Allergic conjunctivitis – the jet inflammation of a conjunctiva caused by immune reactions in response to contact with allergen. At allergic conjunctivitis hyperaemia and hypostasis mucous eyes, an itch and puffiness a century, dacryagogue, a photophobia develop. Diagnostics is based on collecting the allergologichesky anamnesis, carrying out skin tests, provocative allergic tests (conjunctival, nasal, hypoglossal), laboratory researches. In treatment of allergic conjunctivitis antihistaminic medicines (inside and locally), topichesky corticosteroids, a specific immunotherapy are applied.
Allergic conjunctivitis occurs approximately at 15% of the population and is a significant problem of modern allergology and ophthalmology. Allergic damage of an organ of vision in 90% of cases is followed by development of conjunctivitis, is more rare – an allergic blefarit, dermatitis a century, an allergic keratit, a uveit, Irit, a retinit, neuritis. Allergic conjunctivitis occurs at persons of both floors, mainly young age. Allergic conjunctivitis is often combined with other allergoza - allergic rhinitis, bronchial asthma, atopic dermatitis.
Classification of allergic conjunctivitis
Allergic damages of eyes can proceed in the form of polynosic conjunctivitis, a spring keratokonjyunktivit, krupnopapillyarny conjunctivitis, medicinal conjunctivitis, chronic allergic conjunctivitis, an atopic keratokonjyunktivit.
On a current allergic conjunctivitis can be sharp, subsharp or chronic; on emergence time – seasonal or year-round.
The IgE-mediated hypersensitivity reaction is the cornerstone of pathogenesis of allergic conjunctivitis. As a starting factor of allergic conjunctivitis serves the direct contact of allergen with a conjunctiva leading to degranulation of corpulent cages, activation of lymphocytes and eosinophils and the clinical answer with the subsequent inflammatory and allergic reaction. The mediators released by corpulent cages (a histamine, serotonin, leykotriyena, etc.) cause development of characteristic symptoms of allergic conjunctivitis.
Weight of a course of allergic conjunctivitis depends on concentration of allergen and reactivity of an organism. Speed of development of reaction of hypersensitivity at allergic conjunctivitis can be immediate (within 30 minutes from the moment of contact with allergen) and slowed down (in 24-48 and more hours). Such classification of allergic conjunctivitis is almost significant for the choice of medicamentous therapy.
Reasons of allergic conjunctivitis
The general in an etiology of all forms of allergic conjunctivitis is hypersensibility to different factors of the environment. Owing to features of an anatomic structure and arrangement of an eye are most subject to contact with exogenous allergens.
Polynosic conjunctivitis (hay fever, pollen allergy) - the seasonal allergic conjunctivitis caused by pollen allergens during blossoming of herbs, trees, cereals. The exacerbation of polynosic conjunctivitis is connected with the period of blossoming of plants in this or that region. Seasonal allergic conjunctivitis at 7% of patients becomes aggravated in the spring (at the end of April - the end of May), at 75% - in the summer (at the beginning of June – the end of July), at 6,3% - in off-season (at the end of July – the middle of September) that respectively coincides with pollination of trees, meadow herbs and weeds.
The etiology of spring conjunctivitis is studied a little. The disease becomes aggravated in the spring - at the beginning of summer and regresses in the fall. This form of allergic conjunctivitis usually passes spontaneously during the pubertatny period that allows to assume a certain role of an endocrine factor in its development.
The main factor of development of krupnopapillyarny conjunctivitis carrying contact lenses and eye artificial limbs, long contact mucous with a foreign matter of an eye, existence of the seams irritating a conjunctiva after extraction of a cataract or a keratoplasty, adjournment of calcium in a cornea etc. is considered. At this form of allergic conjunctivitis inflammatory reaction is followed by education on mucous an upper eyelid of the large flattened nipples.
Medicinal conjunctivitis develops as local allergic reaction in response to topichesky (90,1%), use of medicines is more rare system (9,9%). Developing of medicinal allergic conjunctivitis is promoted by self-treatment, individual intolerance of components of medicine, polytherapy - a combination of several medicines without their interaction. Most often leads use of antibacterial and antiviral eye drops and ointments to medicinal allergic conjunctivitis.
Chronic allergic conjunctivitis makes more than 23% of cases of all allergic diseases of eyes. At the minimum clinical manifestations the course of chronic allergic conjunctivitis differs in persistent character. As direct allergens in this case house dust, hair of animals, a dry feed for fishes, a feather, down, foodstuff, perfumery, cosmetics and household chemicals usually act. Chronic allergic conjunctivitis is often associated with eczema and bronchial asthma.
Atopic keratokonjyunktivit is an allergic disease of a multifactorial etiology. Usually develops at system immunological reactions therefore often proceeds against the background of atopic dermatitis, asthma, hay fever, a small tortoiseshell.
Symptoms of allergic conjunctivitis
At allergic conjunctivitis both eyes, as a rule, are surprised. Symptoms of allergic conjunctivitis develop in terms from several minutes to 1-2 days from the allergen influence moment. Allergic conjunctivitis is characterized by a severe itch of eyes, burning under centuries, dacryagogue, puffiness and hyperaemia of a conjunctiva; at a heavy current – development of a photophobia, blefarospazm, ptoz.
The itch at allergic conjunctivitis is expressed so intensively that forces the patient to pound constantly eyes that, in turn, even more strengthens other clinical manifestations. On mucous small nipples or follicles can be formed. Separated from eyes at allergic conjunctivitis usually mucous, transparent, sometimes – viscous, threadlike. At stratification of an infection in corners of eyes the purulent secret appears.
At some forms of allergic conjunctivitis (a spring and atopic keratokonjyunktivit) there is a defeat of a cornea. At a medicinal allergy damages of skin the century, corneas, retinas, a vascular cover, an optic nerve can be observed. Sharp medicinal conjunctivitis is sometimes aggravated with anaphylactic shock, Quincke's hypostasis, a sharp small tortoiseshell, a system kapillyarotoksikoz.
At chronic allergic conjunctivitis the symptomatology is expressed poorly: complaints to a periodic itch a century, burning of eyes, reddening a century, dacryagogue, moderate quantity of separated are characteristic. Speak about chronic allergic conjunctivitis if the disease lasts 6-12 months.
Diagnosis of allergic conjunctivitis
In diagnostics and treatment of allergic conjunctivitis the coordinated interaction of the ophthalmologist and allergist-immunologist is important. If in the anamnesis accurate connection of conjunctivitis with influence of external allergen is traced, the diagnosis, as a rule, does not raise doubts.
Ophthalmologic survey reveals changes of a conjunctiva (hypostasis, hyperaemia, a giperplaziya of nipples etc.). The microscopic research of conjunctival scrape at allergic conjunctivitis allows to find eosinophils (from 10% and above). In blood more than 100-150 ME are typical increase in IgE.
For establishment of the reason of allergic conjunctivitis tests are carried out: eliminative when against the background of clinical manifestations the contact with estimated allergen, and the exposition, consisting in repeated influence by this allergen after subsiding symptoms is excluded.
After subsiding of sharp allergic displays of conjunctivitis carry out skin and allergic tests (application, skarifikatsionny, elektroforezny, the prik-test). During remission resort to conducting provocative tests - conjunctival, hypoglossal and nasal.
At chronic allergic conjunctivitis the research of eyelashes on is shown. At suspicion on infectious damage of eyes the bacteriological research of dab from a conjunctiva on microflora is conducted.
Treatment of allergic conjunctivitis
Treat the basic principles of treatment of allergic conjunctivitis: elimination (exception) of allergen, performing the local and system desensibilizing therapy, symptomatic medicinal therapy, a specific immunotherapy, prevention of secondary infections and complications. At krupnopapillyarny conjunctivitis the termination of carrying contact lenses, eye artificial limbs, removal of postoperative seams or removal of a foreign matter is necessary.
At allergic conjunctivitis reception of antihistaminic medicines inside (, , etc.) and application of antiallergic eye drops (, , ) 2-4 times a day are appointed. Local use in the form of drops of derivatives of kromoglitsiyevy acid (stabilizers of corpulent cages) is also shown. At development of a syndrome of a dry eye slezozamenitel are appointed; at defeat of a cornea - eye drops with dekspantenoly and vitamins.
Severe forms of allergic conjunctivitis can demand purpose of topichesky corticosteroids (eye drops or ointments with dexamethasone, a hydrocortisone), topichesky NPVP (eye drops with diclofenac). Persistently recurrent allergic conjunctivitis is the basis for carrying out a specific immunotherapy.
Forecast and prevention of allergic conjunctivitis
In most cases, at establishment and elimination of allergen, the forecast of allergic conjunctivitis favorable. In the absence of treatment accession of an infection with development of a secondary herpetic or bacterial keratit, decrease in visual acuity is possible.
For the purpose of prevention of allergic conjunctivitis whenever possible it is necessary to exclude contact with the known allergens. At seasonal forms of allergic conjunctivitis carrying out preventive courses of the desensibilizing therapy is necessary. The patients having allergic conjunctivitis have to be observed at the ophthalmologist and the allergist.