A Fight Against The Allergen! An Algorithmic Approach To Stepwise Management Of Ocular Allergy At A Tertiary Eye Care Hospital
Published 2023 - 41st Congress of the ESCRS
Reference: PP02.17 | Type: Free paper | DOI: 10.82333/v9d2-5z97
Authors: Pranitha Satarasi* 1 , Sharon D’Souza 1 , Sowmya Nagaraj 2 , Rohit Shetty 1
1Cornea and refractive surgery,Narayana Nethralaya,Bangalore,India, 2Depatment of Immunology,Narayana Nethralaya,Bangalore,India
Purpose
To study the clinical, and demographic features in patients with ocular allergy with respect to staging, management, outcomes, and systemic allergy profile.
Setting
The study was conducted at a Tertiary care specialty eye hospital in Southern India.
Methods
Patients presenting to our hospital with features of ocular allergy were studied in detail for their clinical presentation, management, and outcomes. Their systemic and allergy profile were also noted and correlated. This was further used to formulate a management algorithm to treat these patients.
Results
525 patients(1050 eyes), of which165 were pediatric patients. Age ranged from 4 to 68 years & visual acuity ranged between 6/6 and 6/120 (Snellen’s acuity). The patients with mild allergy were 390, moderate 42, and severe in 93 patients. Associated systemic allergy was seen in 72 patients.106 cases had associated Keratoconus. Serum Immunoglobulin E levels were correlated with disease severity, with levels more than 2500 IU/ml found in severe cases. 367 eyes required management in the form of systemic therapy. 10 patients required additional surgical treatment like supra tarsal steroid injections, epithelial debridement, and amniotic membrane transplant. Follow-up ranged between 1 to 10 years.
Conclusions
Milder forms of allergy were treated with mast cell stabilizers and low-potency topical steroids in short courses. In patients who had chronic or recalcitrant disease, nonsteroidal immunomodulatory agents like cyclosporine and tacrolimus were added. In severe cases, a combination of systemic treatment in consultation with the immunologist in form of sublingual immunotherapy, monitoring serum IgE levels, and avoidance therapy has been advised. Surgical interventions like supra tarsal steroid injections and shield ulcer debridement were utilized in cases with corneal involvements like shield ulcers. The simplified treatment algorithm based on this study will help clinicians treat patients with ocular allergies more easily and effectively.