ALLERGIC CONJUNCTIVITIS AMIRAH BT JAMALUDIN NURHIDAYATUL HUSNA BT JOHARI

Introduction Allergic conjunctivitis is an inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. If something irritates this conjunctiva, eyes may become red and swollen. The eyes also may itch, hurt or watery. It is also known as “pink eye”.

Types of allergic conjunctivitis: Allergic simple conjunctivitis Spring catarrh Phlyctenular kerato-conjunctivitis Giant papillary conjunctivitis

Allergic simple conjunctivitis Definition : Occurring as the result of exposure to a wide variety of allergens Simple allergic conjunctivitis often results from exposure to eye medications or contact lens solutions (or their preservatives). Symptoms: Itching and tearing in response to antigen exposure. Signs : Unilateral or bilateral Mild to moderate conjunctiva hyperaemia Chemosis

Management: General measures include: Avoid allergen where possible Avoid wearing contact lenses until symptoms and signs resolve Avoid rubbing the eyes Cool compresses and preservative-free lubricants may also help If severe, Oral or topical anti-histamine Mast cell stabilizer

Phlyctenular conjunctivitis Definition: Kerato-conjunctivitis produced as an allergy to an endogenous agent. Aetiology: It is a manifestation of allergy to an endogenous toxin as Tuberculo-protein Intestinal parasites Septic foci as in tonsils and adenoids Symptoms : Discomfort and lacrimation If cornea involved,photophobia and blepharospasm occur

Signs : Phlyctens Rounded nodules Size 1-3 mm Grayish in color Eleveated above the surface Surrounded by a small area of injection

Complications: (1)Cornea A-Corneal phlycten B-Phlyctenular ulcers C-Phlyctenular pannus (2)Eczema of lids (3)Muco-purulent conjunctivitis: due to secondary infection with staph. Aureus (4)Recurrence: are common if the cause is not removed. Treatments : Local cortisone drops and ointment Atropine if cornea is involved Fascicular ulcer needs cautery with carbolic + Periotomy & cautery of vessel

Spring catarrh (Vernal Conjunctivitis) Definition : It is a bilateral seasonal conjunctivitis recurring in the warm seasons. Aetiology : It is an allergy of the conjunctiva to an unknown exogenous factor. The contributing factors are : U.V rays Heat Dust

Incidence : Age : Children Sex : boys more Season : summer (not spring) Symptoms : Itching Photophobia Lacrimation Ropy discharge (thread): formed of mucus,eosinophils and epithelial debris so that it is scanty,white and elastic

Palpebral type (70%) Large flat-topped papillae Bluish white color Cobble stone arrangement Fornix always free Milky white film (ropy discharge) Bulbar type (10%) Gelatinous masses (due to thickened epithelium and hyaline degeneration ) Tranta spots (white spots) Mixed type (20%) Keratitis superficialis vernalis of Tobgy Superficial ulcers Epithelial plaque formation that should be scraped Weakness of the cornea with higher incidence of Keratoconus and Keratectesia

Treatment: -Cold compression for sensation of heat General: -Antiallergy drugs (antistine,Benadryl,calcium etc) Local: -Dark glasses for photophobia -Cold compression for sensation of heat -Frequent washing with cold lotion as 4 % boric acid -Local antihistaminic as antistine of preisoline drops -Local vasoconstrictor as adrenaline or privine for hyperaemia -Local cortisone drops (Dexamethasone 0.1 %) pulse therapy during an attack every 2 hours for 5 days only to guard against its complication (may induce glaucoma) -Local disodium chromoglycate eye drops to stabilize the mast cells “one month before summer”

Giant papillary conjunctivitis Definition : It is an allergic conjunctivitis characterized by the formation of giant papillae. It occurs most probably due to mechanical irritation of the palpebral conjunctiva in case of : -Contact lenses (more with extended wear CL and with lens deposits) -Artificial eyes -Prominent suture following surgery Symptoms : -Red Eye -Mucoid discharge -Itching

Signs : Conjunctival hyperaemia Giant papillae on superior tarsal conjunctiva Superficial punctuate keratitis Peripheral corneal subepithelial infilterates Treatment : Stops using contact lenses for 2 weeks Topical mast cell stabilizer (disodium chromoglycate) 4 times daily Topical steroids for few days only Use new daily wear lenses after complete cure  

Thank you Syukran Terima kasih…