Upload
ophthalmgmcri
View
580
Download
1
Embed Size (px)
Citation preview
ALLERGIC CONJUNCTIVITIS Acute allergic rhino conjunctivitis
Vernal kerato conjunctivitis
Atopic kerato conjunctivitis
Giant papillary conjunctivitis
Allergic conjunctivitis IgE mediated hypersensitivity reaction on
exposure to environmental allergens ALLERGENS : pollen ,dust, bacterial
antigens, cosmetics, animal , birds , etc
Clinical features SYMPTOMS Itching , itching, itching Mild redness Mucoid discharge ( ROPY DISCHARGE)
MANAGEMENTGENERAL MEASURES Avoid exposure to allergens -
DARK GOGGLES Cold compress Not to rub the eyes
TREATMENT To control the present attack Topical steroids - FML , loteprednal Topical antihistamine – CPM, epinastineTo prevent further attacks Mast cell stabilizers – sodium
cromoglycate, olopatidine
ACUTE ALLERGIC RHINO CONJUNCTIVITIS SEASONAL
ALLERGIC CONJUNCTIVITIS
Spring & summer
Commonest form
Tree and grass pollen
PERENNIAL ALLERGIC CONJUNCTIVITIS
↑ Autumn
Milder & less common
House dust mites, animal dander & fungal allergen
ACUTE ALLERGIC RHINO CONJUNCTIVITIS TREATMENT Mast cell stabilisers –
sodium cromoglycate q.i.d
Antihistamines
Combined therapy
Steroids – rarely indicated
VERNAL CONJUNCTIVITIS VERNAL KERATOCONJUNCTIVITIS SPRING CATARRH
Bilateral recurrent allergic conjunctivitis Ig E & cell mediated immune
mechanisms
VERNAL KERATOCONJUNCTIVITIS RISK FACTORS Boys ≥ girls , mean age – 7 yrs
Family history of atopy
Peak incidence in spring & summer
VERNAL KERATOCONJUNCTIVITIS
DIFFUSE PAPILLARY HYPERTROPY OF UPPER TARSUS
MACROPAILLAE / COBBLE STONES - ≥ 1MM
PALPEBRAL FORM
VERNAL KERATOCONJUNCTIVITIS
KERATOPATHY Punctate epithelial
erosions
Macroerosions
Shield ulcers & plaques
VERNAL KERATOCONJUNCTIVITIS
KERATOPATHY Pseudogerontoxon –
resembles arcus senilis
Peripheral superficial vascularisation
HSV keratitis & keratoconus
VERNAL KERATOCONJUNCTIVITISTREATMENT TOPICAL Mast cell stabilisers - ↓ need for steroids
Antihistamines
Steroids – mainstay Fluromethalone 0.1 %
Cyclosporin – qid in steroid resistant cases
MUST KNOW Other names IgE mediated & cell mediated allergic Itching & ROPY DISCHARGE Papillae – COBBLE STONE APPEARANCE limbus – HORNER TRANTA’S SPOT TREATMENT – antihistamine steroid mast cell stabilizer
ATOPIC KERATOCONJUNCTIVITIS Associated with atopic dermatitis , asthma,
allergic rhinitis . Chronic, unremitting , extremely severe form
of allergic conjunctivitis → significant visual morbidity
GIANT PAPILLARY CONJUNCTIVITIS
Giant papilla- > 1 mm Soft CL wear, ocular prosthesis , exposed
sutures, filtering blebs FB sensation , redness, itching, CL intolerance TREATMENT: Remove the cause Lubricating eye drops Same as allergic conjunctivitis
ASSIGNMENT ocular side effects of using steroids (topical /
systemic) Name four ocular diseases in which steroids
are used for treatment
Immune mediated -PHYLCTENULAR CONJUNCTIVITIS Hypersensitivity reaction to endogenous
bacterial protein (tuberculosis, adenoiditis/tonsillitis)
TYPES : Conjunctival Limbal Corneal
XEROPHTHALMIA Spectrum of ocular disease ranging caused
by vitamin A deficiency. Nutritional blindness CAUSES: malnutrition, malabsorption,
chronic alcoholics, diseases which precipitate malnutrition like measles, malaria, diarrhoea , acute illness in children.
HOW ? VITAMIN A is essential for the synthesis of
retinal photo pigments & conjunctival glycoproteins.
RHODOPSIN Visual cycle delayed dark adaptation / Night Blindness
Conjunctival epithelial dysfunction ocular surface dryness
XEROPHTHALMIA XN: NIGHT BLINDNESS EARLIEST SYMPTOM responds rapidly to vitamin A therapy [ within
24-48 hours]
CONJUNCTIVAL XEROSIS X1 A : - the conjunctival epithelium undergoes
KERATANISING METAPLASIA. i.e. the normal columnar epithelium is transformed into stratified squamous epithelium. Goblet cells will be lost & keratinization occurs.
- conjunctival xerosis – starts at the temporal side
BITOT’S SPOT- keratin + saprophytic bacilli
[ CORYNEBACTERIUM XEROSIS] accumulate on the xerotic surface FOAMY APPEARANCE== BITOT’S SPOT
- Begin to resolve within 2-5 days & disappear by 2 weeks of treatment
-In Chronic cases, the spots will not disappear
CORNEAL XEROSIS – X2 Lustreless dry appearance , in the inferior
limbus Responds within 2-5 days, disappear within 2
weeks of treatment
X3A & X3B : KERATOMALACIA
COLLIQUATIVE NECROSIS/ LIQUAFACTIVE NECROSIS sterile corneal melting
Round or oval punched out ulcers involving the inferonasal quadrant
Perforation adherent leucoma, anterior staphyloma, phthisis bulbi
XEROPHTHALMIA- XS &XF XS: CORNEAL SCARRING -Nebula, macula , leucoma XF: XEROPHTHALMIC FUNDUS
/UYEMURA’S FUNDUS -Small white lesions in the retina
TREATMENT - MEDICAL EMERGENCY
VITAMIN A: ( 3 DOSES) 2 LAKH I.U - ORALLY OR 1 LAKH I.U – I.M 1ST DAY, 2ND DAY & WITHIN 1-4 WEEKS CHILDREN BETWEEN 6-11 MONTHS: HALF
THE DOSE CHIDREN < 6 MONTHS : QUARTER THE
DOSE
QUESTIONS VKC / SPRING CATARRAH XEROPHTHALMIA
Causes of night blindness Treatment of xerophthalmia Treatment of allergic conjunctivitis What is Bitot’s spot ? Difference between papillae & follicle.
24.2.16 - symposium Causes of Limbal nodule Acute red eye – enumerate the causes. How
to differentiate between them. Ophthalmia neonatorum Trachoma – clinical features & management