Conjunctivitis Preferred Practice Pattern®

Varu, Divya M; Rhee, Michelle K.; Akpek, Esen K.; Amescua, Guillermo; Farid, Marjan; Garcia-Ferrer, Francisco; Lin, Amy; Musch, David C.; Mah, Francis S.; Dunn, Steven P.; Panel, External Disease

doi:10.1016/j.ophtha.2018.10.020

Cited by 90 publications

(126 citation statements)

References 250 publications

(235 reference statements)

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“…A detailed case history and direct physical examination of the eye and adnexa including evaluation by slit-lamp biomicroscopy are paramount in the evaluation of moderate and severe AC, both to confirm the diagnosis and rule-out other ocular diseases that may require different treatment considerations. Ophthalmic steroid drops are effective for the treatment of AC, although prolonged therapy with steroids requires close supervision and frequent eye examinations by an optometrist or ophthalmologist due to increased risk of elevated intra-ocular pressure, development of cataract and central serous chorioretinopathy as well as other less likely concerns such as ptosis, mydriasis and eyelid skin thinning in the case of skin applications [26][27][28].…”

Section: Importance Of Appropriate Professional Carementioning

confidence: 99%

“…An allergic 'shiner' , a bluish discoloration below the eyes, may be present in acute disease, and is as a result of venous congestion [7]. During acute or chronic exposures, watery discharge may be noted, but mucous discharge may also be visualized in the tear film [28]. Otherwise, bilateral conjunctival injection is the most obvious general finding.…”

Section: Physical Examinationmentioning

confidence: 99%

“…Compared with either antihistamines or mast cell stabilizers, topical dual-activity agents are generally clinically superior due to both symptom/sign relief and tolerability [46]. These are now considered first-line treatment in AC and are the most common ophthalmic agents prescribed by allergists and eyecare practitioners [28]. These agents provide the benefits of two classes of drugs: the immediate relief of antihistamines with the prophylactic benefit of mast cell stabilizers, and as well some have been shown to have other actions including inhibition of eosinophil migration and other mediators of inflammation (e.g.…”

Section: Topical Dual-activity Agents (Antihistamine/mast-cell Stabilmentioning

confidence: 99%

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A contemporary look at allergic conjunctivitis

Dupuis

Prokopich

Hynes³

et al. 2020

Allergy Asthma Clin Immunol

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Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.

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Section: Importance Of Appropriate Professional Carementioning

confidence: 99%

Section: Physical Examinationmentioning

confidence: 99%

Section: Topical Dual-activity Agents (Antihistamine/mast-cell Stabilmentioning

confidence: 99%

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A contemporary look at allergic conjunctivitis

Dupuis

Prokopich

Hynes³

et al. 2020

Allergy Asthma Clin Immunol

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“…136,137 Because corticosteroids provide effective relief of a broad range of signs and symptoms of ocular inflammation, these agents are considered an effective treatment option for all forms of ocular allergy. 10,18,90,123,126,133,138 However, topical corticosteroids are not commonly used because of a fear of associated ocular side effects. These effects include increasing IOP and possible induction or exacerbation of glaucoma, formation of cataracts, delayed wound healing, and increased susceptibility to infection or superinfections.…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

“…[140][141][142] As a result, most guidelines recommend that their use be limited to more severe forms of OA or severe exacerbations of the more milder forms that are not controlled by other treatments and that these agents be used for as short a duration as possible. 10,90,126,133,138 Only patients with more chronic forms of allergic conjunctivitis uncontrolled with other agents should use topical corticosteroids on a daily basis. Ophthalmologic consultation should be obtained for any patient using ocular corticosteroids for more than 2 weeks to assess cataract formation or increased IOP.…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

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Bielory

Delgado

Katelaris

et al. 2020

Annals of Allergy, Asthma & Immunology

109

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Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.

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Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Asbell

Sanfilippo²,

Sahm³

et al. 2020

JAMA Ophthalmol

105

131

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IMPORTANCE Antibiotic resistance in ocular infections can affect treatment outcomes. Surveillance data on evolving antibacterial susceptibility patterns inform the treatment of such infections. OBJECTIVE To assess overall antibiotic resistance profiles and trends among bacterial isolates from ocular sources collected during 10 years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of longitudinal data from the ongoing, nationwide, prospective, laboratory-based surveillance study, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study, included clinically relevant isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae cultured from patients with ocular infections at US centers from January 1, 2009, to December 31, 2018.MAIN OUTCOMES AND MEASURES Minimum inhibitory concentrations were determined for various combinations of antibiotics and species. Odds ratios (ORs) were determined for concurrent antibiotic resistance; analysis of variance and χ 2 tests were used to evaluate resistance rates by patient age and geographic region; Cochran-Armitage tests identified changing antibiotic susceptibility trends over time.RESULTS A total of 6091 isolates (2189 S aureus, 1765 CoNS, 590 S pneumoniae, 767 P aeruginosa, and 780 H influenzae) from 6091 patients were submitted by 88 sites. Overall, 765 S aureus (34.9%) and 871 CoNS (49.3%) isolates were methicillin resistant and more likely to be concurrently resistant to macrolides

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Conjunctivitis Preferred Practice Pattern®

Abstract: for Quality Eye Care without any external financial support. Authors and reviewers of the guidelines are volunteers and do not receive any financial compensation for their contributions to the documents. The guidelines are externally reviewed by experts and stakeholders before publication.

Cited by 90 publications

References 250 publications

A contemporary look at allergic conjunctivitis

A contemporary look at allergic conjunctivitis

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Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

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