ALLERGIC CONJUNCTIVITIS

Question 1

what are the main symptoms of allergic conjunctivitis?

Answer 1

RED, TEARY, ITCHY EYES

Question 2

what are the main signs of allergic conjunctivitis?

Answer 2

bilateral, chemosis, and papillae

Question 3

how do you treat acute allergic conjunctivitis?

Answer 3

• Eliminate the inciting agent
• Cool compresses several times per day.
• Mild cases – ATs 4x-8x per day.
• Moderate cases – antihistamine or antihistamine/mast cell stabilizer combo
• Sever cases – mild topical steroid (loteprednol or fluorometholone).
  – Oral antihistamine in moderate to severe cases can be helpful.
• F/U –> 2 weeks.

Question 4

what are the 3 types of allergic conjunctivitis?

Answer 4

1. allergic conjunctivitis
2. atopic kerato-conjunctivitis (AKC)
3. vernal kerato-conjunctivitis (VKC)

Question 5

define allergic conjunctivitis.

Answer 5

• General term used to talk about the hypersensitivity disorder that involves the conjunctiva, lid, and/or cornea.

Question 6

allergic conjunctivitis is divided into 2 categories. What are they?

Answer 6

1. seasonal allergic conjunctivitis
2. perennial allergic conjunctivitis

Question 7

what is seasonal allergic conjunctivitis? what type of hypersensitivity?

Answer 7

type 1 hypersensitivity rxn that is triggered by airborne allergens – pollen, hay fever.

Question 8

what season(s) is seasonal allergic conjunctivitis the worst?

Answer 8

• spring & summer

Question 9

what is perennial allergic conjunctivitis? what type of hypersensitivity rxn is it?

Answer 9

Type 1 hypersensitivity rxn triggered by household allergens (dust, mold, animal dander).

Question 10

what season(s) is perennial allergic conjunctivitis the worst?

Answer 10

• year long but worse in the fall.

Question 11

what is atopic kerato-conjunctivitis (AKC)? what hypersensitivity rxn is it?

Answer 11

It is a rare type 1 & 4 hypersensitivity rxn that is associated with atopic conditions like:
* eczema
* allergic rhinitis
* asthma

Question 12

who gets Atopic keratoconjunctivitis?

Answer 12

• Most common in young middle-aged adults (teens – 40s)

Question 13

symptoms of AKC?

Answer 13

• general allergic conjunctivis symptoms
• photophobia
• eye pain

Question 14

signs of AKC?

Answer 14

• general allergic conj signs (inferior papillae)
• Hertoghe sign - thinning or loss of the outer third of the eyebrow.
• Dennie’s lines - extra crease under the lower lid due to periorbital edema.
• symblepharon

cornea signs:
* PEE
* peripheral neovascularization
* KCN
* cataracts

Question 15

what is is vernal kerato-conjunctivitis (VKC)? what hypersensitivity is it?

Answer 15

• It is a rare type 1 hypersensitivity rxn that impacts those under 10 yrs of age and characterized by seasonal outbreaks.

Question 16

who gets VKC? what climate?

Answer 16

boys <10 yrs of age who live in hot climates & have predilection for atopy.

Question 17

when does VKC spontaneously get better?

Answer 17

VKC resolves during puberty

Question 18

symptoms of VKC?

Answer 18

• general allergic conj symptoms.
• photophobia
• eye pain

Question 19

signs for VKC?

Answer 19

• general allergic conj signs
• thick ropy discharge
• Cobblestone papillae - in the superior tarsal conjunctiva.
• Trantas dots - white, jelly-like papillae around the limbus. (Filled w/ eosinophils)

May involve cornea:
* Starts as PEE –> coalesces into macro erosions –> leads to plaque and localized ulceration (shield ulcer) –> scarring

Question 20

distinguish AKC vs. VKC

Answer 20

• AKC - signs are inferior & mainly involve lids & margin.
• VKC - signs are superior & mainly involve conjunctiva and cornea.

Question 21

tx for VKC?

Answer 21

treat like acute allergic conjunctivitis + cornea findings (ABx).
* If shield ulcer present add –> topical steroid qid & topical Abx gtt qid or ung qid.
* F/U –> 2 weeks
* F/U –> 1-3 days if shield ulcer