Student.Handout.HEENT (2)

Common allergens pollen animal dander topical

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Common allergens Pollen, animal dander, topical products Clinical signs Inflamed conjunctiva Itchy and watery eyes Photophobia Photo adopted from:
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12 Types of Allergic Conjunctivitis Acute Sudden onset hypersensitivity Intense presentation Seasonal Occurs in a specific pollen season Associated with allergic rhinitis Perennial Occurs in response to year round allergens
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13 Nonpharmacologic Treatment for Allergic Conjunctivitis Allergen avoidance Cold compress Avoid wearing contact lenses Do not rub eyes Preventative measures Check pollen counts before going outdoors Keep windows closed Change air filters Dust and vacuum home often
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14 Pharmacologic Treatment for AC 1 st line treatment for minor AC: Artificial tears Ophthalmic antihistamine / mast cell stabilizer Ophthalmic decongestants +/- antihistamines Oral antihistamines
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15 Antihistamine / Mast Cell Stabilizer Ketotifen fumarate 0.025% Zaditor ® , Alaway ® Zyrtec Itchy Eye Drops ® Inhibits mast cell degranulation Potent H1-antagonist activity Previously Rx Only Age ≥ 3 years The safest and most effective product for the treatment of seasonal and perennial allergic conjunctivitis Photo adopted from:
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16 Ophthalmic Decongestants Alpha Agonists Relieve redness and swelling Tetrahydrozoline 0.05% Murine tear Plus ® , Opti-Clear ® , Visine ® Naphazoline 0.01 – 0.03% All Clear ® , Clear Eyes ® , Naphcon ® Oxymetazoline 0.025% Visine L.R. ® Phenylephrine 0.12% Relief ® Photo adopted from:
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17 Decongestant Counseling Points Avoid long-term use (> 72 hours) Rebound congestion, epithelial xerosis Oxymetazoline, phenylephrine Store at room temperature Keep out of reach of young children Ingestion can cause systemic effects and/or death Cautioned use in hypertension, cardiovascular disease, diabetes, and hyperthyroidism Contraindicated in angle-closure glaucoma
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18 Topical Antihistamines Immediate relief of itching and discomfort Most effective when combined with a decongestant Pheniramine + naphazoline : Naphcon-A ® , Opcon-A ® , Visine-A ® Antazoline + naphazoline : Vasocon-A ® Common burning, stinging, and discomfort upon instillation Photo adopted from:
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19 Oral Antihistamines For relief of persistent allergy-related symptoms Full effects seen after multiple days of use Effective in preventative therapy Non-sedating 2 nd generation antihistamines Fexofenadine (Allegra ® ) Loratadine (Claritin ® ) Desloratadine (Clarinex ® ) Cetirizine (Zyrtec ® ) Photo adopted from:
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Patient Case JM is a 26 yo AAM who has had itchy and watery eyes for is a 26 yo AAM who has had itchy and watery eyes for the past 2 weeks since the spring season began. His ocular
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