Ocular Allergy
Allergy is a pathologic condition that can occur in genetically predisposed individuals who generate an aberrant immune response against environmental antigens, defined allergens. This immune response is characterized by the differentiation of T-helper (T
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Ocular Allergy Andrea Leonardi and Neal P. Barney
Contents
1.1
1.1
Definition.....................................................
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1.2 1.2.1 1.2.2 1.2.3 1.2.4
Etiology ....................................................... Innate Immunity and Ocular Allergy ........... The Allergic Process .................................... Allergic Inflammation .................................. Allergic Inflammation and Corneal Damage ....................................
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1.3 1.3.1 1.3.2 1.3.3 1.3.4 1.3.5 1.3.6
Clinical Symptoms and Signs of the Underlying Condition/Disorder ................ Seasonal and Perennial Allergic Conjunctivitis ............................................... Vernal Keratoconjunctivitis.......................... Atopic Keratoconjunctivitis ......................... Giant Papillary Conjunctivitis ...................... Contact Blepharoconjunctivitis .................... Drug-Induced Conjunctivitis or Keratoconjunctivitis .....................................
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1.4
Differential Diagnosis ................................
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1.5
Diagnostic Tests in Ocular Allergy ...........
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Treatment of Ocular Allergy ..................... Non-pharmacological Management ............. Treatment of Allergic Conjunctivitis ........... Systemic Pharmacological Treatment .......... Specific Immunotherapy .............................. Treatment of GPC ........................................ Treatment of VKC ....................................... Treatment of AKC ....................................... Surgical Treatment of Severe Allergic Keratoconjunctivitis ....................... References ...............................................................
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1.6 1.6.1 1.6.2 1.6.3 1.6.4 1.6.5 1.6.6 1.6.7 1.6.8
A. Leonardi, MD (*) Department of Neuroscience, Ophthalmology Unit, University of Padua, Via Giustiniani 2, Padua 35128, Italy e-mail: [email protected]
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Definition
Allergy is a pathologic condition that can occur in genetically predisposed individuals who generate an aberrant immune response against environmental antigens, defined allergens. This immune response is characterized by the differentiation of T-helper (Th) cells in the Th type 2 (Th2) cell and by the production of allergen-specific IgE. Ocular allergy can involve all the components of the ocular surface including the lid and the lid margin, the conjunctiva, and the lacrimal system. Corneal involvement is typically restricted to the two most severe forms of ocular allergy, vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). In fact, anatomical, physiological, and immunological properties of the cornea render it relatively protected from allergic inflammation. The cornea is more frequently involved in autoimmune diseases, at times as the initial presenting sign of a new autoimmune disease or as a new sign in patients with a long-standing history of autoimmune systemic disease. Approximately one-third of the world population is affected by some form of alle
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