A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents.

A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents. © 2011 British Contact Lens Association.

The development of a solid waste management strategy

This research is concerned with the application of operational research techniques in the development of a long- term waste management policy by an English waste disposal authority. The main aspects which have been considered are the estimation of future waste production and the assessment of the effects of proposed systems. Only household and commercial wastes have been dealt with in detail, though suggestions are made for the extension of the effect assessment to cover industrial and other wastes. Similarly, the only effects considered in detail have been costs, but possible extensions are discussed. An important feature of the study is that it was conducted in close collaboration with a waste disposal authority, and so pays more attention to the actual needs of the authority than is usual in such research. A critical examination of previous waste forecasting work leads to the use of simple trend extrapolation methods, with some consideration of seasonal effects. The possibility of relating waste production to other social and economic indicators is discussed. It is concluded that, at present, large uncertainties in predictions are inevitable; waste management systems must therefore be designed to cope with this uncertainty. Linear programming is used to assess the overall costs of proposals. Two alternative linear programming formulations of this problem are used and discussed. The first is a straightforward approach, which has been .implemented as an interactive computer program. The second is more sophisticated and represents the behaviour of incineration plants more realistically. Careful attention is paid to the choice of appropriate data and the interpretation of the results. Recommendations are made on methods for immediate use, on the choice of data to be collected for future plans, and on the most useful lines for further research and development.

Management of allergic conjunctivitis and dry eye

Ocular allergy is a common eye condition encountered in clinical practice. However, little is known how seasonal allergic conjunctivitis (SAC), the most common subtype, is managed in clinical practice. Further, dry eye, another common eye condition, may be misdiagnosed as SAC and vice-versa as they share similar signs and symptoms. In addition, despite the frequent recommendation of non-pharmacological treatments for SAC, evidenceto support their use has not been identified in the scientific literature. The aim of this thesis was therefore to determine the actual diagnosis and management of SAC and dry eye in clinical practice and investigate the efficacy of non-pharmacological treatments for these conditions. The diagnostic and management strategies for SAC and dry eye employed by pharmacy staff are found to be inconsistent with current guidelines and scientific evidence based upon a mystery shopper design. Cluster analysis of tear film metrics in normal and dry eye patients identified several clinically relevant groups of patients that may allow for targeted treatment recommendations. Using a novel environmental chamber model of SAC, the use of artificial tears and cold compresses, either alone or combined is an effective treatment modality for acute and symptomatic SAC, on a par with topical anti-allergic medication, and has been demonstrated for the first time. In addition, eyelid warming therapy with a simple, readily available, seed filled device is an effective method of treating meibomian gland dysfunction (MGD) related evaporative dry eye, perhaps the most common dry eye subtype. A greater focus on ophthalmology must be implemented as part of the formal education and training of pharmacy staff, while greater professional communication between community pharmacists, optometrists and the population they serve is required. Artificial tears and cold compresses may be considered as front line agents for acute SAC by pharmacy staff and optometrists, to whom pharmacological treatment options are limited.

Oil bearing seasonal crops in India:energy and phytoremediation potential

Purpose: A variety of biomass plantations are being raised for energy production. This case study is on energy production potential of seasonal oil bearing crops in India. These crops have the advantage of producing oil (liquid fuel) as well as biomass as agro residue (solid fuel). The purpose of the study is to estimate total energy yields of oil bearing crops and compare with other types of energy plantations. Also oil bearing crops bioaccumulate metals and thus phytoremediate soil. This provides scope for waste water irrigation. Design/methodology/approach: Relevant published papers on energy production by raising oil bearing crops have been analyzed. The effect of waste water irrigation and agronomic practices on increasing productivity is given special attention. Findings: It is shown that the seasonal oil bearing crops such as castor have a high potential to generate energy and this is comparable to energy produced by many perennial grasses. The energy yields of castor under irrigated condition was 196×103 MJ/ha and this is comparable to the reed canary grass which yields 195×103 MJ/ha. Some of the oil bearing crops are also super accumulators of certain toxic metals. Research limitations/implications: In this study, only all the accessible papers on the topic could be analyzed. Practical implications: This case study indicates that raising oil bearing crops such as castor using waste water has many advantages which include high energy yields, utilization of waste water for productive purpose and phytoremediation of soil. Originality/value: The comparison made between various types of energy crops for their energy generation is an original contribution. Findings of economic and environmental benefits by waste water irrigation are also of value. © Emerald Group Publishing Limited.