Healthcare and Medicine Reference
In-Depth Information
In the presence of corneal ulcer, steroid eye-drops or ointment with
preventative antibiotic coverage and eye patching are necessary and a strict
follow-up is required. In case, amniotic membrane patching can enhance
re-epithelization.
Surgical removal of corneal plaques is sometimes useful. Giant papillae
excision is convenient in the event of relevant mechanical pseudo-ptosis.
ATOPIC KERATOCONJUNCTIVITIS
AKC is the most severe chronic form of allergic disease of the ocular surface;
both allergic and proper non-allergic signs and symptoms and complications
have to be monitored.
Environmental and preventative measures are necessary, although far
from suffi cient. As AKC is not only an ocular disorder, a systemic therapeutic
approach is recommended. Antihistamine oral therapy is the fi rst-step
treatment; it is quite safe and can be taken all-year round with limited side
effects. However, systemic steroids are often necessary to obtain a signifi cant
control of the infl ammation. In case of refractive AKC and as an alternative
to steroids, a T-cell targeted approach with low dose oral cyclosporine A or
tacrolimus (FK-506) usually guarantees good results (Cornish et al. 2010,
Stumpf et al. 2006). Alternatively or in addition to steroids or to cyclosporine,
other immunosuppressive agents, like azathioprine and mycophenolate
mofetil, are used in severe atopic dermatitis. The trend for future treatment
focuses on biological therapies; omalizumab, a humanised monoclonal
IgE antibody that complexes with free circulating IgE, demonstrated its
effi cacy in asthma control and has been proposed also for AKC (Williams
et al. 2005).
Ocular therapy includes antihistamines and mast cell stabilizers, that
are able to reduce the ocular swelling only partially, and topical steroids,
that usually ensure a rapid palliation of symptoms. A number of steroid-
sparing medications were assessed, such as cyclosporine eye-drops and
tacrolimus ointment or eye-drops (FK-506) (Ebihara et al. 2009, Attas-Fox
et al. 2008).
Topical or systemic antibiotics are often necessary to treat infectious
blepharitis or microbial keratitis, as well as antiviral has to be administered
when a herpetic infection occurs. In case of recurrent HSV keratitis, oral
acyclovir 400 mg twice daily is prescribed for a long period as prophylaxis
against relapses (Guglielmetti et al. 2010).
Surgery may be necessary in case of complications. Cataract may
develop also in younger patients; typically in AKC it is an anterior polar
cataract, while posterior capsular opacity is secondary to a prolonged steroid
treatment. Glaucoma in steroid-dependent subjects sometimes required
a fi ltering surgery, in some cases a drainage implants. The outcome is
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