Spring Qatar

Spring catarrh (spring keratoconjunctivitis) is an allergic disease in which only the conjunctiva and the cornea are affected. Until the 50's. XX century. The disease was considered a rare ocular pathology. Over the past decades, significant progress has been made in developing issues of epidemiology, pathogenesis, diagnosis, clinics and treatment of spring catarrh.

Spring catarrh is a recurrent, bilateral inflammation that affects primarily boys living in warm, dry climates. This is an allergic disorder in which IgE plays an important role and cell-mediated immune mechanisms play an important role. In 3/4 patients - associated atony, and 2/3 - have atopy in relatives. Such patients often develop asthma and eczema in childhood. Spring keratoconjunctivitis usually begins after 5 years and continues until puberty, occasionally persists for more than 25 years.

Spring catarrh can proceed seasonally, with a peak at the end of spring and summer, although in many patients the disease occurs year-round. Patients with spring keratoconjunctivitis often encounter keratoconus, as well as other types of corneal ectasia, such as transparent marginal degeneration and keratoglobus.

Spring catarrh occurs in various parts of the globe: most often in countries with hot climates (in Africa, South Asia, the Mediterranean), much less often in northern countries (Sweden, Norway, Finland). To date, there is no precise data on its prevalence in the world. In our country, a high prevalence is observed in the southern regions, as well as in Central Asia.

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The reason for the development of the spring catarrh to the present time has not been finally clarified. Painful phenomena are especially evident in spring and summer. It is believed that the disease is caused by the action of ultraviolet rays with increased sensitivity to them.

Spring catarrh is usually observed in boys, begins at the age of 4, lasts for several years, exacerbating in the spring-summer period, and completely regresses during puberty, regardless of the treatment methods used. These facts indicate a definite role of endocrine changes in a growing organism.

Spring catarrh is characterized by pronounced seasonality: it begins in the early spring (March-April), reaches a maximum in the summer (in July-August), regresses in the autumn (September-October). In the southern regions of our country, as a rule, the exacerbation of the disease begins in February and ends in October-November. Year-round course of the disease is observed in people with a history of allergic anamnesis (food and drug allergy) or concomitant allergies (eczema, neurodermatitis, vasomotor rhinitis, bronchial asthma). Seasonality of the disease is less pronounced in countries of the tropical and subtropical climate.

The main symptoms are intense itch of the eyes, which can be accompanied by lacrimation, photophobia, sensation of foreign body and burning, there are also abundant mucous discharge and ptosis.

Spring catarrh begins with a slight itch in the eyes, which, progressively increasing, becomes intolerable. The child constantly rubs his eyes with his hands, which makes the itching worse. It is characteristic that the itching intensifies toward evening. The dream is broken, the child becomes irritable, disobedient, which causes parents to turn to the psychoneurologist. The use of sleeping pills, sedatives is ineffective: they often wake up the course of the disease, complicating its drug allergy.

An excruciating itching accompanied by a filiform discharge. Thick white peaches of the mucous discharge can form spiraling clusters under the upper eyelid, which causes particular concern to patients, increasing itching. The threads are removed with a cotton swab, not always easy due to their stickiness, but without disturbing the integrity of the mucosal epithelium. Photophobia, lacrimation, blepharospasm, and visual impairment are associated with corneal involvement. Usually both eyes are equally affected. With unilateral damage, especially in young children, there is a torticollis requiring long-term treatment.

Symptoms of spring catarrh are so typical that with a pronounced form the diagnosis does not present difficulties. Only old forms of the disease are differentiated with trachoma, allergic conjunctivitis by medication, follicular conjunctivitis, sometimes with flicktupule keratoconjunctivitis.

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There are three main forms of spring catarrh:

• palpebral, or tarsal;
• limbal, or tabloid;
• mixed.

The tarsal form of spring catarrh is characterized by the formation within the upper eyelid of papillary growths in the form of a cobblestone pavement. Papillae are pale pink in color, flat, sometimes large in size. A typical filamentary viscous discharge. In the initial stages before the appearance of the papillae the conjunctiva is thickened, matte (milky).

Spring limb, or bulbar form of spring catarrh, is characterized by changes in the prelimbial conjunctiva of the eyeball and the limb itself. More often in the field of the eye slit there is a proliferation of tissue of yellow-gray or pinkish-gray color, which has a gelatinous appearance. Framing the limb, this fabric rises above it with a dense roller, sometimes cystically altered. In cases of severe foci and flat lesions, as well as possible pigmentation of newly formed tissue, nevus of the limbal conjunctiva is often suspected.

A severe impression is made by a patient with a ring-shaped lesion of the prelimbial conjunctiva and a pronounced infection of the surrounding conjunctiva. However, even in these cases, the conjunctiva of the upper eyelid, as a rule, is slightly altered, the cornea remains transparent, so the visual acuity does not decrease. Newly formed tissue can grow on the limbus and on the cornea. Its surface is uneven, shiny with protruding white dots and Tratas spots, consisting of eosinophils and degenerated epithelial cells. Depressions in the limbus, sometimes called the trenches of Tranas, indicate a regression of the disease.

The defeat of the cornea in spring catarrh often develops with severe tarsal changes and usually leads to visual impairment. Following the expansion of the upper limb, micropanthus can develop, finding on the cornea no more than 3-4 mm. Sometimes, on the upper limb, there is a pronounced dryness of the cornea with a dry patina of paraffin, closely adherent to the underlying corneal epithelium. With superficial punctate keratitis, the upper third of the cornea is also affected.

Epitheliopathy of the cornea is expressed in the appearance of point, sometimes larger areas of light staining of the cornea with fyuorescein. Slightly delimited large areas of corneal erosions are found less often, usually in the paracentral area. The bottom of erosion is clean, the defect of the epithelium is quickly restored during treatment.

In the case of infiltration, a flat surface corneal ulcer can form for the erosive surface.

With the long-term existence of erosion, its surface can be covered with a dry film, the edges of which slightly lag behind the underlying corneal tissue and are easily broken off if they are pinched by a scalpel. In the center the film is tightly welded to the cornea, and it can be removed only with great effort.

Stromal infiltrates, purulent corneal ulcers in spring catarrh are observed in cases of secondary infection or complications when taking medications.

With easy flow, instillations of alomide and (or) lekrolina are made 3 times a day for 3-4 weeks. In severe cases, use spersallerg or allergic phthalate 2 times a day. When treating spring catarrh it is necessary to combine anti-allergic drops with corticosteroids: instillation of eye drops of dexanos, maxidex or otan-dexamethasone 2-3 times a day for 3-4 weeks. In addition, antitistamine drugs (diazolin, suprastin or claritin) are administered internally for 10 days. With the ulcer of the cornea, reparative agents are used (eye drops Vitasik, taufon or gel solkoseril, root gel) 2 times a day until the cornea improves. With a long, stubborn flow of spring catarrh, a course of treatment with histoglobulin (4-10 injections) is performed.