allergic conjunctivitis
DESCRIPTION
konjungtivitis alergiTRANSCRIPT
Allergic conjunctivitis
February 8th, 2012 | Author: Kantatasamsara
Allergic conjunctivitis:
Allergic conjunctivitis may be classified into the followings :
1. Simple Allergic conjunctivitis2. Vernal conjunctivitis
3. Atopic conjunctivitis
4. Phlyctenular conjunctivitis
5. Giant papillary conjunctivitis
Allergic rhino conjunctivitis /Simple Allergic conjunctivitis:
1.Acute allergic rhinoconjunctivitis
2.seasonal allergic conjunctivitis ( hay fever), with onset during
the spring and summer .
3.perennial allergic conjunctivitis causes symptoms through out
the year with exacerbation in the autumn .
Diagnosis:
Presentation Symtomps
Transient,acute attacks of redness, watering and itching.
Associated with sneezing and nasal discharge
Signs—lid oedema—chemosis and a papillary reaction
Treatment:
Mast cell satbilizers Antihistamines
Combined antihistamines and mast cell stabilizers
Steroids
Vernal kerato conjunctivitis:
Vernal Keratoconjunctivitis is a bilateral, recurrent, disorder in which IGE and cell mediated
immune mechanisms plays important roles.It primarily affects boys and usually presents in the first decade of life. 95% of cases remit by the late teens and the remainder develops atopic keratoconjunctivitis.Classification:
o Palpebral disease primarily involves the upper tarsal conjunctiva.
o Limbal disease typically affects black and Asian people.
o Mixed has features of both palpebral and limbal disease.
Diagnosis:
o Symptoms consists of intense itching, which may be associated with lacrimation,photophobia, a foreign body sensation, burning and thick mucoid discharge
o Palpebral disease
o Diffuse papillary hypertrophy on the superior tarsus
o Macropapillae(1mm)(cobblestones)
o Giant papillae
o Limbal disease
o Gelatinous papillae on the limbal conjunctiva that may be associated with discrete white spots at their apices(Trantas dots)
o In tropical regions limbal disease may be very severe
o Keratopathy
o Punctate epithelial erosions
o Epithelial macroerosions
o Shield ulcer and plaque
o Pseudogenerontoxon
o Perpheral superficial vascularization
o Herpes simplex keratirtis
Treatment:
o Topicalo Mast cell stabilizers
o Antihistamines
o Steroids
o Acetylcysteine
o Ciclosporin
o Supratarsal steroid injection
o Systemic
o Immunosupressive agent
o Oral antihistamines
o Surgery
o Superficial keratectomy
o Amniotic membrance overlay graft
Atopic kerato conjunctivitis:
Atopic keratoconjunctivitis is a rare bilateral and symmetrical disease that typically develops in young men following a long history of severe atopic dermatitis.
Diagnosis:
o Symptomps are similar to VKC but often more severe and unremitting.o Eyelids
o Red,thickened,macerated and fissured lids with chronic staphylococcal blephiaritis and madarosis.
o Tightening of the facial skin may cause lower lid ectropion and epiphora.
o Conjunctiva
o Micropapillary conjunctivitis
o Giant papillae
o Scarring and infiltration
o Cicatricial conjunctivitis
o Symblepharon
o Keratopathy:
o Punctate epithelial erosions
o Persistent epithelial defect
o Prediposing to keratoconus
o Treatment:
o Topical
o Mast cell stabilizers
o Ketorolac
o Antihistamines
o Steroids
o Acetylcysteine
o Ciclosporin
o Antibiotics
o Supratarsal steroid injection
o Systemic antihistamines
o Antibiotics
o Ciclosporin
o Phlyctenular conjunctivitis:
It is an allergicreaction of the conjunctiva caused by endogenous bacterial toxins and characterised by bleb or nodule formation near the limbus.
o Aetiology:o Tuberculo-protien
o Toxins from staphylo-coccus or streptococcus.
o Toxins from intestinal parasites.
o Clinical types:
o Phyctenular conjunctivitis
o Phlyctenular kerato-conjunctivitis.
o Phlyctenular keratitis.
o Symptoms:
o Redness with formation of bleb.
o Irritation and lacrimation.
o Pain and photophobia.
o Signs:
o One or more,small ,round and raised nodule at or near the limbus
o Localised bubar congestion
o No conjunctival discharge.
o Secondary infection.
o Complications:
o Phlyctenular keratitis
o Fascicular ulcer
o Superficial phlyctenular pannus.
o Ring ulcer.
o Investigations:
o To detect tuberculosis:
o Sputum for AFB.
o Blood for TLC,DLC,ESR.
o X-ray chest.
o Mantoux test.
o ENT consultation to exclude chronic tonsilitis or adentis.
o Stool for OPC.
o Conjunctival swab and corneal scraping.
o Treatment:
o Corticosteroid eye drop.
o In case of secondary infection, first treat bacterial conjunctivitis,by local antibiotic drops and then treat with local cortico-steroid drops.
o When cornea involved-atropin(1%) eye oinment
o Improvement of the nutritional status
o Treatement of causal factors.
o Treatement of tuberculosis
o Treatement of tonsilitis or adenitis
o Antihelmintics for intestinal parasites.