OCULAR ALLERGY IN

CHILDREN

Presenter: Dr C.L.A Ogundo

Consultant Ophthalmologist

KPA conference April 2017

Introduction

• Hypersensitivity disorder

• Conjunctival surface is accessible to allergens and is the site of all allergic reactions

• Common problem in children

• Associations:

• Asthma

• Allergic rhinitis

• Atopic dermatitis

Just in case you’ve forgotten

cornea

(conjunctiva)

Prevalence

• Kenya: 27.3% in 2012 according to hosp. based statistics from OSU

• Nigeria: as high as 32%¹ to 42%²

• In children : reported 7.3% ( ages 5-17) i Nigeria³ , 7.9% i Ga ia , 9.1% i Gha a

1. Malu KN. Allergic conjunctivitis in Jos-Nigeria. Niger Med J 2014;55:166-70.

2. Adenuga OO, Samuel OJ. Pattern of eye diseases in an air force hospital in Nigeria. Pak J Ophthalmol 2012;28:144-8.

3. Abah ER, Oladigbolu KK, Samalia E, Gani-Ikilama A. O ular disorders i hildre i Zaria hildre s s hool. Niger J Clin Pract 2011;14:473-6.

4. Wade PD, Iwuora AN, Lopez L. Allergic conjunctivitis at Sheikh Zayed reginal eye care centre, Gambia. J Ophthalmic Vis Res 2012;7:24-8.

5.Abokyi S, Koffuor GA, Ntodie M, Kyei S, Gyanfosu L. Epidemiological profile and pharmacological management of allergic conjunctivitis: A study in Ghana. Int J Pharm Biomed Res 2012;3:195-201.

Classification

Ocular allergy

Non sight threatening

Seasonal allergic conjunctivitis

Perennial allergic conjunctivitis

Giant papillary allergic

conjunctivitis

Sight threatening

Vernal keratoconjunctivitis

Atopic keratoconjunctivitis

Slide credit Dr C. Kareko

Pathophysiology

Immediate allergic symptoms e.g

conjunctival itching,redness

Nasal discharge

bronchoconstriction

Late&ongoing allergic symptoms e.g

Conjunctival redness,swelling,papillae

Nasal congestion

urticaria

Adapted from ResearchGate.net: IgE dependent allergy cascade

Seasonal Allergic Conjunctivitis

• Common clinical entity

• Ig E mediated, specific seasonal airborne allergens : pollens

• Often ass. with rhinitis/ sinusitis

• Sequelae: min. or local inflammation that remits or resolves

• Pediatric ophthalmology and strabismus pg198; AAO

• AAO conjunctivitis preferred practice pattern guidelines

Perennial Allergic Conjunctivitis

• Less common, milder

• Type 1 hypersensitivity rxn to common allergens : mould etc

• Often ass. with rhinitis

• Sequelae: min. or local inflammation that remits or resolves

• Pediatric ophthalmology and strabismus pg198; AAO

• AAO conjunctivitis preferred practice pattern guidelines

Diagnosis

• History

• Usually : personal/ familial hx of atopy

• Symptoms: Marked bilateral itching +/- redness and tearing • Other nonspecific symptoms: stinging, burning, photophobia

• Examination

• Signs :bilateral injection, chemosis, watery discharge, mild mucous discharge

• Remember to evert eyelid

• Others: reduced VA

Differential diagnoses

• Infectious conjunctivitis

• Blepharitis

• Dry Eye Syndrome

• Keratitis

• Episcleritis/ Scleritis

• Ocular rosacea

If it it hes it s pro a ly allergy

If it ur s it s pro a ly DES

If it dis harges it s pro a ly infectious

Management

• COUNSELLING

• Avoidance of allergens

• Avoidance of eye rubbing

• Use of cold compress

• Use of artificial tears

Management: drug therapy

• Vasoconstrictors – relatively inexpensive but have rebound vasodilatation

• e.g tetrahydrozoline HCl, oxymetazoline HCl

• Usually for adults

• H₁ receptor blockers- more effective

• e.g emedastine, levocabastine HCl, epinastine

Management: drug therapy

• Mast-cell stabilizers – for chronic/recurrent cases

• e.g cromolyn sodium, lodoxamide

• Co bi ed H₁ & MCS- more effective than MCS

• e.g olopatadine hydrochloride 0.1%

• Oral antihistamines if pt has systemic symptoms

Vernal Keratoconjunctivitis

• Mast cell/lymphocyte mediated

Vernal Keratoconjunctivitis

• Male predeliction

• Aggressive for about 4-5 years then resolves

• Follows SAC patterns bt more in warm, dry areas

• Affects both palpebral & bulbar conj

Vernal Keratoconjunctivitis contd

• Symptoms : bilateral itchiness, tearing, redness, photophobia

• Signs : bilateral injection, chemosis, mucoid discharge, superior tarsal o lesto es Trantas dots, intense hyperpigmentation, hazy cornea

• Sequelae: eyelid thickening, shield ulcers, KC, conj. scarring, cataract, blindness

Management

• For the danger signs, give lubrication and refer immediately

Management

• COUNSELLING

• Avoidance of allergens

• Avoidance of eye rubbing

• Cold compress

• Co i atio of MCS a d H₁ re eptor lo ker

Take home

• If it it hes ilaterally it s pro a ly allergy

• Ocular allergy can cause blindness, when in doubt refer

• Use antihistamines, mast cell stabilizers, combinations, artificial tears

• Refer recurrent or refractory cases

• STAY AWAY from STEROIDS

EROKAMANO!!