Allergic conjunctivitis in children

Allergic conjunctivitis in children is an inflammatory reaction of the conjunctiva, which occurs with an elevated, genetically engineered sensitivity of the organism to one or another allergen. Conjunctiva - the most frequent localization of allergic reaction from the side of the eye (up to 90% of allergies). Allergic conjunctivitis is often combined with other allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis).

ICD-10 code

• H10 Conjunctivitis.
  • H10.0 Muco-purulent conjunctivitis.
  • H10.1 Acute atopic conjunctivitis.
  • H10.2 Other acute conjunctivitis.
  • H10.3 Acute conjunctivitis, unspecified.
  • H10.4 Chronic conjunctivitis.
  • H10.5 Blepharoconjunctivitis.
  • H10.8 Other conjunctivitis.

Medicinal conjunctivitis in a child

The disease can occur acutely (within the first hour after the application of any drug) and subacute (during the first 24 hours after using the drug). Most often (in 90% of cases) drug conjunctivitis occurs with prolonged use of drugs (several days or weeks). An allergic reaction can develop both on the drug itself and on the preservative of eye drops, most often with topical application of antibacterial drugs and local anesthetics.

In acute allergic conjunctivitis is characterized by the emergence of rapidly growing vitreous chemosis and edema of the conjunctiva, there are severe itching, burning, abundant mucous (sometimes filmy) detachable from the conjunctival cavity. Some parts of the mucous membrane can be eroded. Mark papillary hypertrophy of the upper eyelid, follicles appear in the conjunctiva of the lower transitional fold and lower eyelid.

Infectious-allergic conjunctivitis in children

Bacterial, viral, fungal and parasitic allergens can cause the development of an allergic reaction in various tissues of the eye, including the mucosa.

Most often among microbial allergens, the cause of inflammation is the staphylococcal exotoxins produced by saprophytic strains. The disease is referred to as delayed-type allergic reactions. Characteristic chronic course, expressed subjective symptoms and moderate objective data (congestion hyperemia, papillary hypertrophy of the conjunctiva of the eyelids). The causative agent in conjunctiva is absent.

Tuberculosis-allergic phlyctenular keratoconjunctivitis (scrofulous keratoconjunctivitis, or scrofula). Characteristic appearance in the conjunctiva and the cornea of single or multiple nodules (fliken). In them there are lymphocytes, macrophages, but the causative agent and caseous necrosis there is no inflammatory process - an allergic reaction to circulating in blood products of mycobacteria decay. As a rule, nodules disappear without a trace, but sometimes they can ulcerate with subsequent scarring. The triad of subjective corneal symptoms (photophobia, lacrimation, blepharospasm) is pronounced, a patient with a drip anesthesia can not open his eyes. Convulsive contraction of the eyelids and constant lacrimation cause edema and maceration of the skin of the eyelids and nose. The disease begins acutely, then it takes a prolonged course, characterized by frequent relapses.

Pollinous (hay) conjunctivitis

Pollinous conjunctivitis is a seasonal allergic eye disease caused by pollen during flowering of grasses, cereals, and trees. Pollinosis is classified as a group of exoallergic diseases that occur immediately. Inflammation of the eye mucosa can be combined with damage to the upper respiratory tract, skin, GI tract, various parts of the nervous system or other organs.

This conjunctivitis is characterized by an acute onset. Against the background of severe unbearable itching, edema of the skin and hyperemia of the eyelid margin, pronounced edema of the conjunctiva, up to the development of chemosis; in the conjunctival cavity appears a transparent, mucous, dense, sticky discharge; on the conjunctiva of the upper eyelid note diffuse papillary hypertrophy. In the cornea, marginal superficial infiltrates prone to ulceration may occur. Diffuse epitheliopathy is possible. Often, a polynural allergosis occurs as seasonal chronic conjunctivitis.

Spring Qatar

Occurs in children aged 5-12 years (more often in boys) and has a chronic, persistent current with exacerbations during the sunny season. Typical are complaints of visual fatigue, a sense of foreign body and severe itching. Allocate conjunctival, limbal and mixed forms of the disease.

Characteristic papillary growths on conjunctiva cartilage of the upper eyelid, flattened, medium and large in the form of "cobblestone pavement." The conjunctiva is thickened, milky-pale, matte, with a sticky, viscous mucous discharge. The conjunctiva of other departments is unaffected.

In the region of the limbus, the growth of the gelatin-like cushion is yellow or pink-gray in color. Its surface is uneven, shiny with protruding white dots (Trattas spots), consisting of eosinophils and altered epitheliocytes. In the period of regression in the affected zone of the limbus, depressions are formed.

With a mixed form, the simultaneous lesion of the tarsal conjunctiva and the limb zone is characteristic. The defeat of the cornea occurs against a background of severe changes in the conjunctiva of the upper eyelid: epitheliopathy, erosion, thyroid ulcers of the cornea, hyperkeratosis. The pathology of the cornea is accompanied by a decrease in vision.

Hyperpapillary (large-papilled) conjunctivitis

The disease occurs with prolonged contact of the conjunctiva of the upper eyelid with a foreign body (contact lenses, eye prostheses, sutures after extraction of cataracts or keratoplasty). Patients complain of itching and mucous discharge, in severe cases, ptosis occurs. Upon examination, giant (1 mm or more) papillae of the conjunctiva of the upper eyelid are revealed. The clinical picture is similar to the manifestations of the conjunctival form of spring catarrh, but there is no itching sticky mucous discharge, damage to the limbus and cornea. The main treatment is removal of the foreign body and local antiallergic therapy.

Treatment of allergic conjunctivitis in children

The basis of the treatment is the elimination of the allergen or the withdrawal of the drug that caused the allergic reaction.

• Antiallergic drops:
  • antazolin + tetrisolin or diphenhydramine + nafazolin or olopatadia 2-3 times a day no more than 7-10 days (combined preparations for an acute allergic reaction);
  • preparations of ketotifen, olopatadine or cromoglycic acid 2 times a day, if necessary, with prolonged courses from 3-4 weeks to 2 months (after acute acute or subacute, chronic reaction).
• NSAIDs (indomethacin, diclofenac) 1-2 times a day.
• Local glucocorticoid preparations (0.1% solution of dexamethasone, etc.) are an obligatory component in spring keratoconjunctivitis and corneal involvement. Given that long-term treatment with glucocorticoids may lead to side effects, it is necessary to use lower concentrations of dexamethasone (0.01-0.05%), which are prepared ex tempore.
• Ointments with glucocorticoids on the edges of the eyelids - prednisolone, hydrocortisone (in case of involvement of the eyelids and concomitant blepharitis).
• Stimulators of cornea regeneration (taurine, dexpanthenol 2 times a day) and tear-replacing drugs (hypromellose + dextran 3-4 times a day, sodium hyaluronate 2 times a day) with corneal lesions.
• Systemic desensitizing treatment - loratadine: children over 12 years of age 10 mg once a day, children 2-12 years, 5 mg once a day. With long-term courses, the change in the antihistamine drug is 1 time in 10 days.

The most effective method of treating severe allergic conjunctivitis in children is a specific hyposensitization of pollen allergens, which is carried out outside the period of exacerbation of the disease.