Questions and Answers
What is a characteristically observed condition in pediatric glaucoma?
Which medication is NOT a recommended treatment for pediatric glaucoma?
What is the primary reason for referring a child with glaucoma to a specialist?
What should be avoided in managing hyphema due to its potential risks?
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Which of the following is advised for treating inflammation in a hyphema patient?
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What is a typical intraocular pressure (IOP) reading for children with glaucoma?
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What is a common side effect of systemic steroids in children?
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Which of the following medications is suitable for children ages 4 years and older?
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What formulation of Fluticasone is suitable for children aged 2 years and older?
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Which medication is classified as a 1st generation antihistamine?
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What is the recommended age for using Rhinocort (Budesonide) in children?
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Which symptom is commonly associated with allergic conjunctivitis but not always present?
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Which medication is not typically used for treating ADHD?
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What is the first place to observe papillae in cases of ocular allergies?
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Which of the following medications is commonly prescribed as a systemic steroid?
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Which treatment is often the first choice for allergic conjunctivitis?
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What is a typical sign in severe allergic conjunctivitis that suggests significant irritation?
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What is the FDA approved medication for vernal keratoconjunctivitis?
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Which condition is characterized by challenging symptoms like severe itching, photophobia, and blepharospasm, particularly in younger males?
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Which of the following treatments for allergic conjunctivitis is considered off-label?
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What is the primary type of discharge observed in patients with severe allergic conjunctivitis?
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What would typically NOT be a recommended action to mitigate allergens for children with ocular allergies?
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Which additional treatment may be required in severe cases of allergic conjunctivitis when conventional treatments are ineffective?
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Study Notes
Ocular Allergy Overview
- History taking should include inquiry about medical conditions, new pets or environments, and potential drug or food allergies.
- Key symptoms of allergic conjunctivitis typically present bilaterally: itching, redness, tearing, eye rubbing, runny nose, and sneezing.
Signs of Allergic Conjunctivitis
- Presence of papillae and edema/chemosis in the conjunctiva.
- Conjunctival injection and caruncle involvement can indicate allergic reactions.
- "Allergic shiner" is a noticeable under-eye feature associated with allergies.
Common Antihistamine and Mast Cell Stabilizer Treatments
- Ketotifen (0.025%) suitable for children ≥3 years; available as Zaditor or Alaway, dosed BID.
- Epinastine HCl (0.05%), for children ≥2 years; marketed as Elestat, dosed BID.
- Azelastine HCl (0.05%) usable for children ≥3 years; known as Optivar, dosed BID.
- Bepotastine Besilate (1.5%) safe for children ≥2 years; available as Bepreve, dosed BID.
- Emastadine Difumarate (0.05%) for children ≥3 years; branded as Emadine, dosed QID.
Additional Treatment Options
- Alcaftadine (0.25%) approved for children ≥2 years; Lastacaft can be taken once daily and is economical.
- Olopatadine comes in various concentrations (0.1%, 0.2%, 0.7%) for children ≥3 years; includes Pataday in varying dosages.
- Pemirolast Potassium (0.1%), a mast cell stabilizer, suitable for children ≥3 years; marketed as Alamast.
- Nedocromil Sodium (2%) and Lodoxamide Trimethamine (0.1%) available for children ≥2-3 years.
- Cromolyn Sodium (4%) permissible for ages ≥4; branded as Opticrom or Crolom, dosed QID.
VKC Management
- Vernal Keratoconjunctivitis (VKC) is notably more severe, affecting males more (3-4:1 ratio), typically appearing before age 10.
- Symptoms include significant itching, irritation, photophobia, foreign body sensation, blurred vision, and blepharospasm.
- Signs feature conjunctival injection, hyperemia, ptosis, thick ropy discharge, and cobblestone-like papillae.
Treatment Approaches for VKC
- Mild cases typically self-resolve by puberty, while conventional treatments may prove inadequate.
- Moderate cases require a combination of mast cell stabilizers and antihistamines.
- Severe VKC may necessitate topical steroids, with oral steroids for sight-threatening situations; Verkazia (cyclosporine 0.1%) is the first FDA-approved medication for VKC.
Glaucoma in Children
- Found in about 1 in 10,000 live births, leading to buphthalmos and megalocornea.
- Surgical intervention typically required, with medical treatments including beta-blockers; prostaglandin analogs are often ineffective.
Hyphema Management
- Require Atropine BID, tapering to QD post-clot healing, and use of Pred Forte for inflammation.
- Monitoring for increased IOP and ensuring bed rest with head elevation to 30° is crucial.
Systemic Medications for Children
- Systemic steroids prescribed for conditions like asthma, allergies, and inflammation with potential side effects, including increased blood sugar and cataracts.
- Allergic rhinitis treatments include a variety of intranasal steroid sprays and oral antihistamines suitable for different age groups.
- Common ADHD medications include Ritalin, Adderall, and Strattera; SSRIs used for depression and anxiety in children.
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Description
This quiz covers essential information regarding ocular allergies, including their history, symptoms, and potential triggers such as medical conditions and environmental factors. Test your knowledge on allergic conjunctivitis and its common signs.
