OCULAR ALLERGY IN CHILDREN. Presenter: Dr C.L.A Ogundo Consultant Ophthalmologist KPA conference April 2017
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1 OCULAR ALLERGY IN CHILDREN Presenter: Dr C.L.A Ogundo Consultant Ophthalmologist KPA conference April 2017
2 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
3 Just in case you ve forgotten cornea (conjunctiva)
4 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: Adenuga OO, Samuel OJ. Pattern of eye diseases in an air force hospital in Nigeria. Pak J Ophthalmol 2012;28: 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: Wade PD, Iwuora AN, Lopez L. Allergic conjunctivitis at Sheikh Zayed reginal eye care centre, Gambia. J Ophthalmic Vis Res 2012;7: 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:
5 Classification Ocular allergy Non sight threatening Sight threatening Seasonal allergic conjunctivitis Perennial allergic conjunctivitis Giant papillary allergic conjunctivitis Vernal keratoconjunctivitis Atopic keratoconjunctivitis Slide credit Dr C. Kareko
6 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
7 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
8 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
9 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
10 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
11 Management COUNSELLING Avoidance of allergens Avoidance of eye rubbing Use of cold compress Use of artificial tears
12 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
13 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
14 Vernal Keratoconjunctivitis Mast cell/lymphocyte mediated
15 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
16 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
17 Management For the danger signs, give lubrication and refer immediately
18
19 Management COUNSELLING Avoidance of allergens Avoidance of eye rubbing Cold compress Co i atio of MCS a d H₁ re eptor lo ker
20 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
21 EROKAMANO!!
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