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Conjunctivitis - allergic - Management
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- Scenario: Seasonal or perennial allergic conjunctivitis: covers the management of seasonal conjunctivitis that is characterized by recurrent conjunctivitis often at the same time each year, and the management of perennial conjunctivitis that is characterized by daily symptoms of conjunctivitis throughout the year, often on waking each morning.
- Scenario: Giant papillary conjunctivitis: covers the management of where macropapillae (0.3–1 mm) and giant papillae (1–2 mm) present on the inside of the upper lid. It occurs predominantly in people using contact lenses, although it may occur in people following eye surgery. Symptoms generally progress slowly. When caused by contact lenses, the person experiences increased awareness when wearing the lenses.
- Scenario: Contact dermatoconjunctivitis: covers the management of people with allergic dermatitis of the eyelids. It occurs most commonly in a person using eye drops and does not occur more frequently in people with atopy and does not respond to use of antihistamines and mast cell stabilizers.
Scenario: Seasonal or perennial allergic conjunctivitis
Definition
- Seasonal allergic conjunctivitis is a recurrent conjunctivitis occurring at the same time each year typically caused by allergy to grass and tree pollens.
- Perennial allergic conjunctivitis is a recurrent conjunctivitis occurring throughout the year typically caused by allergy to house dust mite or animal dander.
What self care advice can I give a person with seasonal or perennial conjunctivitis?
- Advise symptomatic people with seasonal or perennial allergic conjunctivitis to:
- Remove contact lenses, if these are worn, until symptoms and signs resolve.
- Avoid rubbing their eyes.
- Avoid exposure to the allergen when practical.
- Place cool compresses on the affected eyes to ease symptoms.
In depth
What drug treatments should I prescribe for a person with seasonal or perennial conjunctivitis?
- Before treating a person with seasonal or perennial allergic conjunctivitis, you must exclude the serious causes of a red eye that can result in permanent visual impairment. For further information, see Diagnosing allergic conjunctivitis.
- When rapid relief of symptoms is required, prescribe an oral or topical ocular antihistamine, depending on the person's preference and previous response to treatment.
- When prolonged control of symptoms is required, prescribe an oral antihistamine, topical ocular antihistamine, or a topical ocular mast cell stabilizer, depending on the person's preference and previous response to treatment.
- When a topical ocular mast cell stabilizer is prescribed long term, also prescribe an oral antihistamine, or a topical ocular antihistamine if:
- Symptom control is needed in the first few weeks while waiting for the mast cell stabilizer to take effect.
- Breakthrough symptoms occur.
- When symptoms persist despite treatment with an antihistamine and a mast cell stabilizer:
- Reassess the diagnosis.
- Consider prescribing a different antihistamine or mast cell stabilizer.
- Refer for specialist assessment, depending on clinical judgement.
- When symptoms are severe and there is no doubt about the diagnosis, consider prescribing a 3–5 day course of an oral corticosteroid for rapid control of symptoms. Refer to an immunologist if oral corticosteroids are required more than very occasionally.
In depth
Prescriptions
Antihistamine eye drops for rapid relief
Age from 3 years onwards
Emedastine 0.05% eye drops
Emedastine 0.05% eye drops
Put one drop into each eye twice a day.
Supply 5 ml.
Ketotifen 250micrograms/ml eye drops
Ketotifen 250micrograms/ml eye drops
Put one drop into each eye twice a day.
Supply 5 ml.
Age from 4 years onwards
Azelastine 0.05% eye drops
Azelastine 0.05% eye drops
Put one drop into each eye twice a day. Increase to four times a day if required.
Supply 8 ml.
Age from 12 years onwards
Otrivine-Antistin® eye drops
Antazoline 0.5% / Xylometazoline 0.05% eye drops
Put one drop into each eye 2 to 3 times a day.
Supply 10 ml.
Non-sedating oral antihistamines
Age from 2 years to 5 years 11 months
Cetirizine s/f solution: 5mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take one 5ml spoonful once a day.
Supply 150 ml.
Loratadine syrup: 5mg once a day
Loratadine 5mg/5ml oral solution
Take one 5ml spoonful once a day.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Cetirizine s/f solution: 10mg once a day
Cetirizine 1mg/ml oral solution sugar free
Take two 5ml spoonfuls once a day.
Supply 300 ml.
Loratadine syrup: 10mg once a day
Loratadine 5mg/5ml oral solution
Take two 5ml spoonfuls once a day.
Supply 300 ml.
Age from 12 years onwards
Cetirizine tablets: 10mg once a day
Cetirizine 10mg tablets
Take one tablet once a day.
Supply 28 tablets.
Loratadine tablets: 10mg once a day
Loratadine 10mg tablets
Take one tablet once a day.
Supply 28 tablets.
Fexofenadine tablets: 120mg once a day
Fexofenadine 120mg tablets
Take one tablet once a day.
Supply 30 tablets.
Mast cell stabilizer eye drops for prophylaxis
Age from 1 year onwards
Sodium cromoglicate 2% eye drops
Sodium cromoglicate 2% eye drops
Put one drop into each eye four times a day.
Supply 14 ml.
Age from 4 years onwards
Lodoxamide 0.1% eye drops
Lodoxamide 0.1% eye drops
Put one drop into each eye four times a day.
Supply 10 ml.
Age from 6 years onwards
Nedocromil 2% eye drops
Put one drop into each eye twice a day. Increase to four times a day if required.
Supply 10 ml.
Short course of oral prednisolone (children)
Age from 2 years to 11 years 11 months
Prednisolone soluble tablets: 10mg each morning for 3 days
Prednisolone 5mg soluble tablets
Take two tablets each morning (as a single dose) for 3 days.
Supply 6 tablets.
Prednisolone soluble tablets: 10mg each morning for 5 days
Prednisolone 5mg soluble tablets
Take two tablets each morning (as a single dose) for 5 days.
Supply 10 tablets.
Short course of oral prednisolone (adults)
Age from 16 years onwards
Prednisolone tablets: 30mg each morning for 5 days
Prednisolone 5mg tablets
Take six tablets each morning (as a single dose) for 5 days.
Supply 30 tablets.
Prednisolone e/c tablets: 30mg each morning for 5 days
Prednisolone 5mg gastro-resistant tablets
Take six tablets each morning (as a single dose) for 5 days.
Supply 30 tablets.
Scenario: Giant papillary conjunctivitis
Definition
- Giant papillary conjunctivitis is a chronic conjunctivitis characterized by the presence of giant papillae typically caused by wearing of soft contact lenses, although it may occur in people using hard contact lenses and following eye surgery.
How do I manage a person with giant papillary conjunctivitis?
- Before treating a person with a red eye for giant papillary conjunctivitis, you must exclude the serious causes of a red eye that can result in permanent visual impairment. For further information, see Diagnosing allergic conjunctivitis.
- Advise people with giant papillary conjunctivitis to:
- Avoid rubbing their eyes.
- Place cool compresses on the affected eyes to ease symptoms.
- Remove contact lenses, if these are worn, and see an optician for further management.
- Refer people with giant papillary conjunctivitis following eye surgery to an ophthalmologist.
In depth
Scenario: Contact dermatoconjunctivitis
Definition
- Contact dermatoconjunctivitis is characterized by conjunctivitis with allergic dermatitis of the eyelids and a complete lack of response to antihistamines and mast cell stabilizers. Typically it is caused by the use of eye drops.
How should I manage someone with contact dermatoconjunctivitis?
- Before treating a person with a red eye for contact dermatoconjunctivitis, you must exclude the serious causes of a red eye that can result in permanent visual impairment. For further information, see Diagnosing allergic conjunctivitis.
- Advise people to:
- Remove contact lenses, if they are worn, until symptoms and signs resolve.
- Avoid rubbing their eyes.
- Place cool compresses on the affected eyes to ease symptoms.
- Avoid exposure to the identified allergen. When caused by cosmetics, symptoms should be allowed to resolve completely before trying an alternative product.
- When contact dermatoconjunctivitis is due to eye drops, seek specialist advice as to an appropriate alternative, when continued treatment is necessary.
- When contact dermatoconjunctivitis is severe, refer for same-day assessment and further management by a specialist.
In depth
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