MACHO 17

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. 

 Trantas Dots                                                    

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

PARS PLANA VITRECTOMY IN RESOURCE LIMITED COUNTRIES

Introduction

Retina Detachment Surgery and other surgeries of the vitreous body require an invasive procedure known as Pars Plana Vitrectomy. This involves accessing the vitreous body in the eye through small openings on the Sclera and inserting a Vitrectomy Probe, Light Source, Infusion Line and some other instruments as required by the procedure in question. For this surgery to be performed one would need an Operating Microscope with special adaptor for lenses that will allow for intra-ocular viewing, A Vitrectomy Machine that will have several components integrated and a Laser Machine. Most Ophthalmology Centres will have an operating microscope for which posterior segment viewing adaptors can be attached or contact vitrectomy lenses. The problem tends to be the expensive Vitrectomy / Phacoemulsification Machine that will include a Light Source, Laser Aperture, Air Injector, Oil Injector, Oil Extractor and Diathermy. These Combo machines retail in excess of $ 50,000 and most require consumables for each procedure. 

Question

Is it possible to perform Pars Plana Vitrectomy cheaply and safely in resource limited environment? This is the question that I always had. Can Retina Detachment Surgery be done a low prices and safely? In trying to answer this question I had a look at the following options.

Appasamy Avit-1 Vitrectomy Machine 

Geuder Xenotron III Light Source

Appasamy Acura-1 Air Injector

Aurolab Aurocautery

Iridex 810nm Diode Laser

Khosla AAV5 Air Pressure Driven Vitrectomy Machine

Geuder G-31890 Silicone Oil Injector

Geuder G-28752 Silicone Oil Injector Extractor

Indo-German IG-6250 Silicone Oil Injector

Answer

The total cost of these equipment is about $ 30,050/= without considering freight and customs charges. Each will require disposable consumables for each patient (Vitrectomy Probe $ 150, Light Pipe $ 150, Laser Probe $ 200, Air Tubing $ 10, Diathermy Cables $ 100 and Silicone Oil $ 200) totalling some $ 810. But as the capital equipment investment is not very large, the need to recover the principal will be reduced, therefore it will keep the cost of surgery per patient relatively low, an important factor in resource limited countries such as Tanzania. Oil injection and oil extraction can be done with manual screw type devices using 10ml syringes available from Geuder (G-31890 or G-28752) or Indo-German (IG-6250).