Ocular Allergy Research Articles

Therapeutic Profile of Human Umbilical Cord Blood Serum and Autologous Serum Therapies in Treatment of Ocular Surface Disorders: A Pilot Study

Purpose: Umbilical cord blood serum (UCBS) is an effective adjunctive treatment along with conventional therapy in ocular surface disorders (OSDs). It aids in rapid ocular surface restoration thereby achieving epithelial integrity, in addition to improvement in subjective and objective parameters. The study aims to compare the efficacy of human umbilical cord blood serum and autologous serum (AS) in treatment of OSD. Methods: A prospective randomized study was conducted on 101 eyes diagnosed with OSD resulting from dry eye disease (DED; n = 40), acute chemical burn (ACB; n = 21), and ocular allergy (OA; n = 40). Randomization was done in Group I, administered with AS, and Group II with UCBS. Outcomes evaluated were visual acuity (VA), eye sensation score (ESS), ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer's value, Corneal Fluorescein Score, epithelial defect, limbal ischemia, corneal clarity (CC), and improvement in grade of severity. Statistical analysis was done using Wilcoxon signed-rank, Wilcoxon rank sum, Chi-square, and Z-test with a significance level (P ≤ 0.05). Results: In DED, Group II showed significant improvement in VA, ESS, and OSDI by the 7th day, whereas the mean Schirmer, TBUT, and corneal fluorescein staining score improved by 3 months. In ACB, Group II showed improvement in VA, reepithelialization, reduction in limbal ischemia, and CC by 3 months. In OA, Group II showed improvement in ESS by day 7. Conclusion: Human umbilical cord blood serum is more effective than AS in restoring ocular surface.

Ocular Morbidity in Children with Allergic Conjunctivitis: A Rural-urban Survey

Abstract Background: Allergic conjunctivitis occasionally may result in some ocular morbidities. This ranges from innocuous to severe forms of ocular disorders. Aim: This study reports and compares ocular morbidities among children with ocular allergies living in an urban and rural community. Materials and Methods: A comparative cross-sectional study conducted in urban and rural schools among children aged 5–15 years using a multistage sampling method. Sociodemographic data, past ocular history, history of ocular allergies, and treatment were collected with an interviewer-based questionnaire and were analysed using the Statistical Package for the Social Sciences (SPSS) software version 25. Descriptive analyses of sociodemographic variables and associated ocular morbidity were carried out. The Chi-square test was used to test associations between rural and urban groups. A P = 0.05 or less was considered significant. Results: Associated ocular morbidities were seen in 8% (19/238) of the children with allergic conjunctivitis. There was no statistically significant difference in the proportion of ocular morbidities observed between both locations (8.1 vs. 7.9 in the rural and urban location, respectively, with a P = 1.000). Children with mild forms of allergic conjunctivitis were 197 (82.8%), and only 1.7% had severe forms. The moderate and severe form of allergic conjunctivitis were more prevalent in the rural area (P = 0.002) while untreated allergic conjunctivitis was found in 168 (70.6%) of those affected. Conclusion: This study demonstrated a higher proportion of moderate-to-severe forms of allergic conjunctivitis among school children in the rural region with the majority being untreated.

Factorial design-assisted reverse phase HPLC–UV approach for the concurrent estimation of cetirizine and azelastine in aqueous humor

A new analytical quality by design-assisted HPLC–UV approach is presented, for the first time, for the concurrent determination of cetirizine (CTZ) and azelastine (AZE) in raw materials, commercial eye drops and aqueous humor. The two drugs are co-administered as eye drops in severe ocular allergies. A 23 full factorial design was adopted for the chromatographic optimization to ensure the best analytical performance and reliability, as well as to save time, effort and solvent consumption. The parameters, including pH, acetonitrile ratio, and flow rate, were selected as independent factors. The responses analyzed were resolution and tailing of peaks. The separation was achieved through isocratic elution on C8 column with mobile phase made up of acetonitrile: 0.3% triethylamine of pH 5 (60:40 v/v) at a flow rate of 1.2 mL min−1 and detection at 216 nm. The elution time was less than 6 min. The approach was fully validated in accordance with International Council for Harmonization (ICH) guidelines. Good linearity was achieved over the concentration ranges of 1.0–30 and 0.5–10 µg mL−1 with limits of detection of 0.310 and 0.158 µg mL−1 and limits of quantification of 0.940 and 0.479 µg mL−1 for CTZ and AZE, respectively, with correlation coefficients of 0.9998. The intra- and inter-day precisions were lower than 2%. The good sensitivity of the approach permits the analysis of CTZ and AZE in spiked aqueous humor with mean percentage recoveries of 100.93 ± 1.42 and 100.11 ± 1.55, respectively. The statistical comparison between results of the developed method and the comparison method revealed no differences, indicating the accuracy of the method.

Epitope Mapping of Anti-Mouse CCR3 Monoclonal Antibodies Using Flow Cytometry.

The CC chemokine receptor 3 (CCR3) is a receptor for CC chemokines, including CCL5/RANTES, CCL7/MCP-3, and CCL11/eotaxin. CCR3 is expressed on the surface of eosinophils, basophils, a subset of Th2 lymphocytes, mast cells, and airway epithelial cells. CCR3 and its ligands are involved in airway hyperresponsiveness in allergic asthma, ocular allergies, and cancers. Therefore, CCR3 is an attractive target for those therapies. Previously, anti-mouse CCR3 (mCCR3) monoclonal antibodies (mAbs), C3Mab-3 (rat IgG2a, kappa), and C3Mab-4 (rat IgG2a, kappa) were developed using the Cell-Based Immunization and Screening (CBIS) method. In this study, the binding epitope of these mAbs was investigated using flow cytometry. A CCR3 extracellular domain-substituted mutant analysis showed that C3Mab-3, C3Mab-4, and a commercially available mAb (J073E5) recognized the N-terminal region (amino acids 1-38) of mCCR3. Next, alanine scanning was conducted in the N-terminal region. The results revealed that the Ala2, Phe3, Asn4, and Thr5 of mCCR3 are involved in C3Mab-3 binding, whereas Ala2, Phe3, and Thr5 are essential to C3Mab-4 binding, and Ala2 and Phe3 are crucial to J073E5 binding. These results reveal the involvement of the N-terminus of mCCR3 in the recognition of C3Mab-3, C3Mab-4, and J073E5.

Clinical characteristics and outcomes of ocular allergy in Thai children.

Allergic conjunctivitis (AC) is the most common ocular condition in allergic children. In tropical countries, the study about the clinical features and outcome of treatment is very limited. To review clinical characteristics and outcomes of treatment in children with ocular allergy. Children with history of AC were classified to seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). The clinical history and outcome of treatment were recorded. One hundred and sixty-four children were recruited. PAC was the most common type (61.6%), followed by SAC (21.3%), VKC (12.2%), and AKC (4.9%). Male preponderance was found in all groups. Mean age of onset was 6.8 ? 2.8 years. Allergic rhinitis was the most common co-morbidity (97.6%). The common sensitized allergen is house-dust mites (86.1%). Standard treatments in all groups were natural tear and topical olopatadine. Add-on medications were usually needed in severe types of AC (VKC, AKC). History of topical corticosteroid use was 68.8% and 12.5% in VKC and AKC, respectively. All of them can discontinue topical corticosteroid when topical tacrolimus was applied. The overall remission was found 35% in VKC group and 63% in AKC group. The median duration of treatment was 20.5 months in VKC group and 11 months in AKC group. most Thai children with AC sensitized to house-dust mites. In severe forms of AC, most patients needed addon medication. The use of topical calcineurin inhibitor as an add-on therapy can decrease the use of topical corticosteroid.

Phytoremediation potential of indoor plants in reducing air pollutants

Indoor air quality (IAQ), specifically after the COVID-19 pandemic, has become an international issue, as humans spend 80–90% of their time in indoor microenvironments. Poor IAQ has been related to the sick-building syndrome, nasal and ocular irritations, allergies, and respiratory dysfunction, including premature deaths. Phytoremediation is a novel strategy to absorb, adsorb, assimilate or transfer/reduce air pollutants and improve the IAQ using plants. Hence, the current review aims to explore indoor plants' role in improving indoor air quality, including their purification capabilities. There is increasing evidence that various plant species (e.g., Ficus benjamina, Chlorophytum comosum, Draceana) or their parts can reliably reduce the concentration of numerous air pollutants in the indoor microenvironment and promote human wellbeing. However, the indoor air pollutants removal efficiency depends on the species of plant, various plant characteristics such as leaf size, thickness, area, photosynthetic activity, light intensity and part of plant involved, i.e., roots, leaves, wax, cuticle and stomata. Using indoor plants is one of the most cost-effective and reliable methods of making a healthier indoor environment. Better public health can be maintained at a lower cost, with less strain on the health care system, if more emphasis is placed on creating a biophilic atmosphere and increasing the use of indoor plants. However, there are no established criteria for the best indoor plants and the impact of indoor plants on various factors such as interior ventilation, temperature, humidity, etc. Therefore, further experimental research is needed that simulates the interior environment to monitor the impacts of indoor plants on factors such as humidity, temperature, ventilation, etc., in improving the microenvironment of a closed space/room.

Progressive Flattening after Corneal Collagen Crosslinking: A 10-Year Follow-Up

Purpose: This study aimed to demonstrate the importance of long-term follow-up after corneal collagen crosslinking. Methods: This case report showed an intense progressive flattening of keratometric parameters in a patient without risk factors such as high maximum keratometry, thin cornea, uncontrolled ocular allergy, collagen, or rheumatologic diseases. Even with significant haze formation and progressive flattening, the patient exhibited progression after a long follow-up period. Results: The patient presented with grade 2 haze associated with progressive flattening of approximately 10 D in keratometric parameters (Kmax, K1, K2, and Kmean) during the first 5 years after surgery. Corneal opacity altered the minimum pachymetry reading on Pentacam to 265 microns. Anterior corneal follow-up optical coherence tomography revealed a thickness of 453 microns. The patient developed low visual acuity while wearing glasses. The scleral lens was fitted, allowing a visual acuity of 20/30, with satisfactory visual quality. Keratometric stability was observed between the fifth and tenth year. In the tenth year, the patient maintained haze, but there was a progression of 1.7 D in the Pentacam comparative map. Conclusions: Long-term monitoring after corneal crosslinking should be performed. Eyes with haze and intense progressive flattening may fail after a long period.

Evaluation of AYUSH PE Eye drops in the management of acute allergic conjunctivitis

Abstract Introduction: Ocular allergy is one of the most common prevalent clinical conditions in the world with a rapid increase in the past few years. It has a multifactorial etiology and is a conjunctival inflammatory response due to immunoglobulin E-mediated mast cell activation. The disease is characterized by itching, redness, burning sensation, and watering of eyes which go off and on. Abhishyanda, a disease having similar characteristics, is described in Ayurveda, for which extensive treatment modalities are available in the classical texts. Hence, a safe, and cost-effective potent Ayurveda drug, AYUSH PE Eye drops was developed after undergoing all quality assurance tests. Materials and methods: A multicenter open-labeled single-group prospective study was conducted at four research institutes of the Central Council for Research in Ayurvedic Sciences (CCRAS), Ministry of AYUSH, from May 2019 to December 2019. A total of 221 participants who had signs and symptoms of acute manifestation of allergic conjunctivitis (AC) were enrolled based on purposive sampling at four study sites. The participants were evaluated based on the signs and symptoms of AC using the visual analog scale score (0–100). Two drops of the drug AYUSH PE Eye drops were instilled to the affected eyes six times a day and the patients were reviewed after 1 week. The medicine was then stopped and a second follow-up was done again after 1 more week. Results: A total of 217 participants were analyzed for the outcomes. Statistically significant changes were observed in all the assessment parameters, namely itching, redness of eyes, watery discharge, lid swelling, foreign body sensation, liking for warm touches, heaviness in eyes, feeling of stickiness in eyes, the appearance of allergic hue in eyes, feeling of excessive cold in eyes, and slimy secretions from eyes at 7th day (P < 0.001) and at 14th day (P < 0.001) as compared to baseline. Conclusion: AYUSH PE Eye drops are safe and effective in the management of acute AC.

Editorial introductions.

Editorial introductions.

Immunobiologicals and ocular surface disease.

Immunobiologicals have surfaced to become a new cornerstone of treatment for a wide spectrum of inflammatory disorders with an immune basis. The targets have ranged from autoimmune conditions to transplantation, and now more into atopic inflammatory disorders with primary targets of asthma and atopic dermatitis. The clinical information garnered from these studies have provided an initial snapshot on the potential adverse effects of the immunobiologicals on the ocular surface as well as providing a potential opening of their use in the treatment of various chronic ocular surface and intraocular inflammatory disorders that have previously been relegated to limited therapeutic options primarily to the broad anti-inflammatory use of glucocorticosteroids. The use of immunobiologicals provides a more directed therapeutic approach to many of the ocular inflammatory disorders, as we continue to appreciate more of their underlying immunopathophysiology of ocular surface disorder,s including ocular allergy and tear film dysfunction.

Alleviating experimental allergic eye disease by inhibiting pro-lymphangiogenic VEGFR3 signal

PurposeOcular allergy leads to acute and chronic inflammation that may deteriorate the conjunctiva and other ocular tissue. The conjunctiva is covered with abundant lymphatic vessels but how the conjunctival lymphatic system patriciates in the development of allergic eye disease (AED) remains to be elucidated. Methods and resultsBy using ovalbumin (OVA)+pertussis toxin (PTX) as a sensitizer followed by daily OVA challenges, we induced optimized AED manifestations in mice. We show that conjunctival lymphatics underwent significant expansion after 28 days of chronic OVA challenge, and this process can be prevented by inducible genetic ablation of lymphatic Vegfr3. Through transcriptomic profile analysis in combination with histopathological examinations, we found that pro-lymphangiogenic VEGFR3 signal promoted allergy-induced activation of T helper 2 (Th2) type immune responses, including antigen presentation, and Th2 cells, B cells and mast cell-related pathways in the conjunctiva, thereby critically contributing to the immunoglobulin E (IgE) production and AED manifestations. As a result, ocular allergy can be alleviated by genetic inhibition of lymphatic Vegfr3. Interestingly, pro-lymphangiogenic VEGFR3 signal did not appear to affect the obstruction of meibomian glands (MGs) or the activation of Th17 type and neutrophil pathways that are associated with AED. ConclusionsThese data reveal the key role of pro-lymphangiogenic VEGFR3 signaling in the development of AED and provide experimental evidence that VEGFR3 inhibition may be useful in treating ocular allergy in patients.

Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance.

PurposeTo evaluate the effect of eye rubbing on the epithelial thickness profile in tomographically normal corneas by AS-OCT and to compare right and left eyes in right-handed children.MethodsThirty right-handed boys (mean age 11.2 years) with ocular allergy and history of eye rubbing were evaluated using Scheimpflug (Pentacam HR, Oculus Wetzlar, Germany) and anterior segment optical coherence tomography. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared between right and left eyes with a non-parametric Mann–Whitney test. A p-value lower than 0.05 was considered for statistical significance.ResultsNo eyes had topometric nor tomographic criteria for keratoconus. The min-max ET was lower in right eyes (−2.8 µm vs −3.5; p = 0.02). The difference between inferior and superior (I-S) octants was lower in right eyes (1.1 µm vs 1.9 µm; p = 0.03) as a result of inferotemporal thinning. The highest ET difference was registered between nasal and temporal octants and was more pronounced in the right eyes (2 µm vs 3.1 µm; p < 0.001).ConclusionAS-OCT analyses reveal different epithelial thickness patterns between the eyes in young atopic patients, likely eye rubbers. Inferior and temporal epithelial thickness seem to be more affected by thinning in the eye on the side of the dominant hand.

Analysis of Cytokine Production Profiles of Local and Systemic Lymphocytes in Sick Building Syndrome Compared with Ocular Allergy.

PurposeWe have previously studied clinical and allergological aspects of sick building syndrome (SBS) cases with ocular disorders and found that SBS is suggested to be partially induced by an allergic response. We analyzed the cytokine production profiles of conjunctival and peripheral blood lymphocytes in patients with SBS with ocular manifestations to further evaluate the pathophysiology of SBS from an immunological standpoint.MethodsWe obtained conjunctival samples and peripheral blood mononuclear cells (PBMC) from 15 cases of SBS with ocular findings, 49 cases of allergic conjunctival diseases (ACD) (allergic conjunctivitis (AC), atopic keratoconjunctivitis (AKC), and vernal keratoconjunctivitis (VKC)), and normal controls. Frequencies of cytokine-producing T cells were analyzed by flow cytometry based on an intracellular cytokine staining method.ResultsAlthough no significant difference was observed in the percentage of interferon (IFN)-γ-producing CD4+ T cells in PBMC between patients with SBS and controls, the percentage of interleukin (IL)-4-producing PBMC CD4+ T cells in patients with SBS was significantly higher than that in controls. The percentage of IL-4-producing CD4+ T cells in the conjunctiva in patients with SBS was significantly higher than that in controls, whereas it was significantly lower than that in AKC and VKC. A significant correlation was observed between the percentage of IL-4-producing CD4+ T cells in the conjunctiva and clinical score.ConclusionThese results suggest that SBS may be a kind of allergic disorder and that IL-4 plays a role in the development of allergic disorders in SBS ocular lesions.

Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy.

Objectives:To investigate the intraocular pressure (IOP)-lowering efficacy, safety, and treatment tolerability of brinzolamide/ brimonidine fixed combination (BBFC) in maximum medical therapy.Materials and Methods:The medical records of 92 patients with glaucoma or ocular hypertension who had previously been treated with a different antiglaucomatous regimen and were switched to a treatment regimen that included BBFC were retrospectively analyzed. Patients were divided into 4 groups including 22, 20, 27, and 23 patients based on previous glaucoma treatment. All patients received maximum medical treatment regimen by adding a combination of beta blocker-prostaglandin analogue therapy along with BBFC. IOP values at baseline and month 1, month 3 and month 6 after starting BBFC and ocular adverse effects at follow-up visits were evaluated.Results:The mean age of all patients was 62.7±16.6 years (range: 18-90). Fifty-two patients (56.5%) were women and 40 (43.5%) were men. Forty-eight (52.2%) patients had primary open-angle glaucoma, 35 (38.0%) had pseudoexfoliation glaucoma, and 9 (9.8%) had ocular hypertension. The IOP of the all eyes was 21.1±4.8 mmHg (range: 17-25) before and 17.6±3.7 mmHg, 17.3±3.4, and 17.0±3.5 mmHg at month 1, 3, and 6 after the introduction of BBFC, respectively (p<0.001 for all time points compared to baseline). In all 4 groups, a significant decrease in IOP was observed at month 1, 3, and 6 follow-ups compared to baseline after the introduction of BBFC. The mean number of antiglaucoma drops was significantly reduced from 2.5±0.6 at baseline to 2 after BBFC (p<0.001). The most frequent ocular adverse event was ocular allergic reactions reported in 8 patients (8.7%), conjunctival hyperemia in 5 patients (5.4%), and ocular discomfort in 2 patients (2.5%).Conclusion:Maximum medical therapy with BBFC provides significant IOP reduction and antiglaucoma therapy simplification with a favorable safety profile in patients with glaucoma.

Evaluation of knowledge and awareness level of allergic conjunctivitis among people of Killa Abdullah district of Baluchistan

BackgroundAllergic conjunctivitis is a growing health issue impacting the everyday life of patients and their families. Other characteristics of their everyday life activities such as occupational, and social life are impacted. Therefore an enhanced awareness and knowledge of allergic conjunctivitis, its diagnosis, and treatment is important. This study was to evaluate the knowledge and awareness level of allergic conjunctivitis among people of Killa Abdullah, Baluchistan. MethodsA quantitative cross-sectional survey was carried out among 475 respondents from Killa Abdullah, Baluchistan, Pakistan. Every respondent completed a questionnaire focused on awareness and knowledge of ocular allergy. ResultsOut of the 475 participants, 112 (23.6%) know about allergic conjunctivitis. The majority of which being students, with the knowledge level of conjunctivitis normally low. Most of the respondents had collected information mainly from media and the internet. There was a statistically significant relationship between knowledge, and program of study (P<0.001). ConclusionThe overall percentage of knowledge level about allergic conjunctivitis was low. The students who attend the study program their knowledge level being influenced. Public health measures are advised for educating the population on the prevention and control of allergic conjunctivitis in addition to associated complications.

Effects of Antihistamine-Releasing Contact Lenses on Severe Allergic Conjunctivitis

ABSTRACT Half of the patients who used CL daily did not wish to switch to spectacles even with ocular-allergic symptoms and findings. Therefore, continued CL use with suppressed ocular allergy can improve productivity and quality of life for CL users. This study described the clinical courses of CL users with ocular-allergic conjunctivitis who started ARCL trials on their eyes. Diagnoses of the seven understudied cases were AKC in 3, VKC in 2, SAC in 1, and CLPC in 1 case. All seven cases had myopia. Following the use of ARCL, six patients except for case 7 were satisfied, and objective findings were judged to be well-controlled. ARCL can be a useful tool for CL users with allergic conjunctivitis. However, ARCL should be introduced after allergic conjunctivitis is controlled or becomes asymptomatic. Furthermore, ARCL should be immediately discontinued if ocular-allergic symptoms flare after introducing ARCL.

The benefit of scratch patch testing to demonstrate ocular contact allergy to brimonidine tartrate.

Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and the absence of cutaneous testing. Many false-negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method. The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy. A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed. Of the 36 patients identified, half tested positive for brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). Three patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. The absence of eyelid pruritus was associated with negative testing. In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT.

Signaling Pathways Used by the Specialized Pro-Resolving Mediator Maresin 2 Regulate Goblet Cell Function: Comparison with Maresin 1.

Specialized pro-resolving mediators (SPMs), including Maresins (MaR)-1 and 2, contribute to tear film homeostasis and resolve conjunctival inflammation. We investigated MaR2′s signaling pathways in goblet cells (GC) from rat conjunctiva. Agonist-induced [Ca2+]i and high-molecular weight glycoconjugate secretion were measured. MaR2 increased [Ca2+]i and stimulated secretion. MaR2 and MaR1 stimulate conjunctival goblet cell function, especially secretion, by activating different but overlapping GPCR and signaling pathways, and furthermore counter-regulate histamine stimulated increase in [Ca2+]i. Thus, MaR2 and MaR1 play a role in maintaining the ocular surface and tear film homeostasis in health and disease. As MaR2 and MaR1 modulate conjunctival goblet cell function, they each may have potential as novel, but differing, options for the treatment of ocular surface inflammatory diseases including allergic conjunctivitis and dry eye disease. We conclude that in conjunctival GC MaR2 and MaR1, both increase the [Ca2+]i and stimulate secretion to maintain homeostasis by using one set of different, but overlapping, signaling pathways to increase [Ca2+]i and another set to stimulate secretion. MaR2 also resolves ocular allergy.

Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers.

Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):6-17.].

PAF-induced inflammatory and immuno-allergic ophthalmic diseases and their mitigation with PAF receptor antagonists: Cell and nuclear effects.

Ocular allergies are becoming more prevalent as more airborne pollutants, irritants and microbes pervade our environment. Inflammatory and allergic mediators released by dendritic and mast cells within the conjunctiva cause allergic conjunctivitis (AC), a prevalent ocular surface disorder that affects >40% of the world's human population on a seasonal or perennial basis. Even though histamine is a major culprit, platelet-activating factor (PAF) also contributes to AC, acting either directly or synergistically with histamine and other mediators. PAF receptor-meditated inflammatory reactions, via cell-membrane-bound and nuclear-membrane-bound and nuclear PAF receptors, are also implicated in the etiology of other eye diseases such as uveitis, diabetic retinopathy, corneal and choroidal neovascularization, and age-related macular degeneration which cause serious visual impairment and can lead to blindness. This review highlights the various deleterious elements implicated in the pathological aspects of ocular allergic reactions and inflammation and provides concepts and treatment options to mitigate these eye disorders with a special focus on PAF and PAF receptor antagonists.