Eye Department KCMC Newsletter
Issue 3 Volume 5 Serial 17 30 September 2015
Allergic
Conjunctivitis
Allergic Conjunctivitis is an
inflammatory reaction of the conjunctiva to environmental allergens causing
itchy sensation in the eyes, redness and tearing. Eye rubbing makes the
condition worse rather than make it better. After each session of eye rubbing,
the eye itch even more eliciting a more intense rubbing.
Allergic Conjunctivitis is the
most common eye disease encountered among children, there is no gender
predilection. The type of Allergic Conjunctivitis that is encountered here in
North-eastern Tanzania is known as Vernal Keratoconjunctivits.
Table: Number of Allergic Conjunctivitis Cases at Eye Department KCMC
2010
|
2011
|
2012
|
2013
|
2014
|
|
Cases
|
2794
|
2974
|
3481
|
4248
|
4787
|
Rank
|
Nr 5
|
Nr 5
|
Nr 3
|
Nr 3
|
Nr 1
|
Percentage of Total
|
12.5%
|
12%
|
14%
|
17%
|
18%
|
All allergic reactions are
generically termed as Hypersensitivity Reactions, of which there are of four
kinds. Allergic Conjunctivitis is Hypersensitivity Type I (Anaphylaxis) and IV (Cell
Mediated Reaction). These patients mount an exaggerated immune response to
substances that for the rest of the population there is no reaction. Some of
the allergens involved include house dust (Excrement of arthropods who feed on
desquamated human skin on furniture). Patients with Allergic Conjunctivitis
tend to have also Allergic Rhinitis. Mast Cells in conjunctiva degranulate
Histamine which causes the inflammation and eye itch.
A patient with Allergic
Conjunctivitis would report Itchy Eyes, Red Eyes, Tearing, Photophobia and Eye
Discharge. The symptoms may be periodic or continuous.
Upon examination, clinician would
note the following:
1. Inflamed Conjunctiva.
2. Excessive Tearing.
3. Nodular elevations of the
Conjunctiva lining the inner surface of the upper eyelid known as Tarsal Papillae.
4. Pigmentation of the Conjunctiva in chronic cases.
5. Nodular elevations on the
Limbus peaked with white granular deposits known as Trantas Dots.
6. Punctate Keratitis.
7. Cornea Shield Ulcer in severe cases.
Allergic Conjunctivits and its
severe form Vernal Keratoconjunctivits if left untreated will lead to the
following possible complications:
1. Keratoconus.
2. Cornea Scarring from Shield Ulcer.
3. Surface Cornea Vascularization
known as Pannus.
Treatment options available for
Allergic Conjunctivits are as follows:
1. Cold water compresses on the closed eyelids.
2. In mild forms of Allergic
Conjunctivitis, vasoconstriction drugs such as Naphazoline 0.1% and Olopatadine
0.1% Eye Drops can be used as needed.
3. Antihistamine Eye Drops such
as Emedastine 0.05% given three
times a day in case of Seasonal Allergic Conjunctivits in adults.
4. Topical Corticosteroid Eye
Drops such as Prednisolone 1% or Dexamethasone 0.1% in cases of severe
symptoms. Remember that although Corticosteroids give almost instantaneous
results they also put the eye at risk of Cataract, Glaucoma and Infections.
5. Mast Cell Stabilizers such as Sodium Cromoglycate 2% and Lodoxamide 0.1% Eye Drops given four
times a day are ideal drugs because of their limited side effects on long term
use. They act slowly and takes up to five days for the patient to feel the
difference, by this time some patients have already abandoned the use of the
drugs.
6. In severe cases, sub-conjunctiva
injections of Triancinolone can be
used, given once every three months.
7. Topical Cyclosporine 2% Eye Drops given three times a day or topical Tacrolimus 0.1% applied once per day
can be used in severe cases.
Giant Papillae on Tarsal Conjunctiva
Editor: W. Makupa, Eye Department KCMC, P.O.Box 3010 Moshi – Tanzania
Tel: +255 784 332 667 Fax: +255 27 275 4381 Email: makupauw@yahoo.com
