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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047907/
J Asthma Allergy. 2010; 3: 149–158.
Published online 2010 November 24. doi: 10.2147/JAA.S13705.
PMCID: PMC3047907
Copyright © 2010 Kari and Saari, publisher and licensee Dove Medical Press Ltd.
Updates in the treatment of ocular allergies
Osmo Kari1 and K Matti Saari2
1Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland;
2Department of Ophthalmology, University of Turku, Turku, Finland
Correspondence: Osmo Kari, Department of Allergology, Skin and Allergy Hospital, Helsinki University, Central Hospital, BP 160, Helsinki, 00029 HUCH, Finland, Tel +358 9 471 86352, Mobile +358 40 756 1404, Fax +358 9 467 782, Email osmo.kari@optokari.fi
Received November 22, 2010
This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
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The above url links to the full (free) text of the article. It is an extensive article that thoroughly explains all the different types of ocular allergies that can affect different parts of the eye and also discusses current treatment options.
Read the whole thing for a good overview, but this section caught my attention.
Scout
J Asthma Allergy. 2010; 3: 149–158.
Published online 2010 November 24. doi: 10.2147/JAA.S13705.
PMCID: PMC3047907
Copyright © 2010 Kari and Saari, publisher and licensee Dove Medical Press Ltd.
Updates in the treatment of ocular allergies
Osmo Kari1 and K Matti Saari2
1Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland;
2Department of Ophthalmology, University of Turku, Turku, Finland
Correspondence: Osmo Kari, Department of Allergology, Skin and Allergy Hospital, Helsinki University, Central Hospital, BP 160, Helsinki, 00029 HUCH, Finland, Tel +358 9 471 86352, Mobile +358 40 756 1404, Fax +358 9 467 782, Email osmo.kari@optokari.fi
Received November 22, 2010
This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
-----------------------------------------------------------------------------------------------------------
The above url links to the full (free) text of the article. It is an extensive article that thoroughly explains all the different types of ocular allergies that can affect different parts of the eye and also discusses current treatment options.
Read the whole thing for a good overview, but this section caught my attention.
Scout
Contact allergic blepharitis (Figure 8) and contact allergic blepharoconjunctivitis (CABC) are common. In a German study, the predominant causes were allergic contact dermatitis (44%), atopic eczema (25%), airborne contact dermatitis (10%), and irritant contact dermatitis (9%).40
Contact dermatoconjunctivitis is a typical contact T-cell-mediated delayed hypersensitivity reaction to haptens, which become immunogenic only after they bind to tissue protein. Typical delayed type of allergies, the symptoms of which may be only in the eyelids, are nail lacquer and mascara allergies and the components of eyedrops and ointments. The most common place in nail lacquer allergies is just the eyelids. The sensitizer is often the toluensulfonamide–formaldehyde resin. The main allergen in mascara is natural resin, which is used in most mascara as adhesive. The lid mascara often contains nickel and cobalt (blue color), which may cause lid eczema for those who are already sensitized and the mascara may also itself sensitize the users.
All eyedrops and ointments contain allergens, for example antibiotics including neomycin, framycetin, sulfa, chloramphenicol, and (oxy) tetracycline; glaucoma medications, including pilocarpine, beta blockers, brimonidine, apraclonidine, dorzolamide, and prostaglandin derivatives; local anesthetics; antihistamines; anticholinergics; the preservatives benzalkonium chloride and thimerosal; mydriatics including scopolamine, atropine, tropicamide, phenylephrine hydrochloride, and cyclopentolate hydrochloride. These agents can cause very angry allergic reactions which may last a long time and cause, especially in glaucoma therapy, a common intolerance to all topical glaucoma medication. In addition, contact lens care solutions, for example chlorhexidine and papain, can cause robust allergic reactions. These allergic reactions manifest almost always as blepharoconjunctivitis, which means that besides lid eczema, there is also conjunctivitis.
Many different substances can cause symptoms both in the eyelids and in other skin parts of the body, but the thin skin of the eyelids is the most sensitive. Frames of eyeglasses that contain plastics and metal may cause eczema both in the contact area and lid and face.
Delayed type of allergy is caused by many components that spread as aeroallergens and can cause lid or face eczema. These allergens include rubber chemicals, some greenhouse plants, and the lactones of composites.
Skin prick tests and epicutan tests are diagnostics of lid eczema. It is important to test also with the patient’s own materials, because the standard test series cover poorly the allergens which cause lid eczema. Atopic and seborrheic lid eczema (Figure 9) resemble each other. Skin tests help to make the right diagnosis.
In the treatment of CABC, it is most important to clarify the causing agent and to eliminate it. Allergic lid eczema heals also without therapy when the allergen is avoided.
Contact dermatoconjunctivitis is a typical contact T-cell-mediated delayed hypersensitivity reaction to haptens, which become immunogenic only after they bind to tissue protein. Typical delayed type of allergies, the symptoms of which may be only in the eyelids, are nail lacquer and mascara allergies and the components of eyedrops and ointments. The most common place in nail lacquer allergies is just the eyelids. The sensitizer is often the toluensulfonamide–formaldehyde resin. The main allergen in mascara is natural resin, which is used in most mascara as adhesive. The lid mascara often contains nickel and cobalt (blue color), which may cause lid eczema for those who are already sensitized and the mascara may also itself sensitize the users.
All eyedrops and ointments contain allergens, for example antibiotics including neomycin, framycetin, sulfa, chloramphenicol, and (oxy) tetracycline; glaucoma medications, including pilocarpine, beta blockers, brimonidine, apraclonidine, dorzolamide, and prostaglandin derivatives; local anesthetics; antihistamines; anticholinergics; the preservatives benzalkonium chloride and thimerosal; mydriatics including scopolamine, atropine, tropicamide, phenylephrine hydrochloride, and cyclopentolate hydrochloride. These agents can cause very angry allergic reactions which may last a long time and cause, especially in glaucoma therapy, a common intolerance to all topical glaucoma medication. In addition, contact lens care solutions, for example chlorhexidine and papain, can cause robust allergic reactions. These allergic reactions manifest almost always as blepharoconjunctivitis, which means that besides lid eczema, there is also conjunctivitis.
Many different substances can cause symptoms both in the eyelids and in other skin parts of the body, but the thin skin of the eyelids is the most sensitive. Frames of eyeglasses that contain plastics and metal may cause eczema both in the contact area and lid and face.
Delayed type of allergy is caused by many components that spread as aeroallergens and can cause lid or face eczema. These allergens include rubber chemicals, some greenhouse plants, and the lactones of composites.
Skin prick tests and epicutan tests are diagnostics of lid eczema. It is important to test also with the patient’s own materials, because the standard test series cover poorly the allergens which cause lid eczema. Atopic and seborrheic lid eczema (Figure 9) resemble each other. Skin tests help to make the right diagnosis.
In the treatment of CABC, it is most important to clarify the causing agent and to eliminate it. Allergic lid eczema heals also without therapy when the allergen is avoided.
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