Allergic conjunctivitis

Allergic conjunctivitis is an inflammatory reaction of the conjunctiva to the effect of allergens. Allergic conjunctivitis occupies an important place in the group of diseases united by the common name "red eye syndrome", it affects about 15% of the population.

Eyes are often exposed to various allergens. Hypersensitivity is often manifested by an inflammatory reaction of the conjunctiva (allergic conjunctivitis), but any parts of the eye can be affected, and then allergic dermatitis, conjunctivitis, keratitis, iritis, iridocyclitis, optic neuritis develop.

An allergic reaction to the eyes can occur with many systemic immunological diseases. Allergic reaction plays an important role in the clinic of infectious lesions of the eyes. Allergic conjunctivitis is often combined with such systemic allergic diseases as bronchial asthma, allergic rhinitis, atopic dermatitis.

Allergic reactions are divided into immediate (develop within half an hour from the moment of exposure to the allergen) and delayed (develop 24-48 hours later or later after exposure). This separation of allergic reactions is of practical importance in the provision of medicinal care.

In some cases, a typical picture of the disease or a clear connection with the effect of an external allergenic factor does not raise doubts in the diagnosis. In most cases, diagnosis is fraught with great difficulties and requires the use of specific allergological methods of investigation. To establish the correct diagnosis, it is necessary to establish an allergic anamnesis - to clarify the hereditary allergic burden, the features of the course of diseases that can cause an allergic reaction, the periodicity and seasonality of exacerbations, the presence of allergic reactions, in addition to the eye.

Special diagnostic tests are of great diagnostic importance. For example, skin allergic tests used in ophthalmic practice are low-traumatic and at the same time fairly reliable.

Laboratory allergodiagnostics is highly specific and is possible in the acute period of the disease without fear of harming the patient.

A great diagnostic value is the detection of eosinophils in scrapings with the conjunctiva. Basic principles of therapy:

• Exclusion of the allergen, if possible; this is the most effective and safe method of preventing and treating allergic conjunctivitis;
• medicinal symptomatic therapy (local, with the use of eye preparations, general - antihistamines inwards for severe lesions) occupies the main place in the treatment of allergic conjunctivitis;
• specific immunotherapy is performed in medical institutions if the drug therapy is not effective enough and it is impossible to exclude the "guilty" allergen.

Two groups of eye drops are used for antiallergic therapy:

• inhibiting the degranulation of mast cells: Kromopy - 2% lecroline solution, 2% lecroline solution without preservative, 4% solution of kuzikroma and 0.1% solution of lodoxamide (alomide);
• antihistamines: antazolin and tetrisolin (spereallerg) and antazolin and naphazoline (allergothal). Additional drugs: 0.1% solution of dexamethasone (dexanos, maxidex, octane-dexamethasone) and 1% and 2.5% hydrocortisone-PIC solution, as well as nonsteroidal anti-inflammatory drugs - 1% solution of diclofenac ( diclor, slope).

[1], [2]

Symptoms of allergic conjunctivitis

The most common clinical forms of allergic conjunctivitis are:

• Flicktulous (tuberculosis-allergic conjunctivitis);
• Pollinous conjunctivitis, medication conjunctivitis;
• Pollinous conjunctivitis;
• Spring catarrh;
• Senate catarrh;
• Hay conjunctivitis.

Flicktulous (scrofulous) allergic conjunctivitis

Flicktulous (scrofulous) allergic conjunctivitis refers to tuberculosis-allergic eye diseases. On the connective membrane or on the limb, separate inflammatory nodules of a yellowish-pink color appear, which have still preserved the incorrect name "flikteni" - vesicles. The nodule (flictain) consists of cellular elements, mainly lymphoid cells with an admixture of cells of the elitheloid and plasma types, sometimes giant ones.

The appearance of nodules on the conjunctiva, especially on the limb, is accompanied by strong photophobia, lacrimation and blepharism. Nodules can develop on the cornea. Conjunctival infiltration (flicten) most often resolves without a trace, but sometimes it disintegrates with the formation of a sore, which, when alive, is replaced by a connective tissue.

Scrofulous conjunctivitis is observed mainly in children and young people suffering from tuberculosis of cervical and bronchial lymph nodes or lungs. Fliktena - a nodule that resembles its structure with tuberculosis, never contains mycobacterium tuberculosis and does not undergo a curdled decay. Therefore, scrofulous conjunctivitis is considered as a specific reaction of the allergic mucous membrane of the eye to a new supply of decay products of mycobacterium tuberculosis into it. Occurrence flikenen at children should direct attention of the doctor on careful inspection of the child.

A simple and fairly complete classification of AB Katznelson (1968) includes the following allergic conjunctivitis:

1. atopic acute and chronic;
2. contact allergic (dermatoconjunctivitis);
3. microbiological allergic;
4. spring catarrh.

In the development of the first form, pollen, epidermal, medicinal, rarely food and other allergens are more likely than others. The most acute, with pronounced objective symptoms, is acute atopic conjunctivitis. Reflecting the reaction of the immediate type, from: characterized by complaints of the patient na unbearable burning, cutting pains, photophobia, lacrimation, and an objectively very rapid buildup of conjunctival hyperemia and its edema, often vitreous and massive, down to chemosis, with abundant serous discharge, hypertrophy of the papillae of the conjunctiva. Swollen and blush eyelids, but the regional lymph nodes are intact. Eosinophils are found in the detachable and scrapes of the conjunctiva. Occasionally there is superficial point keratitis. Burying on this background of adrenaline, saporin or another vasoconstrictor dramatically changes the picture: while the medicine is working, the conjunctiva looks healthy. A slower, but stable improvement, and soon the recovery of locally administered and inwardly antihistamines is also recovering. Corticosteroids are usually shown.

Chronic atopic conjunctivitis

In a completely different way, a chronic atopic conjunctivitis occurs, characterized by copious complaints of patients and scanty clinical data. Patients persistently demand to relieve them of the constant sensation of "clogging" of the eyes, burning, lacrimation, photophobia, and the doctor at best finds only a slight pallor of the conjunctiva, sometimes mild hyperplasia of the papillae and condensation of the lower transitional fold, and more often sees externally unchanged conjunctiva and may regard complaints as neurotic (AB Katznelson). Diagnosis is often difficult not only because of the symptoms of poverty, but also because the allergen is well-disguised, and until it is found and not eliminated, treatment only brings temporary improvement. The atopic nature of this suffering can be assumed on the basis of a positive allergic anamnesis of the patient and his relatives, which is confirmed by eosinophilia when examining a smear or scraping. When looking for an allergen, complicated by unconvincing skin tests, the observation of the patient is very important. While the search is underway, relief may be given periodically by drops of dimedrol, 1% solution of antipyrine, zinc sulfate with adrenaline, etc. For such patients, usually the elderly, the heating of drops before instillation is especially important, the appointment of weak sedatives (preparations of bromine, valerian , etc.), the attentive and tactful attitude of medical personnel, the suggestion to patients at every visit to the doctor of the thought of complete safety of the disease for sight and general health, its curability under certain conditions s.

[3], [4], [5], [6]

Contact allergic conjunctivitis and dermatoconjunctivitis

Contact allergic conjunctivitis and dermatoconjunctivitis in pathogenesis are identical to contact dermatitis and eczema. More often they arise as a result of the influence of exogenous allergens on the conjunctiva or on the conjunctiva and the skin of the eyelids, are much less often a reflection of endogenous allergic influences. The set of antigens that cause this form of conjunctivitis is as extensive as with dermatitis of the eyelids, but the first place among the irritants is undoubtedly occupied by medicines used locally in the eye area; they are followed by chemicals, cosmetics, pollen, domestic and industrial dust, animal allergens, etc. The food and other allergens that enter the conjunctiva with blood and lymph are of lesser importance. The disease develops in a delayed type, beginning after repeated, often repeated contacts with the allergen.

The clinic of the disease is quite typical: complaints of severe rezings, burning, photophobia, inability to open eyes are marked by intense hyperemia and edema of the conjunctiva of the eyelids and the eyeball, hyperplasia of the papillae, abundant serous-purulent discharge ("from the eyes pour"), in which there are many eosinophils and exposed to mucous degeneration of epithelial cells. Eyelids swell. There are often signs of dermatitis of the eyelids. These symptoms reach a maximum and can last for a long time with continuing exposure to the allergen, which can be detected by skin tests.

[7], [8], [9], [10]

Microbiological allergic conjunctivitis

Microbiological allergic conjunctivitis is named so, and not microbial because it can be caused not only by microbes, but by viruses, fungi, other microorganisms, and also allergens of helminths. However, the most frequent cause of its development are staphylococcal exotoxins, produced more saprophytic strains of the microbe.

From bacterial, viral and other inflammations of the conjunctiva, the allergic process of microbiological genesis is distinguished by the absence of an agent in the conjunctival sac and the peculiarities of clinical manifestations. Being an allergic reaction of a delayed type, such conjunctivitis, as a rule, proceeds; chronically, recalling the abundant complaints of patients and moderate objective data chronic atopic conjunctivitis. Leading symptoms: the growth of papillae of the palpebral conjunctiva, its hyperemia, which increases during work and any irritations. Often the process is combined with simple (dry) or scaly blepharitis. In lean can be eosinophils and altered cells of the conjunctival epithelium. Skin tests with disease-causing microbial allergens are desirable in these cases, and in the search for an irritant, a sample with a staphylococcal antigen is first shown. Treatment with corticosteroids (topically and inwardly), vasoconstrictors, astringents, until the allergen has been eliminated, gives only a transient improvement. The organism is sanitized by appropriate antimicrobial, antiviral and other therapies, combined, if necessary, by surgical and other methods of eliminating foci of chronic infection.

True allergic conjunctivitis is not peculiar to the formation of conjunctival follicles. Their appearance indicates not so much about allergenic, but about the toxic effect of the damaging agent. Such are, for example, atropine and eserine conjunctivitis (catarrhs), mollusc conjunctivitis is a viral disease, but resolved until the mollusk, masked somewhere on the edge of the century, is eliminated.

Considering the great similarity of etiology and pathogenesis with uveal and other allergic processes in the eye, it is considered possible to designate this form as more familiar for ophthalmologists by the term "infectious-allergic conjunctivitis".

As an exception to the general rule, follicles are the only symptom of follicle, reflecting the conjunctival reaction, usually in children, on exogenous and endogenous stimuli. Occasions for the emergence of this chronic condition of the conjunctiva can be anemia, helminthic invasions, nasopharyngeal diseases, gyno and avitaminosis, uncorrected refractive errors, adverse environmental influences. Children with folliculosis need to be examined and treated by a pediatrician or other specialists. Infectious-allergic in nature are rare now follicular conjunctivitis.

To the microbiological allergic processes AB Katznelson classifies phlyctenular keratoconjunctivitis, considering it "a classical clinical model of late type microbial allergy".

The clinical classification of the drug allergy of the conjunctiva, as well as of other departments of the organ of vision, based on the identification of the leading symptom of pathology, was proposed by Yu. F. Maichuk (1983).

A special form of allergic conjunctivitis, which differs significantly from the above processes, is spring catarrh. The disease is unusual in that it is common in more southerly latitudes, it affects mainly males, and more often during childhood and sexual development, and manifests itself with symptoms that are not present under any other pathology of the eyes. Despite the intensified research, none of the features of the disease has yet received a convincing explanation. Eye disease begins in boys in 4-10 years and can continue until the period of maturity, sometimes ending only to 25 years. The average duration of suffering is 6-8 years. In chronic course, the process is cyclical: exacerbations that occur in the spring and summer are replaced by remissions in the cool season, although the year-round activity of the disease is not excluded. Both eyes are affected. Patients are concerned about the sensation of a foreign body, photophobia, lacrimation, vision impairment, but especially itchy eyelids. Objectively, the conjunctiva or limb changes, or both, that allows distinguishing between palpebral or tarsal, limbal or bulbar and mixed forms of catarrh. The first form is characterized by a small ptosis, massive, flat, cobbled road, polygonal, milky-pink or bluish-milky papillary growths on the cartilage conjunctiva of the upper eyelid, which last for years, but disappear without leaving a scar.

With limbal spring catarrh, moderate pericorneal incontinence, dense vitreous, yellowish-gray or pink-gray overgrowth of the conjunctiva along the upper limb, sometimes waxy-yellow nodes, and in severe cases a dense shaft of the newly formed tissue above the limb with an uneven surface on which white dots are visible (Trattas spots). The mixed form combines the affection of the conjunctiva of the superior cartilage and limbus. With all forms of detachment, it is small, it is viscous, stretches with threads, eosinophils are often found in smears and scrapes.

The allergic genesis of the disease does not cause doubts, but the allergen is unclear. Most researchers in one way or another associate spring catarrh with ultraviolet irradiation, hereditary predisposition, endocrine influences, in 43.4% of patients with spring catarrhs, J. F. Maychuk (1983) revealed sensitization to non-bacterial and bacterial allergens.

Treatment of allergic conjunctivitis

The treatment is mainly aimed at desensitization and strengthening of the child's organism, vitamins, a diet with restriction of carbohydrates and the following preparations are recommended:

• 2% solution of sodium cromoglycate or alomide 4-6 times a day;
• 0.1% solution of dexamethasone in droplets 3-4 times a day;
• at local treatment, instill a streptomycin instillation in the dilution of 25 000-50 000 units in 1 ml of solution 2 - 3 times a day;
• 3% solution of calcium chloride 2-3 times a day; cortisone 1% 2-3 times a day.

In case of severe persistent disease, a general course of treatment with streptomycin, PASK and phytivazide should be carried out in doses taken by phthisiatricians and other anti-tuberculosis drugs.

With a pronounced bllfarospazme, tearing, photophobia, pericorneal injection apply 0.1% solution of sulfuric acid atropine 2-3 times a day. It is useful to conduct iontophoresis daily with calcium chloride.

Hay conjunctivitis is an allergic disease caused by the ingestion of an allergen (most often the flower pollen of cereals and some other plants) on the mucous membrane of the eye, nose, upper respiratory tract. It begins acutely, sharply expressed photophobia, lacrimation. Conjunctiva strongly hyperemic, swollen, papillae hypertrophied. Disturbing severe itching, burning. Detachable watery. The disease is accompanied by acute rhinitis, catarrh of the upper respiratory tract, and sometimes even fever. They get senna conjunctivitis even in early childhood or during puberty. The phenomena of conjunctivitis are repeated yearly, but weaken with age and in the elderly can disappear completely.

With senile conjunctivitis, desensitizing therapy is recommended, 2% solution of sodium cromoglycate or "Alomid" 4-6 times a day. Locally appoint cortisone 1-2 drops 3-4 times a day, 5% solution of calcium chloride per 1 tbsp. L. 3 times a day during meals, intravenously 10% solution of calcium chloride 5-10 ml daily.

The development of senile conjunctivitis can sometimes be prevented by carrying out the above treatment long before the beginning of the flowering of cereals. If treatment is unsuccessful, then it is necessary to move to a place where there are no cereals that cause the disease.

How to prevent allergic conjunctivitis?

To prevent the disease, it is necessary to take certain measures.

It is necessary to eliminate the causal factors. It is important to reduce, and if possible, to exclude contacts with such risk factors for allergy development as house dust, cockroaches, domestic animals, dry fish food, household chemicals, cosmetics. It should be remembered that in patients with allergies, eye drops and ointments (especially antibiotics and antiviral agents) can cause not only allergic conjunctivitis, but also a general reaction in the form of hives and dermatitis.

If a person gets into conditions when it is impossible to exclude contact with the factors that cause allergic conjunctivitis, to which he is sensitive, you should start digging in lecromine or alomide 1 drop 1-2 times a day for 2 weeks before contact.

1. If the patient has already fallen into such conditions, allergotheal or spersallerg is instilled, which give an immediate effect, which lasts for 12 hours.
2. With frequent relapses, specific immunotherapy is performed during the remission of conjunctivitis.