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General considerations in allergy and asthma

General considerations in allergy and asthma. AboUT ME. Tom Landgraf OD, FAAO Graduate ICO Residency PCO Ocular Disease Chief SCO UMSL since 11/07. Teaching this course. Readings NBEO Optometric Relevance Case considerations. Allergy and asthma.

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General considerations in allergy and asthma

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  1. General considerations in allergy and asthma

  2. AboUT ME • Tom Landgraf • OD, FAAO • Graduate ICO • Residency PCO • Ocular Disease Chief SCO • UMSL since 11/07

  3. Teaching this course • Readings • NBEO • Optometric Relevance • Case considerations

  4. Allergy and asthma • Readings: Clinical Medicine In Optometric Practice • Chapter 9: Pulmonary Disease • My personal history • Pneumonia and COPD • Chapter 13: Disorders of the Immune System

  5. Allergy and asthma • NBEO • Part I • General immunology • General pathology • Immunopathology, hypersensitivity, autoimmunity, genetic principles and disorders • Respiratory system • Part II • Systemicconditions • Respiratory system: epidemiology, signs and symptoms (COPD, asthma, anaphylaxis) • Laboratory tests • Probably diagnoses and treatment approaches

  6. Allergy and Asthma • Optometric relevance: • You tell me…..

  7. Allergy and Asthma • Optometric relevance: • Use of non-selective beta blockers for glaucoma • Contraindicated • In patients with lung disease • Anaphylaxis to IV NaFl • Allergic conjunctivitis diagnosis today

  8. ALLERGY AND ASTHMA • Use of topical beta blockers • Betagan (and generic),Betimol, Betoptic-S. Istalol, Timoptic (and generic), Timoptic-XE (and generic) • 0.25 vs 0.5%, cap colors? • Non-selective vs selective (Betoptic-S)

  9. ALLERGY and Asthma • Topical beta-adrenergic antagonists • Block stimulation of beta-adrenergic receptors in the lungs • Promote smooth muscle contraction • Airway constriction or bronchoconstriction • SOB?

  10. Allergy and Asthma • Topical beta-andrenergic antagonists • Contraindications • COPD • Emphysema • Chronic bronchitis • Asthma

  11. ANAPHYLAXIS (to IV NaFL) • Type of hypersensitivity? • Immediate • May avoid by taking a great hx • Asthma, allergy, atopic?

  12. ANAPhylaxis (to IV NaFL) • Prior to injection • Consent form reviewed with patient • Signed by patient

  13. Anaphylaxis (to IV NAFL) • Signs and sxs • Cutaneous: hives, itching, angioedema • Respiratory: wheezing, tachypnea, cyanosis, tightness in throat, SOB • EMS and ANA kit (epi-pen) • Monitor vitals / ABC’s of CPR / supplemental oxygen • Trendelenberg position

  14. ANAPHYLAXIS (TO IV NAFL) • Injection treatment • IM 1:1000 epinephrine (Epi-pen) • IM benadryl (diphenhydramine) 10-50 mg/ml • Urticaria, itching • Pre-loaded syringe and needle

  15. ANAPHYlaxis (TO IV NAFL) • Eventually leads: • Shock and death without intervention • Additional signs and sxs: uneasiness, faintness, flushing, facial edema, palpitations

  16. ANAPHYLAxis (to IV NaFL) • S: Signs and sxs • C: Cutaneous • R: Respiratory • E: EMS activation • A: Ana-kit or epi-pen • M: Monitor vitals

  17. Allergic conjunctivitis • Introduction • Localized anaphylaxis • Red eye work-up • Allergic, bacterial, viral,chlamydial • History • at least 4 HPI’s (history of present illness) • Exam

  18. Allergic coNjunctivitis • History • Symptoms • Itching? • Discharge? • Vision affected? • Foreign body sensation • Photophobia

  19. Allergic Conjunctivitis • History • Location and spread? • Quality:pain? • Severity? • Duration? • Timing? • Context? • Modifiers? • Other family members affected?

  20. Allergic conjuctivitis • History • When I walk in the room….. • “What is the worst thing bothering you about your eyes today?”

  21. Allergic conjuctivitis • History • Job and avocations • Day care? • Food handling? • Work excuse?

  22. Allergic conjunctivitis • My experience / history • Mucous discharge: allergic • Serous discharge: viral • Mucopurulent discharge: bacterial

  23. ALLERGIC CONJunctivitis • My experience / history • Itching: allergic • Spread: viral • Pain: uveitis, corneal problem, angle closure

  24. ALLERGICCONJUCTIVITis • My experience / history • Photophobia: corneal disease, uveitis • CL wearer: remove if red, rule out worst case scenario  ulcer • Other family members affected: viral • Day care / elementay school: viral

  25. Allergic conjuctivitis • Exam: minimum data base • Responsible for the whole eye, not just the red conjunctiva • VA’s • EOM’s • Pupils • Confrontation fields • Slit lamp exam • Tonometry • Ophthalmoscopy • Pre-auricular lymph nodes

  26. Allergic conjunctivitis • Slit lamp exam • Adnexa /orbit: edema • Lids / lashes: edema, hyperemia • Bulbar conjunctiva: chemosis, hyperemia

  27. ALLERGIC COnJUNCTIVITIS • Slit lamp exam • Palpebral conjunctiva • Have to flip that upper lid • Papillae: allergic • Vascular bumps • Follicles: viral • Avascular bumps

  28. Allergic conjunctivitis • Slit lamp exam • Cornea • NaFl (sodium fluorescein) evaluation • Anterior chamber

  29. Summary: Allergic conjunctivitis • History: mucous discharge, itching, OU • Slit lamp exam: papillae, edema, hyperemia

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