Download outline5275

RECOGNIZING, TREATING AND AVOIDING
OCULAR ALLERGIES
Joseph P. Shovlin, OD, FAAO
Northeastern Eye Institute
Scranton, PA
Classification of Hypersensitivity Reactions
Types of Allergic Diseases of the Eye
Irritative Keratoconjunctivitis & Drug
Hypersensitivities of the Eye
Atopic Diseases
Vernal Keratoconjunctivitis
Giant Papillary Conjunctivitis
Contact Allergy
Microbial Allergy: Phlyctenulosis
Rosacea
Treatment of Allergic Diseases
Goals:
This presentation will provide a review of the basic mechanisms operant in
allergic eye disease with an emphasis placed on early recognition and differential
diagnosis. Proper treatment and management including ways to avoid allergy will
be offered.
Learning Objectives:
1. Explain the basic process of sensitization and understand the
pathways of early and late phase responses.
2. Recognize the clinical presentations of allergic eye disease.
3. Discuss the clinical management of allergic eye disease and
related systemic disease.
4. Understand the strategies necessary to avoid the various
causes of allergy whenever possible.
Abstract:
Clinicians must be able to easily identify and manage the various
presentations of ocular allergy in the primary eye care practice. Several
cases of ocular allergy will be shared along with the appropriate treatment
plan. Emphasis will be placed on early recognition, differentials to be
considered, means to avoid allergy whenever possible and the use of
appropriate pharmaceuticals.
Outline
I. Classification of Hypersensitivity Reactions
A. Coombs & Gell (1963)
B. Immediate v Delayed Responses
1. Allergic sensitization
2. Early and late phase allergic response
3. Systemic ramifications
II. Ocular Allergy
A. Types of Allergic Diseases of the Eye
1. Characteristics
2. Causes
B. Ocular Conditions
1. Acute Allergic Conjunctivitis
2. Hay Fever Conjunctivitis
3. Atopic Keratoconjunctivitis
4. Vernal Keratoconjunctivitis
5. Giant Papillary Conjunctivitis
6. Contact Allergy and Contact Dermatitis
7. Microbial Allergy (Phlyctenulosis)
C. Differential Diagnoses of Other External Diseases
III. Rosacea: A New Look At An Old Condition
IV. Treatment of Allergic Eye Disease
A. Topical Agents
1. Vasoconstrictors
2. NSAIDs
3. Antihistamines
4. Mast cell stabilizers
5. Corticosteroids
B. Oral Agents
1. Stabilizers
2. Rescue therapy
3. Immunotherapy
C. Supportive Therapy and Avoidance
D. Newly Approved and Experimental Therapies
V. Allergy Resources On the Web
Transcript Quality Course Questions Cope: 7819-AS
1. Which of the following conditions has not been associated with atopic
keratoconjunctivitis:
A. cataracts
B. keratoconus
C. retinal detachment
D. posterior uveitis
2. The two most operant groups of the Coomb and Gell Classification system
associated with ocular allergy are:
A. I and IV
B. II and III
C. I and III
D. II and V
3. Vernal shield ulcers are best described as:
A. an indolent ulcer (sterile) that forms secondary to mechanical and
chemical mediators
B. an infectious ulcer that is primarily due to pseudomonas
C. a sterile neurotrophic ulcer secondary to crack cocaine
D. a sterile ulcer secondary to vitamin A deficiency
4. Topical decongestants should be used with caution in patients with:
A. primary open angle glaucoma
B. secondary pigmentary dispersion glaucoma
C. a known shallow anterior chamber and narrow angle
D. pseudoexfoliative conditions
5. Oral antihistamines are not contraindicated in which patients:
A. nursing mothers
B. pregnant women
C. with a known hypersensitivity to Loratidine
D. with a known hypersensitivity to aspirin
6. Which of the following statements least accurately describes a delayed
hypersensitivity:
A. the allergen is protein
B. best treatment is with the use of anti-lymphocytic drug
C. mechanism of action is primarily through humoral antibodies
D. the process starts at 24 hrs. and ends by 72 hrs.
7. Irritative keratoconjunctivitis can be distinguished from true allergic disease by
all of the following, except:
A. no allergen present
B. inciting agent causes a response only after repeated exposures
C. response is not greater or different between exposures
D. removing the offending agent is often all that is needed to remedy the
condition
8. Atopic disease includes all of the following conditions, except:
A. utricarial reactions
B. asthma and emphysema
C. eczema
D. hayfever
9. Dust mites affect approximately_________% of the population?
A. 10%
B. 35%
C. 70%
D. 99.9%
10. Patients with atopic keratoconjunctivitis and atopic dermatitis should be
protected from exposure to which of the following:
A. herpes simplex and vaccinia
B. herpes simplex and malaria
C. herpes zoster and small pox
D. herpes zoster and malaria
11. Which of the following statements as they relate to a comparison of vernal
keratoconjuctivitis (VKC) and giant papillary conjunctivitis (GPC) is not accurate:
A. both conditions have the potential to produce large papillae of the tarsal
conjuctiva
B. in VKC, more mediator, like histamine, is released than in GPC
C. “phantom” mast cells are more prevalent in GPC
D. a greater number of eosinophils is present in VKC
12. Future direction in new therapy would include the regulation of the following
chemokines:
A. ICAM-1 and ICAM-3
B. ICAM-2 and VCAM-1
C. ICAM-3 and VCAM-2
D. ICAM-2 and ICAM-3
13. Which of the following best characterizes hayfever conjunctivitis:
A. PMN response with minimal IgE response
B. severe discharge, often purulent
C. elevated IgE response, eosinophils may be absent
D. corneal signs are often present and include indolent ulcers
14. The following statements are true as they relate to the use of oral agents in
allergic eye disease, except:
A. should involve an allergist or physician specializing in some aspects of
allergic systemic disease
B. might include as an entry level treatment plan the use of immunotherapy (injections) before employing corticosteroid oral agents
C. oral stabilization therapy might include antihistamines, decongestants
or corticosteroids
D. oral rescue therapy has minimal risks to the eye with prolonged
corticosteroid use
15. Recalcitrant rosacea with advanced circumferential extension of stromal
thinning is best managed by the use of the following agents:
A. 1% compounded medroxyprogesterone and topical cyclosporine
B. oral doxycycline and topical sulfacetamide
C. Theratears Nutrition for Dry Eye and artificial tears
D. topical cyclosporine and artificial tears
16. Phlyctenulosis is best described as :
A. a specific response to any microbial antigen characterized by focal
lesions of the conjunctiva and sometimes the cornea
B. a hypersensitivity reaction to aminoglycosides
C. any response to airborne allergens that produces a Horner’s point or
Trantas’ dot
D. an indolent ulcerative lesion of the cornea caused by staphyloccus and
TB
17. Treatment of contact dermatitis includes all of the following, except:
A. heat applied to the involved skin area regularly
B. mild topical corticosteroids
C. removing the offending agent
D. oral antihistamines
18. Corneal involvement in severe contact allergy would not include the
following:
A. punctuate epithelial erosion
B. thickening of the epithelium (plaque)
C. pannus formation
D. filamentary keratitis
19. Which of the following is least likely to cause giant papillary conjunctivitis?
A. corneal suture material with buried knots
B. corneal adhesive/ glue without the use of a bandage contact lens
C. short-term wear of an ocular prosthesis that is removed and cleaned
every night
D. extruded scleral buckle
20. The best first-line treatment options for hayfever conjunctivitis include:
A. removal of the antigen and aminoglycosides
B. removal of the antigen and the use of vasoconstrictors and
antihistamines
C. topical steroids and sulfacetamides
D. sulfacetamides and vasoconstrictors
ANSWERS: 1. D 2. A 3. A 4. C 5. D 6. C 7. B 8. B 9. C 10. A
11. C 12. A 13. C 14. D 15. A 16. A 17. A 18. D 19. B 20. B