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