Download Vernal Keratoconjunctivitis Atopic Keratoconjunctivitis

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• Topical 2% Sodium Chromoglycolate to
prevent recurrence
• Corticosteroid drops in severe cases
Vernal Keratoconjunctivitis
Definition
Hypersensitivity reaction of conjunctiva to
exogenous allergens
• Age 6-20 yrs, usually males
• Seasonal variation - Prevalent in summer
• Exciting factors - Dust, dry heat, pollens
Symptoms
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Intense itching
Discharge
Photophobia
Burning
Foreign body sensation
Signs
• Cobble stone appearance due to papillary • Hypertrophy in the palpaberal
conjunctiva
• Multiple small nodules around the limbus
• Superficial white spots scattered around
the limbus.
Treatment
• Cold compresses
• Disodium chromoglycolate 4 times / day
reduces itching
• Topical steroids like dexamethasone 4
times daily and tapering dose depending
on the severity.
Long term use of steroids can cause cataract
and glaucoma.
Atopic Keratoconjunctivitis
• Atopic keratoconjunctivitis (AKC) is the
result of a condition called "atopy".
• Atopy is a genetic condition where the
immune system produces higher than
normal antibodies in response to a given
allergen. • Symptoms may worsen in the winter.
• With AKC, the conjunctiva lining the
eyelids is usually red and swollen.
• The lower eyelid is affected more than the
upper eyelid.
• If left untreated, AKC can progress to
ulceration, scarring, cataract, keratoconus,
and corneal vascularization.
Symptoms
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Sensitivity to light
Itching
Burning
Tearing
Red and hardened eyelids
Treatment
• Cold compresses and saline irrigation to
lower the elevated tear pH
• In more severe cases, there is potential for
damage to the eye caused by scratching
and rubbing. Wear cotton gloves at night
to prevent unintentional damage to the
ocular surface.
• Astringent drops, e.g. zinc sulphate, to
relieve symptoms.
• Topical steroids such as prednisolone eye
drops are frequently used.
• Antithistamines are only partially
effective.
• Mast cell stabilizers such as Cromolyn
Sodium 4% and Lodoxamide 0.1% are
effective, if used continuously for many
months.
• Mucous membrane graft to the upper lid
tarsal conjunctiva can be useful.
Injection - dilation of the conjunctival vessels; Compromised - inability to resist infection; Antihistamine - medications to treat
allergies; Recurrence - occur again or repeatedly; Corticosteroid - class of steroid hormones; Hypertrophy - increase in size
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Selective Laser Trabeculoplasty (SLT)
Clinical
What is SLT ?
• SLT is a laser treatment that can reduce
IOP in patients with open-angle glaucoma
(OAG). SLT has a very short pulse
duration (3 ns), which is shorter than the
thermal relaxation time of melanin the
pigment in the eye, allowing for selective
photothermolysis
• Selective photothermolysis is a precise
microsurgery technique used to target
tissue in a specific area. It matches the
specific wavelength of light and heats the
tissue and destroys it with a laser without
affecting or damaging surrounding tissue.
• Selective laser trabeculoplasty was
developed in 1999 by Latina and Park
as an alternative to ALT - Argon laser
trabeculoplasty.
How does it work?
• SLT uses an advanced cool laser system
to target only specific pigmented cells of
the TM (trabecular meshwork) – those
containing melanin, a natural pigment.
• This non-invasive procedure allows for
only these cells to be affected, leaving the
surrounding tissue intact.
• As a result, the body’s own healing
response expands the microscopic pores
in the TM, enhancing aqueous humor
drainage and helping to lower the IOP.
What are the benefits of SLT ?
• Safe: SLT is not associated with systemic
side effects or compliance problems and
cost of daily medications.
• Selective: SLT utilizes selective
photothermolysis to target only specific
pigmented cells. No heat is released
and this prevents the surrounding non
pigmented tissues from damage
• Smart: SLT stimulates the body’s natural
mechanisms to enhance aqueous humor
outflow from the eye.
• Sensible: SLT therapy is reimbursed by
insurance, minimizing expenses.
• The energy level is only 1% of ALT and
hence there is no thermal and structural
damage to the trabecular meshwork and
SLT is potentially repeatable
• Bilateral response
• The incidence of iritis and elevated IOP is
much lower compared to ALT.
• SLT lowers the IOP by about 30% when
used as initial therapy. This is comparable
to the IOP lowering of the most powerful
and commonly used glaucoma medication
What is the treatment protocol?
• Pretreatment with alpha adrenergic
agonist and topical anesthetic drops. Selective Photothermolysis - technique using laser therapy to remove fine lines and wrinkles
Compassion Oct - Dec, 2016
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• Goldmann or Latina lens is placed
onto the eye with methylcellulose, an
eye lubricant for viewing the anterior
chamber. 1.0x magnification maintains
laser spot size for accurate laser energy
delivery. Tilted anterior lens surface
corrects astigmatism to maintain circular
laser beam profile and given sharp images
for examination.
• Aiming beam is focussed at the trabecular
mesh work so that the 400 micron spot
covers the entire trabecular meshwork.
• After the procedure, topical steroids or
NSAID is precribed for 3-5 days.
• IOP is checked after one hour of treatment.
• Follow up is advised after 1 week, 1
month and 3 months and then every 3
months.
• The effect will generally last between 1-5
years the thermal relaxation time - the time
taken for an object to cool down from 100º C
to 50ºC
- Sr. S.V.Saranya
DOT, Glaucoma Clinic,
Aravind - Coimbatore
Eye and its wonders
Human eye can see a candle at a distance of fifteen miles.
One billion messages stream in from the retina for one second.
Eyes blink 17 times, per minute.
‘Magic Eye’ problems have to do with the way the eyes work with each other and the
brain.
Unlike the cameras, the eye sharpens the image along the edges.
Our brain adjusts the reversed image to its right position without the help of a mirror.
In darkness, eye can increase its sensitivity to light upto one lakh times.
Eyes are self-cleaning, self-lubricating and self-repairing.
Eyes are designed differently for each species like owl, fish, flies and others.
Pigmented areas alpha adrenergic agonist - an agent that selectively binds and activates; Alpha-adrenergic receptors - An
agent that selectively binds and activates alpha-adrenergic receptors. In the eye it causes dilation of the pupil of the eye and
reduces the production of aqueous humour.