In 2013, the Russian Association of Allergologists and Clinical Immunologists announced disappointing data. According to foreign epidemiological studies, from 15 to 40% of adults on Earth constantly or occasionally experience manifestations of allergic eye diseases. Over the past years, their prevalence has not decreased, but only increased, especially among children. Symptoms of allergic conjunctivitis, the principles of its detection and treatment are discussed in the proposed material.
Material Content:
Causes of the development of allergic conjunctivitis
Conjunctivitis is an inflammatory process that develops in the thin mucous membrane lining the eyelids from the inside and the eyeball from the outside. If such inflammation is caused by an allergic reaction, conjunctivitis is called allergic.
Any allergy, including ocular, is an inadequate, hypertrophied response of the immune system to a specific protein or external effect.
Read also: cold allergy
Most often, the provocateurs of allergic conjunctivitis are:
- pollen of flowering plants;
- dust mites;
- smoke and other air pollution;
- fungal spores;
- skin excreta, saliva and animal hair;
- Perfumes and cosmetics;
- eye drops and solutions for contact lenses.
A person whose body demonstrates hypersensitivity to these stimuli is called sensitized. His immune cells, when faced with an allergen, trigger a complex cascade of molecular reactions. Histamine, cytokines, prostaglandins, platelet activation factor are sequentially released.As a result, inflammation develops.
Types of disease
Depending on the nature of the course and etiology, allergic conjunctivitis is divided into two large groups - seasonal and year-round:
| Indicator | Seasonal conjunctivitis | Year-round conjunctivitis |
|---|---|---|
| Seasonality | Pronounced. It occurs in spring or summer. In hot sunny or windy weather, the manifestations intensify. | Not expressed. Symptoms occur regardless of the time of year, more often indoors. Manifestations intensify in winter and autumn, when there is no airing. |
| Etiology | It develops in close connection with the spread of plant pollen (spring pollinic conjunctivitis) and fungal spores. | It develops in contact with household allergens, pharmaceuticals and cosmetics, pets. |
| Nature of the current | More often sharp. | More often chronic. If caused by cosmetics or pharmaceuticals - acute. |
Sometimes not only the conjunctiva is involved in the inflammatory process, but also the cornea underlying it. In this case, they talk about the development of allergic keratoconjunctivitis. If sensitization is the result of a bacterial infection of the eye, a separate diagnosis is made - conflict of keratoconjunctivitis or conflict.
Symptoms of Allergic Conjunctivitis
Common external signs of both seasonal and year-round conjunctivitis are redness and debilitating itching of the eyes. Usually both eyes are affected at the same time.
However, the remaining symptoms and indicators may vary slightly:
| Indicator | Seasonal conjunctivitis | Year-round conjunctivitis |
|---|---|---|
| The presence of detachable secretions | Profuse lacrimation. | Lean sticky discharge. |
| Ophthalmoscopy | Strong swelling and loosening of the conjunctiva, angioedema of the eyelids, sometimes with a transition to the face. | Moderate swelling and friability of the conjunctiva, angioedema of the eyelids. |
From contact with an allergen to the onset of symptoms, it usually does not take long. The first signs may appear in a few minutes.
Often intolerable itching causes the patient to rub his eyes with his hands, which can lead to infection. In this case, purulent discharge accumulating in the inner corner of the eye is added to the indicated manifestations.
In severe cases of the disease, pain and pain in the eyes, a feeling of dryness, sand under the eyelids are observed. Photophobia sometimes develops.
Allergic keratoconjunctivitis has its own characteristics. It is accompanied by the appearance of yellowish-white nodules, the so-called "grains of Transas".
How to accurately diagnose?
An exact diagnosis of the disease is made jointly by two doctors - an allergist and an ophthalmologist. Before treating allergic conjunctivitis, an ophthalmologist must exclude other eye diseases: conjunctivitis in systemic, infectious and autoimmune diseases, uveitis, blepharoconjunctivitis, glaucoma.
If you suspect the allergic nature of conjunctivitis, the following tests are primarily prescribed:
- blood analysis;
- study of lacrimal fluid for eosinophils;
- sowing the separated secretions on the microflora.
If the symptoms are mild, it is advisable to prescribe a test for iron (Demodex) - a microscopic ciliary mite. To do this, scraping is taken from the edge of the eyelids.
After differential diagnosis and diagnosis of "allergic conjunctivitis", the patient goes to the allergist, who must find the cause of the disease.
This can be done using three types of test:
| Type of test | Description | Contraindications |
|---|---|---|
| Skin (scarification) test | The old method with high diagnostic efficiency. Scratch marks are made on the skin of the back or forearm, on which solutions of various allergens are applied. According to the skin reaction, the doctor concludes that there is an allergy to any substance. The test allows you to get accurate information in 15-30 minutes. | • children under 4 years old; •pregnancy; •lactation; • stage of exacerbation of allergies; •tuberculosis; •oncological diseases; • skin diseases. |
| IgE blood test | The safest way to diagnose. Blood is drawn from a vein in the morning on an empty stomach, and further studies are carried out in the laboratory without the participation of the patient. The disadvantages of the method are the high price and a large percentage of false results (up to 20%). | There are no contraindications. |
| Provocative test | The essence of the method is the direct exposure to a target organ with an allergen solution. The solution is instilled into one eye and the conjunctiva reaction is monitored for 10-20 minutes. The minus of the method is the frequent development of complications, up to anaphylactic shock. | • contact dermatitis of the eyelids; • blepharitis; • episcleritis; • children's age up to 5 years; • stage of exacerbation of allergies or chronic diseases; • acute respiratory infections; •tuberculosis; • pregnancy and lactation; • blood diseases. |
Skin tests and provocative tests are done only during the period of remission of the disease. A blood test for IgE is given at any time, regardless of the presence of an exacerbation. However, it may require additional research.
Allergic conjunctivitis treatment
After identifying a provoking allergen, treatment for allergic conjunctivitis is prescribed. Basically, it is performed on an outpatient basis. Hospitalization is indicated only with a complicated form of the disease, threatening loss of vision.
In adults
Competent treatment of the disease should go in three directions: elimination measures (exclusion of contact with an allergen), local drug therapy, immunotherapy.
Drug treatment includes the appointment of a complex of several groups of drugs:
| Group | Preparations | Treatment regimen | Contraindications |
|---|---|---|---|
| Histamine receptor blockers | Azelastine "Opatanol" | 1 drop in the eye 2 times a day 1 drop in the eye 2 times a day | Hypersensitivity, pregnancy, lactation. |
| Cromoglicic acid preparations | Cromohexal Optikrom | 2 drops in the eye 4 times a day 1-2 drops in the eye 4 times a day | Hypersensitivity, pregnancy, lactation. |
| Corticosteroids | Hydrocortisone | Lay a strip of ointment for the lower eyelid 3 times a day. | Hypersensitivity, eye infections, corneal epithelium defects, primary glaucoma. |
| Moisturizing solutions (tear substitutes) | Oksial | 1-2 drops in the eye 1-3 times a day | Hypersensitivity. |
Sometimes it is advisable to simultaneously administer antihistamines not only in the form of drops, but also tablet preparations. At the same time, it makes sense to give preference to new generation medicines with a high safety profile - for example, Xisal. The standard regimen is 1 tablet 1 time per day. Contraindications - hypersensitivity, pregnancy, lactation, renal failure.
Along with drug therapy, it is necessary to take measures to stabilize the immune system.
Promising in this regard is the appointment of an allergen - specific immunotherapy.
The bottom line is the repeated administration of small doses of the allergen with a gradual increase in dosage. Over time, addiction develops, and the symptoms are minimized, or disappear.
In children
Allergic conjunctivitis in a child begins to manifest itself, usually at the age of 3-4 years or later. At risk are children with burdened heredity, whose family has patients with any form of allergy.
The principles of treatment of children do not have any significant features. Doctors prescribe antihistamine drops for allergic conjunctivitis, tear substitutes, and cromoglicic acid preparations. The only important difference is a more careful approach to prescribing corticosteroids.
If the child’s disease often recurs, a doctor may prescribe a course of “Histaglobulin” injections. The specific dosage and number of injections are calculated based on the condition of the baby and his body weight.
It is strictly unacceptable to use folk remedies in the treatment of allergic conjunctivitis in children.
The only thing that can be allowed is cool compresses on the eyes dipped in clean water. All kinds of instillations of honey solutions, rinsing with aloe vera or milk lead to the development of serious complications, infections and even loss of vision.
Possible complications
With timely treatment, and strict control, allergic conjunctivitis has a favorable prognosis. Despite the fact that the disease is chronic, it can be safely managed without a significant loss in the quality of life.
However, in advanced cases or with inappropriate use of drugs, complications may develop:
- accession of a viral or bacterial infection;
- conjunctival atrophy;
- corneal ulcers;
- dry eye syndrome;
- blepharitis;
- clouding of the lens;
- retinal disinsertion.
In this regard, preventive measures aimed at preventing the development of the disease are of particular importance.
Disease prevention
Allergies often seem unavoidable. However, according to the clinical recommendations of the Association of Allergologists and Immunologists, the prevention of allergic lesions of the conjunctiva is quite real. For this, complexes of both primary and secondary measures have been developed.
Primary prevention is a warning of the development of allergic conjunctivitis in previously not ill people.
It is as follows:
- proper nutrition during pregnancy, strict adherence to medical recommendations and regimen;
- ensuring the longest period of breastfeeding and the competent selection of breast-milk substitutes;
- complete rejection of active and passive smoking;
- preventing unsystematic administration of pharmaceuticals and eye drops;
- observance of visual hygiene: protection of eyes from dirt, poor-quality cosmetics, excessively bright light, injuries, chemical or thermal burns, overwork, proper use of contact lenses;
- Compliance with home hygiene: wet cleaning, washing clothes and soft toys at a temperature of at least 600 ° C, rejection of carpets, regular airing.
Secondary prevention measures are aimed at preventing exacerbations of conjunctivitis in allergy sufferers:
- identification of the spectrum of allergens that provoke inflammation of the conjunctiva;
- for those allergic to pollen, refusal to take medicine on plant materials, phytocosmetics, closing windows during the peak of flowering plants, wearing sunglasses, refusing to take summer walks in hot or windy weather, or bathing in open waters;
- for those who are allergic to medicines - refusal to use drugs with an active substance that causes a reaction;
- for those suffering from sensitivity to household allergens - adequate room ventilation, daily wet cleaning, the use of vacuum cleaners, linen change 2 times a week, the use of dust covers, hypoallergenic fabrics;
- for those allergic to pets - refusal to keep them in the house, visiting circuses, zoos, buying fur coats and woolen things;
- careful use of cosmetics and perfumes, means for flavoring bed linen, clothes and premises;
- exclusion of active and passive smoking;
- observance of hygiene of sight;
- regular medical examination and compliance with the recommendations of the attending physician;
- training in allergy schools.
All patients with allergic conjunctivitis should receive a "Passport of the patient with an allergic disease" in the form No. 135 / у.
This document makes sense to always keep with you, especially on long trips.
Compliance with preventive measures will avoid both the development of allergic conjunctivitis and its unpleasant consequences.
