Acute atopic conjunctivitis - Clinicals, Diagnosis, and Management

Opthalmology

Clinicals - History

Fact Explanation
Itching of the eyes Patients with seasonal allergic conjunctivitis (SAC) complain of worsening of symptoms during the spring and summer, whereas patients with perennial allergic conjunctivitis (PAC) can be symptomatic throughout the year. Itching of the eyes
Patients with seasonal allergic conjunctivitis (SAC) complain of worsening of symptoms during the spring and summer, whereas patients with perennial allergic conjunctivitis (PAC) can be symptomatic throughout the year.
Redness of the eyes Patients complain of redness of the eyes. Redness of the eyes
Patients complain of redness of the eyes.
Tearing Excessive tearing occurs after being exposed to the allergen. Tearing
Excessive tearing occurs after being exposed to the allergen.
History of allergic rhinitis Around 95% of the patients with allergic rhinitis have comorbid allergic conjunctivitis as well. History of allergic rhinitis
Around 95% of the patients with allergic rhinitis have comorbid allergic conjunctivitis as well.
History of recurrent headaches Patients with allergic conjunctivitis blink frequently and may have a squint. These factors may contribute for the development of recurrent tension headaches. History of recurrent headaches
Patients with allergic conjunctivitis blink frequently and may have a squint. These factors may contribute for the development of recurrent tension headaches.

Clinicals - Examination

Fact Explanation
Conjunctival erythema Inflammatory reaction mediated by the activated mast cells causes erythema of the conjunctiva also referred to as conjunctival injection. Conjunctival erythema
Inflammatory reaction mediated by the activated mast cells causes erythema of the conjunctiva also referred to as conjunctival injection.
Chemosis Conjunctival edema is caused by the inflammatory response, which causes dilatation and increased permeability of the vessels in the conjunctiva. Chemosis
Conjunctival edema is caused by the inflammatory response, which causes dilatation and increased permeability of the vessels in the conjunctiva.
Irritant dermatitis of the eye lids Patients with allergic conjunctivitis can develop irritant dermatitis of the eye lids due to frequent rubbing. Irritant dermatitis of the eye lids
Patients with allergic conjunctivitis can develop irritant dermatitis of the eye lids due to frequent rubbing.

Investigations - Diagnosis

Fact Explanation
Skin testing Skin testing (scratch tests or intradermal injections of allergen) can be done to identify potent allergens. Skin testing
Skin testing (scratch tests or intradermal injections of allergen) can be done to identify potent allergens.

Management - Supportive

Fact Explanation
Health education Patients with atopic conjunctivitis should be advised to avoid the potent allergen as far as possible. Health education
Patients with atopic conjunctivitis should be advised to avoid the potent allergen as far as possible.

Management - Specific

Fact Explanation
Artificial tears Artificial tears are useful in creating a tear film which acts as a barrier minimizing the contact of allergens with the conjunctiva. They also dilutes the allergens and help to washout the allergens. Artificial tears
Artificial tears are useful in creating a tear film which acts as a barrier minimizing the contact of allergens with the conjunctiva. They also dilutes the allergens and help to washout the allergens.
Antihistamines With the exposure to the potential allergens IgE is bound to the mast cell membranes which causes mast cell degranulation and release of histamine. Histamine in turn exerts the allergic reaction. Topical antihistamines (levocabastine hydrochloride, 0.1% olopatadine hydrochloride) block the histamine release, by competitive and reversible blocking of histamine receptors thus minimizing the allergic response. However this action is short lasting and frequent administration of the drug is necessary (up to 4 times a day). Prolonged use can cause irritation of the eye. Oral antihistamines may be necessary to control severe symptoms. Antihistamines
With the exposure to the potential allergens IgE is bound to the mast cell membranes which causes mast cell degranulation and release of histamine. Histamine in turn exerts the allergic reaction. Topical antihistamines (levocabastine hydrochloride, 0.1% olopatadine hydrochloride) block the histamine release, by competitive and reversible blocking of histamine receptors thus minimizing the allergic response. However this action is short lasting and frequent administration of the drug is necessary (up to 4 times a day). Prolonged use can cause irritation of the eye. Oral antihistamines may be necessary to control severe symptoms.
Topical decongestants Decongestants cause vasoconstriction and reduce erythema and conjunctival swelling. Burning sensation, mydriasis, and rebound hyperemia (conjunctivitis medicamentosa) are possible side effects. Often combination of antihistamines and decongestants is used for better symptom control. Topical decongestants
Decongestants cause vasoconstriction and reduce erythema and conjunctival swelling. Burning sensation, mydriasis, and rebound hyperemia (conjunctivitis medicamentosa) are possible side effects. Often combination of antihistamines and decongestants is used for better symptom control.
Mast cell stabilizers Mast cells are responsible for the release of histamine and other chemotactic factors. Mast cell stabilizers decrease the degranulation of mast cells and reduce the inflammation. It should be applied before being exposed to the allergen. Mast cell stabilizers
Mast cells are responsible for the release of histamine and other chemotactic factors. Mast cell stabilizers decrease the degranulation of mast cells and reduce the inflammation. It should be applied before being exposed to the allergen.
Ketotifen This is a novel topical agent which has inhibitory action over eosinophil activation, generation of leukotrienes and cytokine release. Ketotifen
This is a novel topical agent which has inhibitory action over eosinophil activation, generation of leukotrienes and cytokine release.
Azelastine This is a selective second generation H1 receptor blocker. Azelastine also inhibits platelet activating factor (PAF) and blocks the expression of intercellular adhesion molecule 1. Azelastine
This is a selective second generation H1 receptor blocker. Azelastine also inhibits platelet activating factor (PAF) and blocks the expression of intercellular adhesion molecule 1.
Epinastine Epinastine blocks the H1 and H2 receptors and reduce the eyelid swelling. It also exerts mast-cell stabilizing and anti-inflammatory effects. Epinastine
Epinastine blocks the H1 and H2 receptors and reduce the eyelid swelling. It also exerts mast-cell stabilizing and anti-inflammatory effects.
Non-steroidal anti-inflammatory drug (NSAIDs) NSAIDs inhibit the synthesis of prostaglandin D2 and prostaglandin E2 and reduce the conjunctival hyperemia and the pruritus. This can be combined with topical medications for better symptom control. Non-steroidal anti-inflammatory drug (NSAIDs)
NSAIDs inhibit the synthesis of prostaglandin D2 and prostaglandin E2 and reduce the conjunctival hyperemia and the pruritus. This can be combined with topical medications for better symptom control.
Corticosteroids Corticosteroids are immunosuppressive drugs which is helpful in suppressing the immune response to allergens. Secondary infection, elevated intraocular pressure, and formation of cataract are possible side effects of corticosteroids. Due to these side effects corticosteroids are only recommended for a short period of time (up to 2 weeks). If it is necessary to prescribe it for a long time it should be done with close follow up by an ophthalmologist. Corticosteroids
Corticosteroids are immunosuppressive drugs which is helpful in suppressing the immune response to allergens. Secondary infection, elevated intraocular pressure, and formation of cataract are possible side effects of corticosteroids. Due to these side effects corticosteroids are only recommended for a short period of time (up to 2 weeks). If it is necessary to prescribe it for a long time it should be done with close follow up by an ophthalmologist.
Allergen-specific immunotherapy This treatment option is effective in inducing a clinical tolerance to a particular allergen. The production of specific IgG and IgA is increased and production of IgE is reduced with this treatment. Allergen-specific immunotherapy
This treatment option is effective in inducing a clinical tolerance to a particular allergen. The production of specific IgG and IgA is increased and production of IgE is reduced with this treatment.

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