Medicinal conjunctivitis

Allergic reactions of the eyes caused by drugs, referred to as a side effect of the drug, or "eye disease" (drug allergic conjunctivitis), is one of the most frequent manifestations of allergic eye damage.

The frequency and severity of drug complications from the side of the organ of vision continuously increase as the arsenal of biologically active medicines increases. Of the factors that determine the high level of medical complications, it should be noted:

1. increased consumption of medicines, qualified as pharmacomania;
2. widespread self-treatment;
3. insufficiency or delay of medical information about possible medical complications;
4. polytherapy without taking into account the interaction of drugs.

Adverse events and drug complications from the eye are observed earlier and more often than from other organs, and sometimes completely isolated.

[1], [2], [3], [4], [5]

Causes of allergic conjunctivitis

Allergic reactions caused by drugs, according to the speed of development, are usually divided into three groups. Reactions of an acute type occur within the first hour after administration of drugs (acute drug conjunctivitis, anaphylactic shock, acute urticaria, Quincke's edema, systemic capillarotoxicosis, etc.). Drug reactions of the subacute type develop within a day after the administration of drugs. Reactions of a protracted type appear for several days and weeks, usually with prolonged local drug use. This type of eye allergic reactions is most common (90%).

Allergic eye injuries can occur not only with topical application of medicines, but also with the introduction of various drugs inside or parenterally. Contact treatment of eye diseases (drops, ointments, films, electrophoresis, phonophoresis, contact lenses) can cause a general allergic reaction in the form of hives or common dermatitis along with local manifestations of drug allergy. At the same time, with the introduction of drugs inside or parenterally, there may be a pocked eye injury without a general allergic reaction.

[6], [7], [8], [9]

Symptoms of drug conjunctivitis

The most common clinical form of ocular drug allergy is allergic conjunctivitis, which can often be isolated. Mucous membrane of the conjunctiva is abundantly vascularized, rich in reticuloedothelial cells, is accessible to external factors and is closely related to the state of the whole organism.

Acute allergic conjunctivitis (or conjunctival edema) develops within the first 6 hours after application of the drug in patients previously sensitized to it.

Rapidly increasing vitreous chemosis of the conjunctiva of the eyelids and the eyeball is accompanied by a strong itch, abundant mucous separable. In particularly severe cases of acute drug conjunctivitis, the mucous membrane of the eyelids is eroded in places. In rare cases, an allergic reaction is accompanied by a filmy conjunctivitis.

The most common cause of development of acute conjunctivitis is antibiotics - synthomycin, monomycin, etc.

Hyperemia of the conjunctiva - a small peripheral injection of the vessels of the eyeball with a characteristic uneven caliber of the vessels of the conjunctiva and the epicleras of the limbus - most often indicates a general sensitization caused by drugs of general action. Subjective complaints of patients on itching, stinging, burning are prevailing over objective symptoms and often by ophthalmologists and therapists are not taken into consideration until signs of a general allergic reaction (for example, dermatitis) appear. The vascular reaction is more violent and may be accompanied by subconjunctival hemorrhages. A similar reaction is caused by sex hormones with parenteral administration, especially long-acting drugs.

Papillular hypertrophy of the conjunctiva is sometimes very severe, reminiscent of the appearance of catarrh, usually occurs only after prolonged topical application of the medicine - allergen. Appearing against the background of drug treatment, it progressively nasraschaet, accompanied by itching, sometimes significant, and a small edema of the mucous membrane, if the allergen continues to act. Usually filamentous mucous discharge can be replaced by mucopurulent and resemble bacterial conjunctivitis. This most common form of conjunctivitis develops with allergies to various medications, but more often to antibacterial or antiviral drugs. As a rule, the allergy develops after a long (2-4 weeks) local application of the drug-allergen.

Follicular conjunctivitis is typical for the allergic reaction of adenoid subepithelial tissue of the conjunctiva. It develops relatively slowly (weeks, months) and regresses just as slowly after the withdrawal of the drug that caused the disease. Subjective feelings are meager, limited by a feeling of contamination of the eyes, while itching usually does not happen. Often this pathology is diagnosed by the doctor on examination, although the patient does not make any complaints at all. There is practically no detachable if a bacterial infection does not attach. The follicles first appear in the area of the lower transitional fold and the lower cartilage, in places of greatest contact with medicinal substances. Later they can be found in the region of the upper transitional fold, the superior cartilage, the conjunctiva of the sclera near the limb, and even in the limb itself. As a rule, follicular conjunctivitis develops with sensitization to miotics (pilocarpine, phosphacol, armilla, tosmylen, ezeria) and mydriatic (astrogylus, scopolamine), so it is often one-sided. There is a combination of papillary and edematic forms, especially when sensitized to several simultaneously or consistently used medications.

Treatment of drug conjunctivitis

The main thing in the treatment of drug allergy is the abolition of the "guilty" drug or the transition to the same drug without a preservative.

After the abolition of the drug-allergen in an acute course, eye drops are used allergothal or spurssling 2-3 times a day, with chronic - alomide, lekromin or lekromin without preservative 2 times a day. In severe and prolonged course, there may be a need for taking antihistamines inside, 2% solution of sodium cromoglycate or "Alomide" 4-6 times a day.