A. Local therapy
1. Topical steroids. These are effective in all forms
of spring catarrh. However, their use should be
minimised, as they frequently cause steroid
induced glaucoma. Therefore, monitoring of
intraocular pressure is very important during
steroid therapy. Frequent instillation (4 hourly) to
start with (2 days) should be followed by
maintenance therapy for 3-4 times a day for 2
weeks. Commonly used steroid solutions are of
fluorometholone medrysone, betamethasone or
dexamethasone. Medrysone and fluorometholone
are safest of all these.
2. Mast cell stabilizers such as sodium cromoglycate
(2%) drops 4-5 times a day are quite effective in
controlling VKC, especially atopic cases. It is
mast cell stabilizer. Azelastine eye drops are also
effective in controlling VKC.
3. Topical antihistaminics are also effective.
4. Acetyl cysteine (0.5%) used topically has
mucolytic properties and is useful in the treatment
of early plaque formation.
5. Topical cyclosporine (1%) drops have been
recently reported to be effective in severe
unresponsive cases.
B. Systemic therapy
1. Oral antihistaminics may provide some relief
from itching in severe cases.
2. Oral steroids for a short duration have been
recommended for advanced, very severe, nonresponsive
cases.
C. Treatment of large papillae. Very large (giant)
papillae can be tackled either by :
rewarding results.
F. Treatment of vernal keratopathy
1. Topical steroids. These are effective in all forms
of spring catarrh. However, their use should be
minimised, as they frequently cause steroid
induced glaucoma. Therefore, monitoring of
intraocular pressure is very important during
steroid therapy. Frequent instillation (4 hourly) to
start with (2 days) should be followed by
maintenance therapy for 3-4 times a day for 2
weeks. Commonly used steroid solutions are of
fluorometholone medrysone, betamethasone or
dexamethasone. Medrysone and fluorometholone
are safest of all these.
2. Mast cell stabilizers such as sodium cromoglycate
(2%) drops 4-5 times a day are quite effective in
controlling VKC, especially atopic cases. It is
mast cell stabilizer. Azelastine eye drops are also
effective in controlling VKC.
3. Topical antihistaminics are also effective.
4. Acetyl cysteine (0.5%) used topically has
mucolytic properties and is useful in the treatment
of early plaque formation.
5. Topical cyclosporine (1%) drops have been
recently reported to be effective in severe
unresponsive cases.
B. Systemic therapy
1. Oral antihistaminics may provide some relief
from itching in severe cases.
2. Oral steroids for a short duration have been
recommended for advanced, very severe, nonresponsive
cases.
C. Treatment of large papillae. Very large (giant)
papillae can be tackled either by :
- Supratarsal injection of long acting steroid or
- Cryo application
- Surgical excision is recommended for extraordinarily large papillae.
- Dark goggles to prevent photophobia.
- Cold compresses and ice packs have soothing effects.
- Change of place from hot to cold area is recommended for recalcitrant cases.
rewarding results.
F. Treatment of vernal keratopathy
- Punctate epithelial keratitis requires no extra treatment except that instillation of steroids should be increased.
- A large vernal plaque requires surgical excision by superficial keratectomy.
- Severe shield ulcer resistant to medical therapy may need surgical treatment in the form of debridment, superficial keratectomy, excimer laser therapeutic kerateotomy as well as amniotic membrane transplantation to enhance reepithelialization.
No comments :
Post a Comment
Waiting for your comments