Severe chronic atopic keratoconjunctivitis

SEVERE CHRONIC ATOPIC KERATOCONJUNCTIVITISChallenging Eye Allergy Cases: How to Tackle?

19th June 2016Dr. Anton VurdaftFCOphth(ECSA), FICO

AKC OR VKC?Vernal Keratoconjunctivitis: recurrent, bilateral, allergic, primarily in boys before 10 yo; remits in teens; severe in spring and summer, mild symptoms throughout the year. May turn into atopic form later

Atopic Keratoconjunctivitis: typical for adults, bilateral, relentless, chronic, perennial (not seasonal, as VKC), but can be worse in winter

J.Kanski (Clinical Ophthalmology, 7th Ed.)

COMMON SYMPTOMSUsual signs of allergy

COMMON SYMPTOMStearing, photophobia, foreign body sensation, burning and thick mucoid discharge

J.Kanski (Clinical Ophthalmology, 7th Ed.)

COMMON SIGNS Tarsal conjunctiva papillae or cobble stones

J.Kanski (Clinical Ophthalmology, 7th Ed.)

COMMON SIGNSHorner-Trantas Dots in Limbus

J.Kanski (Clinical Ophthalmology, 7th Ed.)

COMMON SIGNSKeratopathy

J.Kanski (Clinical Ophthalmology, 7th Ed.)

(A) Superior punctate erosions and sheets of mucus; (B) macroerosion; (C) early plaque formation; (D) plaque and ‘shield’ ulcer; (E) oval subepithelial scarring; (F) pseudogerontoxon and limbal papillae

COMMON SIGNS18 YO GIRL AND BOY WITH SEVERE CASES

HOW WE CAN HELP?

1) SUN-GLASSES

HOW WE CAN HELP?

2) COOL WET COMPRESSESFREQUENTLY

HOW WE CAN HELP?

3) ANTIALLERGIC TABLETS:

WHAT IS THE DOSAGE?

HOW WE CAN HELP?3) ANTIALLERGIC TABLETS: CHLORPHENAMINE MALEATE (“PIRITON”, ANTIHISTAMINE DRUG)

>12 YO - 1 TABLET 4 TO 6 HOURLY (!), NOT EXCEEDING 6 TABLETS PER 24HRS

6-12 YO – ½ TAB 4-6 HOURLY

PREGNANCY: NOT RECOMMENDEDhttps://www.medicines.org.uk/emc/medicine/16103

HOW WE CAN HELP?

4) ANTIALLERGIC EYEDROPS:

WHAT IS THE DOSAGE?

HOW WE CAN HELP?

4) ANTIALLERGIC EYEDROPS:

SODIUM CROMOGLICATE1 DROP 4 TIMES DAILY, LONG-TERM (AT LEAST 3 MONTHS IN OUR SETUP)

https://www.medicines.org.uk/emc/medicine/22505

HOW WE CAN HELP?

5) ANTIINFLAMMATORY TABLETS

TAB. BRUFEN FOR 10 DAYS

https://www.medicines.org.uk/emc/medicine/22505

HOW WE CAN HELP?

5) ANTIINFLAMMATORY TABLETS

TAB. PREDNISOLON WILL BE OF A LAST HOPE IN HYPERSEVERE CASES (CONSULT WITH THE OPHTHALMOLOGIST)

https://www.medicines.org.uk/emc/medicine/22505

HOW WE CAN HELP?

6) ANTIINFLAMMATORY EYEDROPS

DILUTED STEROID DROPS: DEXAMETHASONE OR PREDNISOLON

https://www.medicines.org.uk/emc/medicine/22505

HOW WE CAN HELP?

WHY DILUTE?LESS CHANCES FOR:STEROID CATARACTSTEROID GLAUCOMA

https://www.medicines.org.uk/emc/medicine/22505

HOW WE CAN HELP?

7) LID HYGIENE (CHECK FOR BLEPHARITIS)

HOW WE CAN HELP?

8) TREAT OTHER ATOPIC DISEASES (RHINITIS IN 20%, ASTHMA 27%, ECZEMA 10%)

doi:10.1038/sj.eye.6700675

HOW WE CAN HELP?

9) HELMINTHS SCREENING (STOOL ANALYSIS?), DEWORMING?

doi:10.1038/sj.eye.6700675

HOW WE CAN HELP?SUMMARY:

1. SUN-GLASSES2. COOL COMPRESSES3. PIRITON TABLETS4. BRUFEN TABLETS

doi:10.1038/sj.eye.6700675

5. SODIUM CROMOGLICATE DROPS6. DILUTED STEROIDS DROPS7. LID HYGIENE8. TREAT CONCURRENT ATOPIC DISEASE9. DEWORMING? STOOL ANALYSIS?

HOW WE CAN HELP?UNFORTUNATELY, THE STATE-OF-THE-ART THERAPY FOR SUCH SEVERE CONDITIONS IS NOT AVAILABLE IN OUR SETUP:TACROLIMUS AND CYCLOSPORINE EYE DROPS,DEPO-MEDRONE AND TRIAMCINOLONE, PENETRATING KERATOPLASTY ALL WILL GIVE ADDITIONAL HOPE FOR THESE PATIENTS

doi:10.1038/sj.eye.6700675

HOW WE CAN HELP?

LET US TRY AND FOLLOW THE PROTOCOL OF WHAT WE CAN DO HERE

HOW WE CAN HELP?SUMMARY:

1. SUN-GLASSES2. COOL COMPRESSES3. PIRITON TABLETS4. BRUFEN TABLETS

5. SODIUM CROMOGLICATE DROPS6. DILUTED STEROIDS DROPS7. LID HYGIENE8. TREAT CONCURRENT ATOPIC DISEASE9. DEWORMING? STOOL ANALYSIS?

THANK YOU

SEVERE CHRONIC ATOPIC KERATOCONJUNCTIVITIS

SEVERE CHRONIC ATOPIC KERATOCONJUNCTIVITISChallenging Eye Allergy Cases: How to Tackle?

19th June 2016Dr. Anton VurdaftFCOphth(ECSA), FICO