- Allergic, Seasonal & Perennial (1 of 9)

1 Patient presents w/ signs & symptoms of

2 DIAGNOSIS Does the clinical No ALTERNATIVE presentation confirm allergic DIAGNOSIS conjunctivitis?

Yes

A Non-pharmacological therapy • Avoid trigger factors • Cold compress • Reduce or avoid use of contact lens during seasonal fl are-ups B Pharmacological therapy Any of the following: • (oral) • Antihistamine w/ or w/o vasoconstrictor (ophthalmic) • Antihistamine/ stabilizer (ophthalmic) • Nonsteroidal anti-infl ammatory drug (ophthalmic) • Vasoconstrictors (ophthalmic) Plus Lubricants (ophthalmic) C Immunotherapy

Consider expert referral B FOLLOWUP Pharmacological therapy Is the condition No • responding to therapy? (ophthalmic), short course

Yes

Prevention A Non-pharmacological therapy • Avoid trigger factors • Maintain controlled (air-conditioned) environment B Pharmacological therapy • Mast cell stabilizers (ophthalmic) • Mast cell stabilizers/ (ophthalmic) Plus Lubricants (ophthalmic) ©Treatment of seasonal allergicMIMS conjunctivitis should be started at least 2-4 wks prior to onset of symptoms to achieve optimum eff ectiveness

Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.

B60 © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC • TestsLab • • Exam Physical • • • • Diagnosis Alternative • TestingImmunoassay ofTear Fluid • • ofTear Exam Cytological Fluid • Microscopy Confocal • • Scrapings Conjunctival • • Possible TriggerDetermine Factors • history Medical • Symptoms History • • • (GPC) Conjunctivitis Papillary Giant • • (AKC) Atopic Keratoconjunctivitis • Vernal (VKC) Keratoconjunctivitis • • (PAC) Conjunctivitis Perennial Allergic • • • (SAC) Conjunctivitis Allergic Seasonal • Rarely needed to make diagnosis tomakediagnosis Rarely needed conjunctival hyperemia &apredominantly reaction papillary Conjunctival chemosis, conditions on patient’s based w/other are usually bilateral signs Clinical age, & vary & association cell mediating type Use oflens ofcontact replacement) (lens hygiene, lenses duration frequency ofuse, - orsolutions , topical products, care Use ofeye - Travel - Occupational exposure - Superior limbickeratoconjunctivitisSuperior eye) (dry syndrome Keratitis tear sicca/dysfunctional Blepharoconjunctivitis conjunctivitis orviral Bacterial usingimmunoassay testing cell’s mast Measure oftryptase the level determining by activity measured Tear be also can levels histamineortryptase - &/orlymphocytes neutrophils presence by ofeosinophils, isindicated Allergic response onslide&stain spread tube, sample tear w/capillary Collect w/underlying conditions forAKC &other disease ocular toevaluate used procedure A non-invasive scraping isinconclusiveNegative itisstrongly suggestive ofallergy foreosinophils If positive Usually orconfi doneforacademic purposes rmatory toallergens ofexposure History - to: w/regards history Review ofother ) allergic conditionsPersonal allergic history (eg , orfamily atopic dermatitis, w/age Symptoms tend todecrease - ofsymptoms &progress the date &timingofonset, Identify - Itching isconsidered the symptom cardinal - exacerbations by sensation; characterized (“allergic &remissionsmosis foreignbody shiner”), discharge, &/orecchy- watery photophobia, stinging, burning, tearing, itching w/redness, Ocular/periocular presentation &clinical history Allergic by conjunctivitis are usuallydiagnosed glaucoma fi prostheses, ocular blebsltering post-operative sutures, other include exposed ofcontact causes w/ use lenses; commonlyMost associated An infl toaforeign object the by reaction eyelids ammatory environmental by triggered often Most factors ofatopy history family Attributed toapositive America) North/South commonlyMost aff India, places tropical (eg MiddleEast, dry inhot, residing youngmaleindividuals ects commonMost climates intropical predilection throughout &recurs the w/noseasonal year Manifests than PAC moreSubjectively severe ofthe (egUsually year at summer) occurs &recurs acertain period commonMost ofallergic conjunctivitis form intemperate climates stimulated are endings also causing pain&itching Nerve - conjunctival &swelling injection &,thus, permeability dilation &increased that capillary ofhistamines tothe causes leading release basophils, inwhichreaction antigens triggering (IgE)onthe cell couple cells antibodies ofmast toreaginic surface & mucosal tothe ofocular environment surfaces exposure Direct that hypersensitivity animmediate causes

- House dust mites, animaldander, dustmites, House &feathers are the major implicated inPAC &AKC -

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (2of9) 1 ALLERGIC CONJUNCTIVITIS 2 DIAGNOSIS B61 © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC • • • • (Ophthalmic) Antihistamines • Cold Compress • • • • • • Avoidance ofTrigger Factors • • Identifi ofTriggercation Factors • • • • • • (Ophthalmic) CellStabilizers Antihistamines/Mast • • • • • (Oral) Antihistamines Fast-acting, eff &generallyective well tolerated &prevent recurrence ofallergic &redness) (eg itchiness conjunctivitis acutesymptoms ocular Relieve - foreither acuteorchronic used May diseases be - forthe sites histaminereceptor Compete , Eg , improve which can patient itching reducing comfort vasoconstriction by Causes counts count patientsSensitive ofhighpollen times shouldattempt during orother tooutdoors tolimitexposure inhotwater sheets &washing mattresses, & onpillows encasings are acommon mites House usingdustmite-proof allergen by reduced be &can flReduce oravoid ofcontact use seasonal lens during are-ups pollen-fl are during recommended glasses Use ofgoggle-type period ying Mainstay allergic ofmanaging conjunctivitis fiEg closingwindows, air,ltering &stuff pets removing &dustingregularly, vacuuming etc toys, ed specifiidentifying c problematic antigens butare rarely needed orallergenSkin testing challenge antigen (serum specifi for useful may measurements) be c IgEantibody Trial ofavoidance antigens may identify - Reduce itching &vasodilation - advice medical without for>6weeks used Should not be advice medical without for>2weeks used shouldnotbe Antihistamine w//vasoconstrictor - of allergic conjunctivitis &symptoms intreating monotherapy signs as orincombination used w//vasoconstrictors May be relief compared ocular immediate as tooralantihistamines Provides - Have mast-cell both &antihistaminic stabilizing activity , , besilate, Bepotastine , Eg Alcaftadine, - More likely than sideeff antihistamines tocause topical ects longer duration buthas of action tissues toocular delivery toophthalmicInferior dueto1- 2-hoursdelay administration antihistamines to primarily systemic from accompanied (eg non-ocular allergic by rhinitis) incases Useful adjunctive allergic therapy conjunctivitis as formoderate tosevere used May be , Chlorpheniramine, Eg , -

& late phases ofthe conjunctival& late phases allergic response In human stimulation conjunctiva, ofH - A selective H Aselective - conjunctivitis allergic ofseasonal &symptoms other signs more eff tobe shown was Emedastine & swelling, eyelid chemosis, in decreasing than Levocabastine ective in vasodilation phobia, especially when used by patients by w/lighter when used irides especially phobia, photo- & Prolonged useofantihistaminesthatarenonselectivemaycauseciliarymuscleparalysis,mydriasis, Binds toH Binds concomitant eye dry inpatients w/ especially production, tear ofmucosal &decreased membranes w/drying associated May be patientsglaucoma, angles) w/narrow angle-closure cause glaucomaMay also of narrow-angle in patients particularly who are at (ie history risk

1 &H 1 antagonist w/noadrenergic, dopaminergic orserotonergic effect 2 Conjunctivitis -Allergic,Seasonal&Perennial (3of9) © infl cell, mast stabilizes &down-regulates receptors, markers thatammatory aff early ects MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A NON-PHARMACOLOGICAL THERAPY B PHARMACOLOGICAL THERAPY 1 receptor mediates symptoms of pruritus whileH ofpruritus symptoms mediates receptor B62 © 2 receptor is involved isinvolved receptor MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC 1 Many ophthalmic lubricants are available. Please see the forspecifi latest MIMS Many ophthalmic see are available. lubricants Please c formulations. • • • • (Ophthalmic)Corticosteroids Lubricants (Ophthalmic) Lubricants • • • (Ophthalmic) CellStabilizers Mast • • • • • • • (Ophthalmic)Vasoconstrictors • Anti-inflNonsteroidal (Ophthalmic) Drugs ammatory • • • • • • - &under the ophthalmologist guidance ofanexperienced oftime(≤2weeks) period forashort used Should only be fast symptoms Relieve that the patient’s relieves &frequency given potency shouldbe Lowest symptoms - cell toantihistamine/mast added were stabilizers be course ifsymptoms notcontrolled can 1-2weeks - when patient’sUsed toother agents have symptoms notresponded infl Block pathwaysammatory the that persistent &chronic ofocular perpetuate forms - forthe treatment Used allergy &chronic ocular ofsevere - Lowest potency & frequency that patient’s relieves &frequency given potency shouldbe symptoms Lowest - - Have slower onset of action as compared ofactionas Have toantihistamines onset slower - &forconditions forprevention ofsymptoms thatUsed are recurrent orpersistent cellsInhibit degranulation ofinfl ofmast the which release limits &platelet-activating mediators ammatory factor Nedocromil, Eg ,, Numerous that lubricants diff composition are &electrolyte available osmolarity class, er by buttreat co-existing notalter defi the tear Do pathophysiology ofthe disease ciency - inthe &dilutionofallergens removal Assist that come incontact surface w/the eye - needed 2-6x/day as which isused agents, combined w/wetting &viscosity ofsalinesolution Consist - Have been shown to have synergistic eff tohave synergistic shown Have been ect - incombinationUsually used w/ophthalmic antihistamines butdonotaff congestion edema &eyelid vascular Decreases allergic response ect Sympathomimetic agents Eg , , Tetrahydrozoline - likeitching orconjunctival &symptoms signs Helps reduce hyperemia ocular - theofprostaglandins blocking production ofcyclooxygenase the activity Inhibits - Eg Ketorolac needed longas as wellGenerally tolerated used &may be help ofallergicMay also rhinitis inimproving symptoms like tospecifi shown Pemirolast was cell inhibitmast cally degranulation, ofchemical preventing mediators the release &symptoms signs & clinical Studies ismore that eff have shown Lodoxamide activation, than Cromoglicic acidinreducing ective relief immediate to provide anophthalmic after decongestant administered Usually have topatients given been w/moderate symptoms, management ofthe eye inthe ofchronic seasonal allergic useful diseases Most - eff toshow multiple Requires applications everyday ects - Chronic use (>10days)Chronic may use conjunctivitis cause medicamentosa

Chronic use of topical steroids is associated w/ glaucoma, cataract formation, & corneal/conjunctival w/glaucoma, steroids oftopical Chronic isassociated use - topreservatives secondary frequently toprevent allergic used reactions formulations be are ifwill recommended Non-preserved - formation aff , ocular notmask Does pressure, orintraocular norcontribute woundhealing ect tocataract

of ocular symptoms after 15days after symptoms of ocular Eff ofCromoglicic 2-5 thedays acid are initiationafter evident of theects therapy improvement w/ maximum symptoms ofallergic conjunctivitissymptoms Naphazoline plus onstudies, Based

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (4of9) Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not B 1

Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing PHARMACOLOGICAL THERAPY (CONT’D) Antazolin orPheniramine were comparable & the signs indecreasing B63 © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC • • • • (SLIT) immunotherapy Sublingual • • (SCIT) Immunotherapy Subcutaneous • • • • • • ofPrinciples erapy • • Has been associated w/ mild oral & GI symptoms & less risk for anaphylaxis compared to SCIT compared foranaphylaxis risk &less toSCIT w/mildoral&GIsymptoms associated been Has toallpatients receiving SLIT Auto/self-injectable prescribed Epinephrine shouldbe treatment tolerate &its reactions whocan tothose systemic limited Use shouldbe A more treatment viable isencouraged self-administration w/this as compared form toSCIT ofanaphylactic &smallrisk basis reactions onregular frequent injection by Limited Effi iscomparablecacy tothat ofnasal course isusually4-5 years Recommended personnel atrained by facility inamedical performed shouldbe Initial dose Any ofthe following: - Evidence ofspecifi results) toallergen test allergy c IgEantibody (positive - forpatientsIndicated w/the following: production IL-13 &reducing IL-10, Tcells thereby Tcells, toallergens CD8+ & humoral altering increasing response by regulatory Activates Only intervention that ofallergic alters rhinoconjunctivitis the natural history allergens tothese w/exposure associated allergicagainst symptoms administration ofspecifiRepeated c allergens conditions inpatients protection toprovide w/IgE-mediated - &slit-lampVisual measured performed acuityshouldbe shouldbe biomicroscopy etiology, &treatment ofthe disease, onthe severity depends Frequency

Adverse eff tomedications ects - toavoidance Poor response measures - medications Required - allergic w/both rhinoconjunctivitis &asthma diagnosed Clinically - - Baseline & periodic measurement isadvised &periodic Baseline - sideeff possible Assesses cataract &glaucoma such as ect - treating patient’s chronic orrecurrent conjunctivitis in doneifcorticosteroids dilation shouldbe used have pressureIntraocular measurement been &pupillary

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (5of9) C IMMUNOTHERAPY FOLLOW-UP B64 © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC 1 Combination preparations are available. Please see the forspecifi latest MIMS Combination preparations see are available. Please c formulations. 5 mg PO 12hrly 5mgPO Mequitazine Loratadine Cetirizine Generation Second 6-8 hrly 6.25-25 mgPO Chlorpheniramine First Generation & Dfarinae ) (D pteronyssinus allergen extract mite House-dust Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All ANTIHISTAMINES (ALLERGENEXTRACTS) &ANTIALLERGICS Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 300 IR/mL 10 IR/mL Available Strength

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (6of9) 5 mg PO 24hrly 5mgPO <30 kg: 24hrly 10mgPO >30 kg: 2-12 yr: 24 hrly 10 mgPO ≥12 yr: 24 hrly PO 12 hrly or10 mg 5 mgPO 6-11 yr: 24 hrly PO 12 hrly or5 mg 2.5 mgPO 2-5 yr: 12-24 hrly 2.5 mgPO 6 mth-<2 yr: 24 hrly <6 mth:2.5 mgPO 24 hrly 20 mgPO >12 yr: 12-24 hrly divided 10-25mg/day PO 5-10 yr: 12-24 hrly divided 5-15mg/day PO 2-5 yr: 300 mg/day dose: Max 12 hrly 1 mgPO >12 yr: 12 hrly 0.5-1 mgPO 6-12 yr: 12 hrly 0.5 mgPO 3-6 yr: 12 hrly 0.25-0.5 mgPO 1-3 yr: 12 mg/day dose: Max 4-6 hrly 2 mgPO 6-12 yr: 6 mg/day dose: Max 4-6 hrly 1 mgPO 2-5 yr: 12 hrly 1 mgPO 1-2 yr: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not ANTIHISTAMINES (ORAL) &ANTIALLERGICS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing tongue 24hrly tongue mL): Spray 4xunder the (300IR/ 10onwards Day dose Maintenance sprays consecutively 24hrly 1,2,4 doses/day: increasing under w/ the tongue 7-9(300IR/mL):SprayDay 24 hrly until Day 6 6, 8,10sprays consecutively 1,2,4, doses/day: increasing under w/ the tongue 1-6(10IR/mL):SprayDay dose: Initial Dosage Dosage Guidelines Dosage B65 • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse disease Use w/ caution inpatients w/renal/hepatic eff (excessiveects tiredness) );Other bronchospasm, (cough, epistaxis, effmouth, Resp stomach pain,diarrhea); ects GIeff dizziness); headache, (N/V,ects dry effCNS sleepiness, (drowsiness, ects disorder seizure liver disease, chronicproblems bronchitis), (eg asthma, Use w/ caution inpatients w/breathing ventricularhazardous arrhythmias) effCV rarely arrhythmias, (palpitations, ects vision); retention, blurred urinary secretions, Antimuscarinic eff mouth, viscous (dry ects rashes); reactions, (hypersensitivity eff Dermatologic appetite); ects pain,anorexiaorincreased epigastric GIeffhigh doses); (N/V,ects diarrhea, stimulationparadoxical may at occur esp somnolence, incoordination; lassitude, effCNS headache, dizziness, (drowsiness, ects • • Instructions Special • Reactions Adverse swallowing for2minbefore Maintain sublingually diet) sodium oral surgery, modifi low (strict diet ed recent extraction,orallesions, tooth infl oralcavity infection, ammation, Use w/caution inpatients w/fungal eff pruritus) (chest pain,GIupset, ects Other dyspnea); asthma, (bronchitis, eff Resp dizziness); (headache, ects effcongestion, tonsillitis);CNS ects throat nasal irritation, blistering, effNasopharyngeal (oromucosalects Remarks 1 Remarks © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC 1 1 Corticosteroids combined w/ vasoconstrictors are available. Please see the forspecifi latest MIMS see are available. Please Corticosteroids combined w/vasoconstrictors c formulations. Combination preparations are available. Please see the forspecifi latest MIMS Combination preparations see are available. Please c formulations. D xmtaoe0.1%ophth Eeatn 0.05%ophth Emedastine Antihistamine F urmtooe0.1%ophth Fluorometholone Alcaftadine Antihistamine/ CellStabilizers Mast etabonate Loteprednol Eiatn 0.05%ophth Epinastine P ensln 0.12%,0.5%, K ttfn0.025%ophth Ketotifen O oaaie0.1%ophth Olopatadine Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed soln soln 0.25% ophth soln soln soln 0.2% ophth soln

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (7of9) Available Strength .%on Apply 6hrly 0.1% oint drops, susp drops, drops, susp drops, drops 0.5% ophth susp 0.2% ophth drops, susp drops, 1% ophth Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing OPHTHALMIC DECONGESTANTS 6-12 hrly Instill 1drop 24 hrly Instill 1drop 12 hrly Instill 1drop 12 hrly Instill 1drop ≥3 yr: 24 hrly Instill 1drop 12 hrly Instill 1-2drops EYE CORTICOSTEROIDS Dosage Guidelines drops 1-6hrlydrops Instill 1-2 drops 6-12hrlydrops Instill 1-2 drops 6hrlydrops Instill 1-2 or as required or as 4-12hrlydrops Instill 1-2 Dosage Dosage B66 • • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse reinsert after 10mins after reinsert contactRemove toadministration lens prior then impairment Use w/ caution inpatients w/renal or hepatic abnormal dreams) rhinitis, asthenia, (headache, eff Other blurred vision,dryeye,tearing); ects effLocal (transient burning/stinging, ocular ects reinsert after 10mins after reinsert contactRemove toadministration lens prior then operate machineries Use or w/ caution inpatients drive whowill - rhinitis)(headache, discharge, disturbance); visual Other eff ects effLocal sensation, hyperemia, (burning ects • • • Instructions Special • • • • Reactions Adverse

Ketotifen mayKetotifen somnolence, cause allergic reactions Should be monitored by aspecialist by monitored Should be than chronic prolonged treatment isdesirable ratherthe acutesymptomatic phase treatment courseShort pulse during ispreferred ofallergic conjunctivitis cases w/caution &onlyinsevere used Should be discharge, sideeff potential forsystemic ects Transient Rarely: ocular burning; stinging, the cornea/conjunctiva; cataract formation of infection woundhealing; May corneal slow blindness) irreversible damage &possible opticnerve (irreversible angleglaucoma open tosecondary lead Can duration ofuse dependent onconcentration, & frequency pressure intraocular that is Increased 1 1 Remarks Remarks © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC 1 Combination preparations are available. Please see the forspecifi latest MIMS Combination preparations see are available. Please c formulations. naphazoline / Antihistamine/Vasoconstrictors tetrahydroline) ( Antazoline/ Antazoline/ cromoglycate) Na cromoglycate, Na, Disodium acid ( Cromoglicic CellStabilizers Mast Lodoxamide Pemirolast Ketorolac Anti-inflNonsteroidal Drug ammatory Cromolyn Cromolyn Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed ophth soln 0.5/0.05% ophth drops 0.05%/0.04% drops 2% ophth drops 0.1% ophth drops 0.1% ophth drops 0.5% ophth

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (8of9) Available Strength Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not OPHTHALMIC DECONGESTANTS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 3-4 hrly Instill 1drop hrly 24 1-2 drops >2 yr: 8-12 hrly Instill 1drop therapy: Maintenance hrly Instill 1drop 3 treatment: Acute hrly 4-6 1-2 drops Instill ≥4 yr: drops 6hrlydrops Instill 1-2 12 hrly Instill 1drop hrly Instill 1drop 6 Dosage Guidelines Dosage B67 • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse disease orinfection disease eye hyperthyroidism, serious hypertension, DM, disease, Use w/caution inpatients w/CV Avoid glaucoma inpatients use w/narrow-angle effLocal (conjunctivalects hyperemia) irritation, reinsert after 15mins after reinsert contactRemove toadministration lens prior then allergies recurring chronic & rhinitis sicca, pheochromocytoma, hyperthyroidism, disease, heart severe Use w/caution inpatients hypertension, w/DM, syndrome eye or dry Avoid glaucoma inpatients use w/narrow-angle drowsiness) hyperemia); Other effmydriasis, (headache, ects effLocal (transient sensation, burning ects Discontinue Pemirolast occurs ifirritation disorders Use w/ caution inpatients w/renal or hepatic Avoid w/contact use lens - erythema) pruritus, effLocal (transient burning/stinging, ocular ects other NSAIDs known sensitivitytoacetylsalicylicacidor w/ time, thator receiving bleeding prolongs tendencies Use w/ caution inpatients w/bleeding Avoid w/contact use lens superficial keratitis) infection, ocular allergicirritation, reactions, effLocal (transient burning/stinging, ocular ects

dermatitis Permirolast maycauseblepharitis,palpebral 1 (CONT’D) Remarks © MIMS Pediatrics 2019 CONJUNCTIVITIS - ALLERGIC 1 Combination preparations are available. Please see the forspecifi latest MIMS Combination preparations see are available. Please c formulations. Azelastine Iopgui cd4.9%ophth acid Isospaglumic Antiallergics Ophthalmologic Other sodium Nedocromil Npaoie0.05%,0.01%, Naphazoline Vasoconstrictors ( ( Tetrahydrozoline) Tetryzoline Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed

© MIMS Conjunctivitis -Allergic,Seasonal&Perennial (9of9) soln 0.05% ophth drops 2% ophth soln drops 0.012% ophth soln/drops soln/drops 0.1% ophth drops 0.05% ophth Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Available Strength Strength OPHTHALMIC DECONGESTANTS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please OTHER EYEPREPARATIONS Dosage Guidelines drops 12hrlydrops Instill 1-2 4-12 hrly Instill 1drop hrly 12 1-2 drops Instill ≥3 yr: hrly upto6 drops Instill 1-2 drops 3-4hrlydrops Instill 1-2 drops 6-12hrlydrops Instill 1-2 Dosage Dosage B68 • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse cover after every use cover every after water,Dip tipofbottle inboiling then dry mouth) dry nausea, headache, eff disturbances, (somnolence, taste ects Other stinging, blurredvision,dryeye,tearing); effLocal (transient burning/ ocular ects Remove contactRemove toadministration lens prior sensation) effLocal & prickling (mildburning ects Avoid w/contact use lens use cover every after water,Dip tipofbottle inboiling then dry disturbance) congestion, taste nasal somnolence); Other eff asthma, (rhinitis, ects effphotophobia); CNS (headache, ects redness, eye conjunctivitis, irritation, effLocal (ocular burning/stinging/ects Remove contactRemove toadministration lens prior hyperthyroidism irregularities, cardiac DM, Use w/caution inpatients w/hypertension, glaucoma Avoid inpatients use w/narrow-angle Tetryzoline N/V, may cause also headache, - drowsiness) hyperglycemia, hypertension, reactions, (sensitivity IOP, Other eff irritation); hyperemia, ects effLocal in dilation, increase (pupillary ects

rebound congestion 1 (CONT’D) Remarks Remarks © MIMS Pediatrics 2019