Allergies Flashcards by Sarah Heath

Main signs of allergies in the eyes

Papilla and chemosis

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AKC

Rare keratoconjunctivitis that classical occurs in young to middle aged adults (teens to 40s) with a history of atopic conditions. It is not seasonal. Type 1 and 4 HS. Requires chronic treatment and Evals

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What type of HS is AKC

1 and 4

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What is AKC assocaited with

Atopic dermatitis

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Eyelid/adnexal signs

Scaly, thickened, and/or swollen outer eyelid margins, Dennie’s lines (additional crease under the eyelid due to periorbital edema), and “atopy shiners”

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Conjunctival signs of AKC

Commonly involve the INFERIOR fornices and tarsal conjunctiva
Small papillae
Milky, pale, edematous conjunctival appearance (can be described as “featureless” appearance)
Symblepharon formation in the inferior fornices may occur in severe cases and could mimic OCP

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Corneal/lenticular findings of AKC

Neo
Kone
Cataracts

More common in AKC than VKC

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Which is more associated with asthma, AKC or VKC

VKC

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VKC

Seasonal, more in warm months
Strong Association with atopic conditions (asthma, eczema, etc)
Extremely rare
Young males under the age of 10 who live in hot/dry climates
5-10 years before resolving around puberty

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Symptoms of VKC

Intense itching
Photophobia 
Thick mucus discharge 
Lacrimation
FB sensation

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Signs of VKC

Prominent papillae (usually bilateral) on SUPERIOR conj (cobblestone papillae) or superior limbus, and trantas dots 
Corneal involvement may develop due to friction between the superior papillae and the corneal epithelium leading to a shield ulcer

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Superior papillae causes

GPC

VKC

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Inferior papillae causes

AKC

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Treating a shield ulcer in AKC

Topical steroid 4-6x/day

loteprednol
pred acetate
dexamethasone

Topical abx drops/ointment QID

polytrim
erythromycin

Cyclopentolate 1% TID

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Seasonal allergic conjunctivitis

Type 1 HS

Airborne allergens

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Perennial allergic conjunctivitis

Type 1 HS (IgE)

Household allergens

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Symptoms/signs of allergic conjunctivitis

Ocular itching 
Hyperemia 
Tearing 
Rhinitis and sneezing 
Papillae
Conj chemosis

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GPC

Chronic inflammatory condition associated with an immune response against CL deposits (protein) or mechanical trauma
Classically associated with CL wear, but may be secondary to exposed sutures, filtering blebs, scleral buckles, and ocular prosthetics

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What CL wearers are at greatest risk of GPC

Increased modulus
SiHy
Extended wear

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Symptoms of GPC

Decreased CL wear time
Ropy discharge
Itching 
Photophobia
Worse after removing CL

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Signs of GPC

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Papillae (>0.3mm) of the upper tarsal conj
Giant papillae (>1mm) form when neighboring [a[illae break down septa’s and coalesce together after prolonged inflammation

Treatment of GPC

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Daily wear (disposable)
Clear care 
DC wear until clear (1-4m)
Combo drop
Steroid drop-severe cases 
F/U 2-4 weeks

Average length of time for development of GPC associated with CL wear is

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8 months

0may occur as early as 3 weeks depending on type of CL and wear schedule

Risk factors for GPC

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Extended wear hydrogel CL
High water-ionic lenses
Higher modulus
Poor replacement compliance

Atopic dermatitis

Common, chronic, relapsing disorder that results from a type 1 HS (85% of patients have elevated IgE during active AD 60% of patients dx within the first year of life One of several types of eczema and associated with a family Hx of AD, allergic rhinitis, and asthma

Signs of atopic dermatitis

Pruritis Skin rash Itch-scratch-rash-itch Chronic steroids needed

Ocular problems with atopic dermatitis

Cataracts (between age 15-30) - shield cataract - PSC Chronic staph blepharitis, causing a thickened, fissured appearance of the eyelids (atopy shiners) due to constant eye rubbing

How many patients with atopic dermatitis have ocular involvement

25-42%

Causes of presenile cataracts

Wilson is MAD - Wilson’s disease - myotonic dystrophy - atopic dermatitis - DM

Which is AKC more associated with, asthma or AD

AD Can be both, but more commonly AD

Ocular problems from AKC

Keratoconnus Corneal neo Cataracts Symblepharon

Causes of papillae

Allergy: VKC, AKC, allergic conj (IgE) Bacterial: bacterial conjunctivitis, gonorrhea Non specific: floppy eyelid, chlamydia (mixed)

Outer eyelid involvement and inferior issues

AKC

8yo boy in the spring with asthma, superior issues, shield ulcer, cobblestone papillae

VKC

What type of vision is affected most by a PSC cataract

Near

Most common cause of visual impairment in AKC is

SPK

Treatment of AKC

Determine the etiologies cause and remove the offending antigen Cool compresses Tropical ophthalmic MCS/antihistamine combo for acute Short term topical ophthalmic steroids Topical ophthalmic MCS for long term therapy Cataract surgery Kones treated with GPCLs, CXL, corneal transplant Treatment of associated atopic dermatitis

Allergy treatment pearls

- cool compresses, alo, ala, crom, BEZPOP, topical steroids | - lotEmax (ester-safer)

GPC treatment

SiHy change to Hy, go daily Clear care Topical steroids (FML/lotemax) and/or combo drop (BEZPOP) Lotemax Q12hrs x 2 weeks then combo x 4 weeks

What do mast cell stabilizers do

Prevent future degranulation of mast cells, but they do not block actions of histamine that has already been released No indicated for acute cases

What are the MSC/antihistamine combo drops

BEZPOP - bepreve - elestat - zaditor - patanol - optivar - pataday

Treatment for mild allergic conjunctivitis

AT 4-8x day

Treatment for moderate allergic conjunctivitis

Combo drop QD/BID

Treatment for severe allergic conjunctivitis

Mild topical steroid with combo drops | -loteprednol 0.2% or FML 0.1% QID x 1-2 weeks

FU schedule for allergic conjunctivitis

2 weeks

Things that can help all stages of allergic conjunctivis

Cool compresses Eliminate allergen Oral antihistamine

Treatment of VKC

Similar to AKC and allergic conjunctivitis

Treatment for GPC

Temporarily DC CL wear Refit CL with greater frequency of replacement PF CL solution Cool compresses Topical ophthalmic mast cell stabilizers/antihistamine combo Short term topical steroids

What are papillae

Inflamed areas of elevated conjunctiva that contain a central vessel, which serves as the source for infiltration of eosinophils, mast cells, neutrophils, and lymphocytes - range from very small to very large - nonspecific to any condition, but common in allergic and bacterial

What are follicles

Avascular, white Gray nodules that are typically located in the tarsal and fornix conjunctiva - immature lymphocytes and macrophages concentrate in the center of the nodule - associated with chlamydia, toxic, viral, toxic

Allergies Flashcards

(50 cards)