The College of Optometrists

How should one deal with allergic/ or papillary conjuctivitis in terms of management and investigation for PQE resits. Should this involve referral/ reporting to GP or not.

Im not quite sure what to do in the ocular disease PQE.

Thanks for your help..

firstly you must make your diagnosis. You roll back the top lid and see papilae. The px should report itchiness and watery discharge (often only slight- so watery eyes). The bulbar parts can be slightly inflamed and pink. In allergy you get mast cell degranularisation causing histamine to be released and this causes via the H1 receptors, blood vessels to dilate (hence pinky eye), lacrimation, itching, mild oedema of the lids and conjunctivae - causing the papilae.

Instill flourescen - make sure there is no other cause (foreign body, corneal abrazion, ingrowing lash etc).

Explain to the px the possible cause and see if they notice any other sig n of allergy - hay fevour will cause rhinitis sinusitis sneezing etc.

It can be caused by contact lenses (or solutions) - so discontinue these. Refit with daily lenses when better.

Relief can be from ice cold compresses - crushed ice in a flannel and over the eyes. Keep the eyes very clean.

Prescribe otravin-antistin drops which will help the imediate problem by constricting the vessels using xylometazoline 0.05% and antazoline 0.5%.

THis can have a rebound red eye effect as well as causing allergy to its preservative - so watch that one.

Check them in a few days to check on progress. If no better (and sometimes there is no answer) - you can suggest the doctor prescribe levacobastine livostin - only available if you are level two drugs. (and not reccommended if they are under ten years old)

to carry on - yes a report to the gp is needed. The examiners will look to see your care plan has safety and fall back positions written all over it. You can only think about treating SAC or GPC - so if you are not sure if it could be PAC or atopic or young kids -then you would have to refer.