Allergic Diseases of the Eye
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
He was not able to get an appointment for the ophthalmologist, but returned a week later with complete resolution of the symptoms and disappearance of the conjunctival redness and swelling. Topical steroids were stopped and he was asked to continue the Olopatadine till he could see the ophthalmologist. He returned in three days with a recurrence of the symptoms and signs. Loteprednol was restarted, and this time continued for two weeks, before reduction in dosage and gradual tapering. A visit to the ophthalmologist confirmed the diagnosis of vernal conjunctivitis. The boy remained symptom free through the summer on Olopatadine, apart from one episode of itching which responded to addition of loteprednol for two weeks. Olopatadine was discontinued when he rejoined school in the fall term, with no recurrence. His parents have been told that it will probably be advisable to restart the drop in March-April of the following year.
Ocular surface as mucosal immune site
Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald in Principles of Mucosal Immunology, 2020
Most types of allergic conjunctivitis are fairly benign, if unpleasant. However, there are exceptions. Vernal keratoconjunctivitis is a relatively rare but serious allergic response that can leave permanent scarring and visual deficit. It occurs most often in spring (vernal) in young boys around 8 years of age and usually resolves spontaneously at puberty, indicating a hormonal influence. It is characterized by conjunctival giant papillae, hyperemia, and frequent involvement of the cornea. Although allergic mechanisms, including presence of typical TH2-type immunity and IgE, are well documented in vernal keratoconjunctivitis, up to 50% of patients do not have a family or medical history of allergic diseases and do not show IgE sensitization, suggesting that this disease is not solely IgE mediated. Recent studies have also pointed out the role of resident conjunctival nonlymphoid cells in the pathogenetic processes of vernal keratoconjunctivitis. Thus, the pathogenesis of the condition is likely to be multifactorial and complex, involving not only the ocular mucosal immune system but also, similarly to Sjögren's syndrome, the nervous and endocrine systems.
How to master MCQs
Chung Nen Chua, Li Wern Voon, Siddhartha Goel in Ophthalmology Fact Fixer, 2017
Vernal keratoconjunctivitis is more common in warm than cold climates. It is characterised by the presence of conjunctival cobblestones confined almost exclusively to the superior tarsal conjunctiva. Interpalebral corneal staining is a feature of dry eye. Shield ulcers are not associated with corneal infiltration. Eye rubbing can increase the discharge of mast cell mediators and increase the severity of symptoms.
Presentation, diagnosis, and the role of subcutaneous and sublingual immunotherapy in the management of ocular allergy
Published in Clinical and Experimental Optometry, 2021
Amruta Trivedi, Constance Katelaris
Vernal keratoconjunctivitis represents 0.5 per cent of allergic eye disease, affects mainly children and young adolescents, has a male predominance, and occurs more commonly in warm climates.28,29 Vernal keratoconjunctivitis is characterised by the presence of corneal epithelial stromal lesions, as well as conjunctival proliferative changes, with giant papillae in the upper conjunctiva, giving it a cobblestone appearance on the surface of the everted eyelid (Figure 2C). Additionally, patients can develop gelatinous eosinophilic and neutrophilic mounds (Trantas dots) (Figure 2D‐E). These changes cause intense itch, tearing, mucous discharge, ocular pain due to corneal involvement, severe photophobia, and intense foreign body sensation due to the irregularity of the conjunctival surface and copious mucous production.18 The massive eosinophilic infiltration and activation in the conjunctiva is responsible for corneal complications. Chronic eye rubbing contributes to keratoconus and other corneal ectasias, and corneal ulcers may form in severe cases.30 If left untreated, corneal involvement causes permanent scarring and visual impairment.
Pediatric versus Adult Corneal Collagen Crosslinking: Long-term Visual, Refractive, Tomographic and Aberrometric Outcomes
Published in Current Eye Research, 2021
Ömür Ö. Uçakhan, Tuna Celik Buyuktepe, Zeynep Yavuz, Penny A. Asbell
An important issue is the “definition” of progression. Indeed, there is no consensus about the definition of progression after CXL. A common parameter used is an increase of more than 1.0 diopter in Kmax. However, consistently measuring and documenting a progression of 1.0 diopter can be challenging, particularly in advanced cases or in contact lens wearing eyes. It has been argued that Kmax may also not be the best parameter to use for progression in tomography systems.30 There is certainly need for development of better and more reproducible parameters to detect corneal ectatic disease progression/regression, however, using the current definition, our failure rate was quite low in both pediatric and adult age groups (1.2% in pediatric population, 0.68% in the whole sample). Although the exact reasons for this favorable outcome is unknown, meticulous treatment of any co-existant morbidity such as allergic or vernal conjunctivitis, vigorous consultation against eye rubbing and frequent use of topical antihistamine-mast cell stabilizing drops for extended periods when required, can be few underlying factors.
Unclassified Axenfeld-Rieger Syndrome: A CASE SERIES and Review of Literature
Published in Seminars in Ophthalmology, 2018
Aparna Rao, Debananda Padhy, Sarada Sarangi, Gopinath Das
Of 56 cases of ARS seen over 10 years, a total 17 eyes of 11 cases (M:F=9:2)with unclassified ASD were identified, with a median age of patients at diagnosis of 28.45±17.75 years (range 6–30 years). Six (55%) were bilateral and 3 (27%) were unilateral, while laterality could not be commented with certainty in two patients due to the presence of a dense leucomatous corneal scar precluding delineation of iris changes. All cases were diagnosed as developmental or juvenile open angle glaucoma, while one was diagnosed as primary angle closure glaucoma outside. Family history was present in only three patients (all three belonged to the same family). None of the 11 patients had associated systemic features. Five eyes of four patients had visually significant cataract while three eyes developed cataract during follow-up. Case 5 had associated vernal keratoconjunctivitis in both eyes with steroid-induced cataract. Table 1 gives the demographic and clinical presentations of the 11 patients in this study.