Allergic conjunctivitis in children

Allergic conjunctivitis in children is an inflammatory reaction of the conjunctiva that occurs with increased, genetically determined sensitivity of the body to a particular allergen. The conjunctiva is the most common localization of an allergic reaction in the visual organ (up to 90% of all allergies). Allergic conjunctivitis is often combined with other allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis).

ICD-10 code

• H10 Conjunctivitis.
  • H10.0 Mucopurulent 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.

Drug-induced conjunctivitis in a child

The disease may develop acutely (within the first hour after using any medication) and subacutely (within the first day 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 to the drug itself and to the preservative of eye drops, most often with local use of antibacterial drugs and local anesthetics.

Acute allergic conjunctivitis is characterized by the appearance of rapidly increasing vitreous chemosis and conjunctival edema, severe itching, burning, and abundant mucous (sometimes filmy) discharge from the conjunctival cavity. Some areas of the mucous membrane may be eroded. Papillary hypertrophy of the upper eyelid is noted, and follicles appear in the area of 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 mucous membrane.

The most common microbial allergens causing inflammation are staphylococcal exotoxins produced by saprophytic strains. The disease is classified as a delayed-type allergic reaction. It is characterized by a chronic course, pronounced subjective symptoms and moderate objective data (conjunctival hyperemia, papillary hypertrophy of the conjunctiva of the eyelids). The pathogen is absent from the conjunctiva.

Tuberculous-allergic phlyctenular keratoconjunctivitis (scrofulous keratoconjunctivitis, or scrofula). Characteristic appearance in the conjunctiva and on the cornea of single or multiple nodules (phlycten). They contain lymphocytes, macrophages, but the pathogen and caseous necrosis are absent inflammatory process - allergic reaction to the products of decay of mycobacteria circulating in the blood. As a rule, the nodules disappear without a trace, but sometimes they can ulcerate with subsequent scarring. The triad of subjective corneal symptoms (photophobia, lacrimation, blepharospasm) is sharply expressed, the patient cannot open his eyes with drip anesthesia. Convulsive squeezing of the eyelids and constant lacrimation cause edema and maceration of the skin of the eyelids and nose. The disease begins acutely, then becomes protracted, and is characterized by frequent relapses.

Pollinosis (hay fever) conjunctivitis

Pollinosis conjunctivitis is a seasonal allergic eye disease caused by pollen during the flowering period of grasses, cereals, and trees. Pollinosis is classified as an exoallergic disease that occurs as an immediate type. Inflammation of the mucous membrane of the eye can be combined with damage to the upper respiratory tract, skin, gastrointestinal tract, various parts of the nervous system, or other organs.

This conjunctivitis is characterized by an acute onset. Against the background of pronounced unbearable itching, there is swelling of the skin and hyperemia of the edges of the eyelids, pronounced swelling of the conjunctiva, up to the development of chemosis; a transparent, mucous, thick sticky discharge appears in the conjunctival cavity; diffuse papillary hypertrophy is noted on the conjunctiva of the upper eyelid. Marginal superficial infiltrates prone to ulceration may occur in the cornea. Diffuse epitheliopathy is possible. Pollinose allergosis often occurs as seasonal chronic conjunctivitis.

Spring catarrh

It occurs in children aged 5-12 years (more often in boys) and has a chronic, persistent course with exacerbations in the sunny season. Typical complaints include visual fatigue, a foreign body sensation and severe itching. Conjunctival, limbal and mixed forms of the disease are distinguished.

Characteristic papillary growths on the conjunctiva of the cartilage of the upper eyelid, flattened, medium and large in the form of a "cobblestone pavement". The conjunctiva is thickened, milky-pale, matte, with sticky, viscous mucous discharge. The conjunctiva of other parts is not affected.

In the limbus area, there is a growth of a gelatinous ridge of yellow or pinkish-gray color. Its surface is uneven, shiny with protruding white dots (Trantas spots), consisting of eosinophils and altered epithelial cells. During the regression period, depressions form in the affected area of the limbus.

In the mixed form, simultaneous damage to the tarsal conjunctiva and limbal zone is characteristic. Damage to the cornea occurs against the background of severe changes in the conjunctiva of the upper eyelid: epitheliopathy, erosion, thyroid ulcer of the cornea, hyperkeratosis. Pathology of the cornea is accompanied by decreased vision.

Hyperpapillary (large papillary) conjunctivitis

The disease occurs with prolonged contact of the upper eyelid conjunctiva with a foreign body (contact lenses, ocular prostheses, sutures after cataract extraction or keratoplasty). Patients complain of itching and mucous discharge; in severe cases, ptosis occurs. During examination, giant (1 mm or more) papillae of the upper eyelid conjunctiva are detected. The clinical picture is similar to the manifestations of the conjunctival form of spring catarrh, but there is no itching, sticky mucous discharge, or lesions of 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 treatment is the elimination of the allergen or discontinuation of the drug that caused the allergic reaction.

• Antiallergic drops:
  • antazoline + tetryzoline or diphenhydramine + naphazoline or olopatadium 2-3 times a day for no more than 7-10 days (combination drugs for acute allergic reactions);
  • ketotifen, olopatadine or cromoglycic acid preparations 2 times a day, if necessary in long courses from 3-4 weeks to 2 months (after stopping the acute or subacute, chronic reaction).
• NSAIDs (indomethacin, diclofenac) 1-2 times a day.
• Local glucocorticoids (0.1% dexamethasone solution, etc.) are a mandatory component in vernal keratoconjunctivitis and corneal lesions. Considering that side effects may develop with prolonged treatment with glucocorticoids, 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 eyelid involvement and concomitant blepharitis).
• Corneal regeneration stimulants (taurine, dexpanthenol 2 times a day) and tear substitutes (hypromellose + dextran 3-4 times a day, sodium hyaluronate 2 times a day) for corneal lesions.
• Systemic desensitizing treatment - loratadine: children over 12 years old 10 mg once a day, children 2-12 years old 5 mg once a day. In long courses, change the antihistamine once every 10 days.

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