Chronic conjunctivitis: causes, symptoms, diagnosis, treatment

Chronic conjunctivitis is conjunctivitis associated with refractive anomalies, diseases of the paranasal sinuses, and gastrointestinal tract with a chronic course. In these pathologies, there are very few objective data: slight hyperemia of the conjunctiva, slight roughness of its surface, which causes a feeling of clogged eyes.

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What causes chronic conjunctivitis?

Chronic conjunctivitis is often associated with poor sanitary and hygienic conditions, such as dust and smoke in poorly ventilated rooms, insufficient lighting; it can be caused by refractive errors (especially hyperopia and astigmatism) and poorly selected lenses. Chronic conjunctival catarrh is often caused by poor nutrition, anemia, metabolic diseases, etc.

It is necessary to keep in mind professional conjunctivitis, which occurs as a result of exposure to coal and wood dust: it is also common in flour mills, wool-beating, paper industries, among workers in hot shops, among loaders exposed to coal salt (foam), and among electric welders.

To determine the causes of chronic conjunctivitis, it is important to examine the condition of the lacrimal ducts, nasal cavity and pharynx, teeth, and paranasal sinuses.

Chronic conjunctivitis often develops after acute conjunctivitis.

Symptoms of chronic conjunctivitis

The course of chronic conjunctivitis is long and persistent; improvements are often attributed to exacerbations. Patients complain of a feeling of heaviness in the eyelids, a feeling of sand in the eyes, burning, tingling and rapid eye fatigue during work.

The conjunctiva shows more or less redness; its surface loses its shine and becomes velvety. The discharge is usually small, and is mucous or mucopurulent in nature; sometimes it is almost absent and only in the morning is it found in small quantities in the corners of the eyelids.

Treatment of chronic conjunctivitis

First of all, it is necessary to eliminate the cause of chronic conjunctivitis. An ophthalmologist consultation is recommended for the correct selection of corrective glasses, especially for astigmatism and presbyopia. In case of abundant discharge, the same means are used as for acute conjunctivitis. If the amount of discharge is insignificant, astringents are used.

For chronic conjunctivitis, baths and lotions are also used, for which they use a 2% solution of borax, a 2% solution of boric acid, a 0.25% solution of vinegar alum, as well as aromatic waters: chamomile infusion, etc. They instill a 0.25% solution of zinc sulfite 3-4 times a day in courses of 7-10 days; instillation of artificial tears.

Chronic allergic conjunctivitis

Allergic conjunctivitis is often chronic: there is moderate burning of the eyes, minor discharge, and until the disease is detected and eliminated, treatment brings only temporary improvement. The atopic nature of this disease can be assumed based on a positive allergic anamnesis of the patient and his relatives, which is confirmed by eosinophilia when examining a smear or scraping. When searching for an allergen, which is complicated by inconclusive skin tests, the patient's own observation is of great importance. To alleviate the patient's condition, periodically replacing drops of diphenhydramine, 1% solution of adrenaline, etc. are prescribed. For such patients, usually elderly people, it is especially important to warm the drops before instillation, prescribe weak sedatives (bromine preparations, valerian, etc.), emphasize the attentive and tactful attitude of the medical staff, instill in patients at each visit to the doctor the idea of the complete safety of the disease for vision and general health, its curability under certain conditions.

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Parasitic chronic conjunctivitis

Onchocerciasis is a type of helminth that is characterized by eye damage.

The causative agent is filaria. The disease is transmitted by midge bites. Onchocerciasis occurs in the midge habitat - in Western, less often - Central Africa, Central America,

Onchocerciasis is characterized by a highly itchy polymorphic rash, "filariasis scabies". The allergic component occupies a central place in the mechanism of skin lesions.

Chronic conjunctivitis is found in almost every patient. A frequent finding is point cutaneous superficial opacities of the cornea. They either disappear without a trace, or the neck increases in size, forming large foci. A prodromal period of the disease is distinguished, characterized by conjunctival-corneal syndrome, in which there are only subjective data - itching of the eyelids, lacrimation, photophobia, and structural changes in the eye are not yet detected.

The disease is caused by the presence of microfilariae in the cornea in the anterior chamber, detected by biomicroscopy. The purity of their detection varies in different onchocirrhotic zones.

The diagnosis is established based on the anamnesis (residence in epidemic areas), characteristic clinical symptoms, detection of microfilariae. An allergic reaction that occurs after a single injection of diethylcarbamisine at a dose of 50 mg (Mazotti test) is used as a diagnostic test. The reaction begins after 15-20 minutes and is manifested primarily by itching, which is more intense, the more microfilariae. The allergic reaction may be accompanied by swelling of the eyelids, swelling and hyperemia of the skin. A general reaction is often observed: fever, headaches, muscle pain. The reaction reaches its maximum after 24 hours, and then subsides within 48 hours. Specific antiparasitic treatment includes sequential or simultaneous use of ditrazine, which acts on microfilariae, and anticrol, which affects adult helminths.

Treatment of onchocerciasis remains a difficult task due to allergic reactions that occur when the parasite dies en masse and due to the toxicity of the drugs. The frequency of severe side effects reaches 30% or more, and fatal outcomes have been described. In this regard, an important principle of antiparasitic therapy is the simultaneous use of antihistamines and corticosteroids and antihistamine therapy.