular conjunctivitis

- Burning
- Stinging
- Epiphora

- Identify and withdraw allergen (if its eyedrops, then use different one)
- Systemic anti-histamines


what is the possible aetiology of Atopic keratoconjunctivitis

what is a possible predisposing factor and give 2 examples of this

what is the 4 main symptoms

what are the 4 signs

what is a ddx

what things can you do for management, for mild, for severe and 2 other general options for both types

- Adult equivalent of vernal keratoconjunctivitis
- Young adult males
- Perennial with exacerbations (all year round)

Predisposing factors
- Atopic history
e.g. eczema, asthma

- Itching
- Epiphora
- Blurred vision
- Mucus discharge

- Eyelids thickened, crusted and fissured
- Blepharitis
- Conjunctival hyperaemia
- Corneal involvement

Differential diagnosis
- Vernal keratoconjunctivitis

- Mild: sodium chromoglicate
- Severe: with corneal involvment, steroids/immunosuppressants
- Lid hygiene
- Antibiotics (if risk of concurrent infection)


what is the possible aetiology of vernal keratoconjunctivitis

what 3 possible predisposing factors

what is the 4 main symptoms

what are the 8 signs

what 5 management options are there

- Uncommon allergic disorder of children

Predisposing factors
- Onset below 10 years
- Exacerbations during spring (but can be all year round)
- Atopic history

- Itching
- Epiphora
- Blurred vision
- Photophobia

- Mucus discharge
- Giant papillae
- Hyperaemia
- Trantas dots
- Punctate corneal staining
- Erosion
- Plaque
- Scarring

- Cold compresses
- Mast cell stabilisers
- Corticosteroids
- Mucolytics
- Ciclosporin
need strong systemic immunosuppresent drug
difficult condition to treat, so needs referring to specialist ophthalmologist to treat


why is vernal keratoconjunctivitis a serious condition and what does it require if seen in practice

- cornea is involved so is sight threatening
- needs referring to specialist ophthalmologist to treat