TREATING ALLERGIC EYES

DR KINJAL DESAITHIRD YEAR RESIDENT

DR PAWAN JARWALTHIRD YEAR RESIDENT

SSG HOSPITAL AND BARODA MEDICAL COLLEGE

INTRODUCTION

• ALLERGIC conjunctivitis is the one of the most common cause of ocular morbidity in India. It is also the leading cause of school absenteeism in children because of distressful symptoms.• Ocular allergic diseases can be of ACUTE or CHRONIC type.

1) ACUTE TYPES: a) Seasonal allergic conjunctivitis b) Perennial allergic conjunctivitis 2) CHRONIC TYPES: a) Vernal keratoconjunctivitis b) Atopic keratoconjunctivitis c) Giant papillary conjunctivitis

The exposure of an allergen to a sensitized mast cell is the basis for mast cell degranulation. The subsequent release of many inflammatory mediators give rise to the clinical signs and symptoms of allergic conjunctivitis; of which, conjunctival congestion and ocular itching are mainly due to the action of histamine on H1 receptors. In chronic types , the pathophysiology is quite complex as there is a constant inflammatory response due to predominance of eosinophils and cytokine release mediated by Th2 cells. The signs and symptoms of allergic conjunctivitis include ITCHING, DISCOMFORT, STINGING, FOREIGN BODY SENSATION, WATERING, PHOTOPHOBIA, LID EDEMA, REDNESS, CHEMOSIS, PAPILLARY REACTION, PANNUS.

The pharmacologic agents that are available as ophthalmic solutions, used in treatment of allergic conjunctivitis belong to different classes:

(1) ANTI HISTAMINICS- which block H1 receptors. e.g Azelastine.

(2) MAST CELL STABILIZERS-which increase calcium influx to the mast cell and prevent changes in membrane permeability resulting in stability of membrane decreasing degranulation of mast cells e.g Sodium cromoglycate.

(3) DUAL ACTING AGENTS- they have both antihistaminic and mast cell stabilizing properties. e.g Olopatadine , Ketotifen.

(4) NSAIDS- e.g Ketorolac, Flurbiprofen.

(5)CORTICOSTEROIDS- e.g Prednisolone, Hydrocortisone, Fluromethalone.

Symptoms and signs 0 1 2 31) Itching Absent Not disturbing daily

activities 

disturbing daily activities 

Unabe to do daily activities2) Discomfort

3) Stinging4) Foreign body sensation

5) Watering6)Photophobia7) lid edema Detected on palpation Able to open the eyes on

their ownNot able to open eyes on their own

8) congestion Diffuse Individual vessel discernible

Not easily discernible

9) Chemosis Conjunctival edema without dellen

Conjunctival edema with dellen

Edema with prolapse of conjunctiva through palpebral aperture

10)Papillary reaction Minimal hyperemia with papillary reaction; size of papillae <0.5mm

Injecton , thickening of conjunctiva with size of papillae 0.5 to 1.00 mm

Injection, thickening and total obscuration of normal vascular pattern with apical staining

:

PAPILLARY REACTION COBBLESTONE APPEARANCE

PURPOSE: The purpose is to judge severity and provide a simple and practically applicable grading system and a stepladder algorithm for treatment of allergic conjunctivitis.

Minimum score = 0

Maximum score = 30

Mild = 1 – 10

Moderate = 11 – 20

Severe = 21 – 30

If there is presence of any other specific sign like TRANTAS DOTS, COBBLESTONES, PANNUS, SPEE, CORNEAL SCARRING, then it is severe.

RESULTS:

Mild :

Allergen avoidance

Lubricants

Any one of ANTIHISATAMINICS, MASTCELL STABILIZERS, DUAL ACTINGS, NSAIDS.

Moderate:

Treatment as MILD plus LOW DOSE STEROIDS.

Severe:

Same as above plus POTENT STEROIDS.

Chronic cases can be maintained with TOPICAL CYCLOSPORINE and if needed SYSTEMIC STEROIDS OR CYCLOSPORINE.

 

CONCLUSION: Grading of severity and periodicity of disease can be very useful in management. Severe and chronic allergies are serious condition with remarkable morbidity and may not satisfactorily treated by current options.

 

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