Clinical evaluation criteria and approach to management of ocular allergy by ophthalmologists in ...

80 Pages·2013·1.95 MB·English

by  Millicent Bore

CLINICAL EVALUATION CRITERIA AND
APPROACH TO MANAGEMENT OF OCULAR
ALLERGY BY OPHTHALMOLOGISTS IN KENYA

Principal Investigator:
Dr. Millicent Bore
H58/64160/10
University of Nairobi
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DEDICATION

This work is dedicated to my family for their continued support and encouragement in my every
endeavour.
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ACKNOWLEDGEMENTS

I wish to acknowledge the contributions of the following individuals and group to the
development of this research paper: 
1. Prof. Ilako, Dr. Kariuki, and J.M Nzinga for their contributed ideas, feedback and advice
during the entire study period.
2. Carol Gitonga for data analysis and Sarah Osano for assistance in preparation of the
thesis.
3. My sponsors, Lions of Bavaria, for the financial support towards the budget of the study.
4. All the ophthalmologists who participated in the study for taking time to do so.
5. Kikuyu Eye Unit and the departments of ophthalmology at the University of Nairobi And
Kenyatta National Hospital for taking part in the focus group discussions.
6. My friends, who made available their support in a number of ways.

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TABLE OF CONTENTS
DECLARATION ............................................................................................................................. i
APPROVAL ................................................................................................................................... ii
ACKNOWLEDGEMENTS ........................................................................................................... iv
LIST OF TABLES ........................................................................................................................ vii
LIST OF ABBREVIATIONS ...................................................................................................... viii
ABSTRACT .................................................................................................................................... x
1. INTRODUCTION TO OCULAR ALLERGY ....................................................................... 1
1.1 DEFINITION ................................................................................................................... 1
1.2 EPIDEMIOLOGY ............................................................................................................ 1
1.3 PATHOLOGY ................................................................................................................. 2
2. LITERATURE REVIEW ........................................................................................................ 3
2.1 CLASSIFICATION ......................................................................................................... 3
2.1 DIAGNOSIS .................................................................................................................... 3
2.2 EVALUATION OF GRADE OF SEVERITY FOR OCULAR ALLERGY ................... 4
2.3 MANAGEMENT ............................................................................................................. 5
2.4 STANDARD TREATMENT GUIDELINES .................................................................. 8
2.5 LITERATURE REVIEW SUMMARY ........................................................................... 8
3. JUSTIFICATION .................................................................................................................... 9
4. STUDY OBJECTIVES ........................................................................................................... 9
4.1 Broad Objectives: ............................................................................................................. 9
4.2 Specific Objectives: .......................................................................................................... 9
5. METHODOLOGY ................................................................................................................ 10
5.1 Study design ................................................................................................................... 10
5.2 Study area ....................................................................................................................... 10
5.3 Study population ............................................................................................................ 10
5.4 Study period ................................................................................................................... 10
5.5 Sampling size ................................................................................................................. 10
5.6 Sampling method ............................................................................................................ 11
5.7 Inclusion criteria ............................................................................................................. 11
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5.8 Exclusion criteria ............................................................................................................ 11
5.9 Tools ............................................................................................................................... 11
5.10 Ethical Considerations .................................................................................................... 12
5.11 Procedure ........................................................................................................................ 12
6. RESULTS .............................................................................................................................. 17
7. DISCUSSION ........................................................................................................................ 41
8. CONCLUSION ..................................................................................................................... 47
9. RECOMMENDATIONS....................................................................................................... 48
10. LIMITATIONS ...................................................................................................................... 49
11. APPENDICES ....................................................................................................................... 50
11.1 APPENDIX I: Approval letter from Ethics and Research Committee .......................... 50
11.2 APPENDIX 11: Information Sheet ................................................................................ 52
11.3 APPENDIX III: Questionnaire....................................................................................... 53
11.4 APPENDIX IV: FGD Consent Form ............................................................................ 56
11.5 APPENDIX V: Discussion Guide .................................................................................. 57
11.6 APPENDIX VI: Studies on Evaluation of Grade of Severity for Ocular Allergy ......... 61
12. REFERENCES .................................................................................................................. 67

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LIST OF FIGURES
Figure 1: Flowchart for online survey participants ....................................................................... 17
Figure 2: Flowchart showing respondents not grading OA .......................................................... 21
Figure 3: Perceived importance of grading OA ............................................................................ 22
Figure 4: Perceived importance of symptoms in the grading of ocular allergy severity .............. 24
Figure 5: Perceived importance of signs in the grading ocular allergy severity ........................... 26
Figure 6: Important factors in the selection of treatment offered ................................................. 28
Figure 7: FGD participants’ flowchart .......................................................................................... 30 

LIST OF TABLES
Table 1: Characteristics of the study participants ......................................................................... 18
Table 3: Important symptoms and signs for diagnosis of ocular allergies ................................... 19
Table 3: Classification and grading of ocular allergies ................................................................ 20
Table 4: Perceived importance of symptoms in OA diagnosis ..................................................... 23
Table 5: Perceived importance of signs for grading severity of OA ............................................ 25
Table 6: Factors of importance in treatment selection .................................................................. 27
Table 7: Mode of treatment and category used ............................................................................. 29
Table 8: Mild ocular allergy ......................................................................................................... 33
Table 9: Moderate ocular allergy .................................................................................................. 34
Table 10: Severe ocular allergy .................................................................................................... 35 

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LIST OF ABBREVIATIONS

AKC- Atopic Keratoconjunctivitis
AOD-Allergic Ocular Diseases
CsA- Cyclosporine A
EACO- Eastern Africa College of Ophthalmologists
ENT- Ear Nose and Throat
FGD- Focus Group Discussion
GPC- Giant Papillary Conjunctivitis
HDM- House Dust Mites
KAP- Knowledge Attitude and Practice
KEU- Kikuyu Eye Unit
KNH- Kenyatta National Hospital
MCJ- Mucocutaneous Junction
MGD- Meibomian Gland Disease
MMed- Master of Medicine
NSAIDs- Non-Steroidal Anti-inflammatory Drugs
OA- Ocular Allergy
OSEA- Ophthalmological Society of Eastern Africa
PAC- Perennial Allergic Conjunctivitis
SAC- Seasonal Allergic Conjunctivitis
SPK- Superficial Punctate Keratitis
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STGs- Standard Treatment Guidelines
UON- University of Nairobi
VKC- Vernal Keratoconjunctivitis

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