Allergic and immunologic disorders of the eye. Part II: Ocular allergy

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Presentation transcript:

Allergic and immunologic disorders of the eye. Part II: Ocular allergy Leonard Bielory, MD Journal of Allergy and Clinical Immunology Volume 106, Issue 6, Pages 1019-1032 (December 2000) DOI: 10.1067/mai.2000.111238 Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 1 In the development of a quality-of-life measurement for rhinoconjunctivitis, the following prevalence of ocular symptoms has been reported. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 2 The differential diagnosis of ocular allergic disorders (“red” eye) includes infectious causes (eg, chlamydial disease, molluscum contagiosum, Parinaud’s oculoglandular syndrome), chronic forms of conjunctivitis (eg, GPC, VKC, AKC, superior limbic conjunctivitis, follicular conjunctivitis), and miscellaneous disorders (eg, keratoconjunctivitis sicca, acne rosacea, ocular pemphigoid, and blepharoconjunctivitis). Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 3 Chemosis represents swelling of the conjunctiva in allergic conjunctivitis. This is similar to an urticarial eruption on the conjunctival surface. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 4 Bulbar conjunctiva is injected and chemotic in a patient with AKC. Periorbital skin is frequently affected by single or double infraorbital creases known as Dennie-Morgan lines that are caused by edema or thickening. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 5 Signs of cobblestoning include bilateral involvement of the conjunctiva (primarily lower tarsal) in the form of fine papillary hypertrophy of the upper and lower tarsal conjunctiva chemosis, limbal hyperemia, and limbal gelatinous hyperplasia with abundant mucoid discharge. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 6 Discrete swellings with small white dots (Trantas-Horner dots) are indicative of degenerating cellular debris, which is commonly seen in VKC and AKC. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 7 Excessive cobblestoning of conjunctival surface in a patient with VKC. The mucus is commonly so excessive that a pseudomembrane forms over the epithelial surface and can be stripped off without bleeding. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions

Fig. 8 In the more chronic forms of ocular allergy, which include VKC and AKC, there is evidence of the breakdown of epithelial barrier function that can lead to severe corneal damage such as corneal ulcers. It has been apparent from a variety of studies that eosinophils may play a crucial role in corneal tissue damage in these more chronic forms of ocular allergy. Journal of Allergy and Clinical Immunology 2000 106, 1019-1032DOI: (10.1067/mai.2000.111238) Copyright © 2000 Mosby, Inc. Terms and Conditions