Current management of ocular allergy by ophthalmologists in Keny

Abstract

Background: Currently, the management of Ocular Allergy (OA) in Kenya is not standardised. The development and implementation of Standard Treatment Guidelines (STGs) is a necessary task in a health care system where numerous treatments may be available. Objectives: To describe the approach to management of ocular allergy in Kenya. Methods: The study was a descriptive (Knowledge, Attitude and Practice) cross-sectional study carried out among practising ophthalmologists in Kenya from 1 st December 2012 to 31 st May 2013. Data was collected using self-administered questionnaires and qualitative methods including focus group discussions and key informant interviews were used for triangulation and to get detailed information on the attitudes and practices of the ophthalmologists regarding OA. Results: A total of 58 ophthalmologists were included in the study (69% response rate). All the participants reported diagnosing OA based on clinical findings. The majority, >70%, of the ophthalmologists considered symptom severity, availability of drugs, and treatment tolerability as important factors in treatment selection. Topical antihistamines and mast cell stabilisers were used by 62% and 57% of the ophthalmologists respectively as the first line treatment. Majority of the participants indicated the use of topical immunomodulators/systemic steroids (75.9%) and periocular steroids (72.4%) only for severe cases though during the discussions, the use of topical immunomodulators and systemic corticosteroids was not mentioned. The rational use of topical steroids was advised by all the discussion participants so as to avoid their overuse. Non-pharmacological treatment including allergen avoidance, cold compresses, and artificial tears were mentioned as being important for providing short-term relief for allergy symptoms. The use of tear supplements in all grades of severity to provide ocular lubrication and also for dilution of allergens was mentioned by the majority of the participants in the discussions. Surgical intervention was suggested only in the management of complications of OA or conditions associated with OA. There is no national standard treatment guideline for the management of OA. Counselling was seen to form a major part of the management of a patient with OA though it is inadequate in our setting. Conclusions: There is no standard treatment guideline followed in the management of ocular allergy. There is a need to come up with a national guideline so as to harmonise the diagnosis, grading and treatment of ocular allergy. Patient counselling needs to be emphasized so as to improve compliance to treatment and follow up appointments.