How to treat allergic conjunctivitis in children: a review of medications. Allergic conjunctivitis: symptoms and treatment with drugs Allergic conjunctivitis how to treat

Allergic conjunctivitis is an inflammation of the conjunctiva (the outer transparent mucous membrane of the eye) caused by an allergic reaction of the body (immune response to a foreign substance - allergen).

Young people, regardless of gender, are much more likely to suffer from this disease. There are no exact statistical data, since in most cases such conjunctivitis accompanies other manifestations of allergies.

According to studies, symptoms of conjunctivitis occur in approximately 20-40 percent of people with other allergic pathologies.

Causes

The basis of this pathology is the mechanism of immediate hypersensitivity. That is, the symptoms of allergic conjunctivitis occur immediately after contact with substances that cause allergies. The anatomical features of the eye are such that allergens easily penetrate the mucous membranes, causing an inflammatory process there.

There are three groups of the most common substances that can provoke the development of allergic conjunctivitis:

household, such as house and library dust, house dust mites, feathers from pillows;
epidermal, for example, animal hair, bird feathers, animal dander, fish food, etc.
pollenaceae, pollen from various plants.

When an allergen gets into the eyes, an inflammatory reaction immediately develops. Severe itching, lacrimation, redness of the conjunctiva and swelling occur. In some cases, photophobia may also develop.

The danger of allergic conjunctivitis is that in the absence of adequate treatment, an infection can join the allergy. If there is an infection, pus may drain from the corner of the eye.

Symptoms

When allergic conjunctivitis occurs, symptoms can appear at different speeds, either a few minutes after contact with the allergen or a day later.

In most cases, the reaction occurs in both eyes. Allergic conjunctivitis in one eye is considered atypical, although this manifestation also occurs. One eye may be affected if, for example, the allergen was brought into it by hand.

The main symptoms of allergic type conjunctivitis;

redness of the eyes.
severe or tolerable persistent itching.
copious and uncontrollable tearing.
a burning sensation in the eyes.
clear or white discharge, which thickens over time and greatly bothers the patient.
photophobia.
blurred picture perceived by vision.

If the disease is severe, photophobia may develop. Allergic conjunctivitis in children is accompanied by the same symptoms as in adults. Moreover, as a rule, the above ocular manifestations are combined with nasal ones, and the development of ocular allergies is accompanied by the development of rhinoconjunctivitis in 85% of cases. Often, the ocular symptoms of this pathological condition bother older patients and children much more than the nasal ones.

Chronic form

If allergic conjunctivitis lasts from six months to a year, then we are talking about a chronic form of the disease. In this case, clinical manifestations are minimal, but are persistent.

As a rule, chronic conjunctivitis associated with allergic reactions is accompanied by bronchial asthma and eczema.

Allergic conjunctivitis in children

Allergic conjunctivitis in children at an early age occurs quite rarely. Usually the disease is accompanied by allergic rhinitis. Children who suffer from AK often experience other manifestations of allergies (diathesis, atopic dermatitis).

It is in children that food allergies are often triggered. After confirming the diagnosis, it is possible to carry out allergen-specific therapy, which is most effective at an early age.

We offer detailed photos for viewing to find out what this disease looks like.

Prevention

Unfortunately, specific prophylaxis to prevent the development of allergic conjunctivitis has not been developed due to the fact that there is not yet a unified theory of why allergies as such develop.

Methods of secondary prevention, aimed at preventing exacerbations of an existing disease, come down to eliminating the allergen from the environment (see Diet and lifestyle features for allergic conjunctivitis) and providing adequate treatment.

Treatment of allergic conjunctivitis

When allergic conjunctivitis is diagnosed, treatment should be carried out in three directions at once:

immediate cessation of contact with the allergen;
local therapy with antihistamines, and in severe cases, corticosteroids;
immunotherapy.

In mild cases, only local treatment is prescribed, and in severe cases, complex therapy is necessary. The doctor can also prescribe specific immunotherapy and symptomatic drug therapy; in case of a protracted process, antimicrobial agents are prescribed prophylactically.

Approximate treatment regimen for allergic conjunctivitis:

Oral administration is indicated - Loratadine, Cetrin, Telfast. They allow you to block the action of histamine and some other inflammatory mediators, which prevents the manifestation of allergy symptoms.
Application – Lecrolin, Opatanol, Histimet. They need to be instilled into the eyes up to four times a day, but this ensures a quick effect and delivery of the drug to the target organ.
It is advisable to use eye drops mast cell stabilizers. Among such drops we can highlight: High-Krom (not for children under 4 years old), CromoHexal, Lecrolin, Krom-Allerg, Lodoxamide.
Some people can develop dry eye syndrome when, for physiological reasons, tear production is reduced or stops altogether. In this case, with allergic conjunctivitis, treatment is indicated with tear substitutes - Inoxa, Oksial, Vidisik, Oftogel, Visin, Systane.

Severe forms of allergic conjunctivitis may require the use of topical corticosteroids (eye drops or ointments with dexamethasone, hydrocortisone), topical NSAIDs (eye drops with diclofenac). Persistently recurrent allergic conjunctivitis is the basis for specific immunotherapy.

It is worth noting that the use of traditional methods for the treatment of allergic conjunctivitis is not recommended due to the fact that this may worsen the situation.

Treatment methods for seasonal allergic conjunctivitis

Often this form of allergy is acute, there is a strong burning sensation in the eyes, the person is afraid of light, he is bothered by severe itching, and the production of tears increases. The following measures need to be taken:

If you drop Spersallerg into your eyes, after a while you can feel how it becomes easier; the drops contain a vasoconstrictor.
When an allergic reaction just begins, it is necessary to take special antihistamine tablets orally.
In cases of chronic conjunctivitis of an allergic nature, it is necessary to instill Alomide and Cromohexal into the eyes.

The general allergization of the population of Russia, and not only our country, is frightening with its aggressive spread. Nowadays, it is difficult to find a person who has not at least once experienced some kind of allergic reaction - food, dust, allergies to animal fur, to flowering plants, medicines, household and cosmetic-perfume chemicals, to alcohol, the sun and even cold .

Allergies can also manifest themselves on a person’s skin, and affect the functions of the respiratory system, the digestive tract, manifest as a runny nose and allergic conjunctivitis. Treatment of allergies is a very difficult task, since the mechanism of allergy occurrence is complex, medicine cannot yet correct the changes that have occurred in the immune system, but can only alleviate its symptoms.

So, how to treat allergic conjunctivitis?

Symptoms of allergic conjunctivitis in children

Upon contact with an allergen, the severity of the symptoms of allergic conjunctivitis directly depends on the concentration of the allergen and on the body's reaction. Therefore, the reaction can be immediate - within half an hour or delayed for 1-2 days.

Most often, allergic conjunctivitis occurs in conjunction with, that is, a runny nose, sneezing complements eye irritation.
Excessive lacrimation, burning in the eyes, under the eyelids, and itching appear.
Children constantly scratch their eyes, which provokes a secondary infection, so ophthalmologists often recommend antimicrobial ointments and drops for long-term allergic conjunctivitis in children.
The itching can be so intense that it forces a child or adult to endlessly rub their eyes.
Small follicles or papillae may appear on the mucous membrane of the eye.
Discharge from the eyes is most often transparent, mucous, less often thread-like, viscous.
When a secondary infection occurs, purulent discharge is found in the corners of the eyes, especially after sleep.
The child also complains of dryness of the mucous membranes of the eyes, a feeling of sand in the eyes, and photophobia appears.
Since tear production decreases and the conjunctiva atrophies (especially in adults and elderly people), pain and cutting discomfort occur when moving the eyes.
Sometimes in children, on the contrary, an increase in the production of tear secretion occurs, usually at the very beginning of the disease.
Children and adults experience eye fatigue.

At year-round allergic conjunctivitis, a child or adult constantly encounters an allergen, most often it is household chemicals, house dust (see) or the hair of pets - cats, dogs, rabbits, rodents, parrot feathers.
At periodic, seasonal allergic conjunctivitis, symptoms appear only at certain times - periods of flowering plants.
At contact conjunctivitis, the development of the disease is provoked by solutions for contact lenses, as well as the use of creams, ointments, and cosmetics by girls and women.

Before starting specific treatment, you should definitely establish the allergen, This is not always an easy task. And often, only one ophthalmologist cannot help the patient, so you should also contact a dermatologist and allergist to determine the allergen that caused the body’s inadequate reaction.

The table below presents the types of allergic conjunctivitis, symptoms characteristic of each type, and the age category of patients susceptible to conjunctivitis.

Types of allergic conjunctivitis	Seasonality of changes	Age	Itchy eyes	Inflammation of the eyelids, corneas	Discharge from the eyes	Tearing
Allergic conjunctivitis - hay fever, chronic (if it lasts a year, six months)	Seasonal disease, often accompanied by an allergic runny nose when weeds, flowers, and trees bloom	any age	strong	No	mucous discharge	there is also significant
Drug	No	any age	There is	eyelid skin, cornea, choroid, retina, optic nerve	There is	There is
Vernal keratoconjunctivitis	exacerbation in summer and spring	more often after 14 years of age, but also occurs in children from 3 years of age	There is	the cornea is affected	viscous discharge, viscous	may be absent or may be intense
Atopic keratoconjunctivitis	No	over 40 years old	There is	There is	various	+-

Treatment of allergic conjunctivitis

As we have already said, the most accurate and reliable way to treat allergic conjunctivitis is to exclude the allergen, which, unfortunately, is not always possible. Further, local (in mild cases) and systemic antihistamine therapy can be used; the doctor can also prescribe specific immunotherapy and symptomatic drug therapy; in case of a protracted process, antimicrobial agents are prescribed prophylactically.

Tablets and drops for allergic conjunctivitis

For allergic conjunctivitis, oral antihistamines are prescribed - Loratadine, Claritin, Zyrtec, Telfast. Not all antihistamines can be taken by children -
Drops from the group of membrane stabilizing agents - Lecrolin (Cromohexal), Zaditen (ketotifen), prices for
Drops from the group of histamine receptor blockers - Opatanol, Histimet (not for children under 12 years old), Allergodil (Azelastine), Visin Alerzhdi.
It is necessary to use eye drops for allergic conjunctivitis, mast cell stabilizers, these are derivatives of cromoglycic acid, they help block the production of histamine, among such drops for allergic conjunctivitis we can highlight - High-Krom (children under 4 years old are not allowed) CromoHexal, Lecrolin, Krom-Allerg, Lodoxamide (Alomid, not for children under 2 years of age)
Older people may develop dry eye syndrome, when, for physiological reasons, tear production is reduced or stops altogether. In this case, with allergic conjunctivitis, treatment is indicated with tear substitutes - Hyphenate (40 rubles), Inoxa, Oksial, Oftolik, Vidisik, Oftogel, Visin pure tear, Systane, natural tear. If the cornea is also involved in the process of inflammation, then eye drops with vitamins are prescribed - Katachrom, Taufon, Emoxipin, Quinax, Catalin, Vita-Iodurol, Khrustalin, Ujala, as well as dexpanthenol.
For very severe forms of allergic conjunctivitis, the doctor may prescribe corticosteroid eye drops or ointments containing dexamethasone or hydrocortisone. Such treatment should always be avoided, since hormone therapy is the last, last resort when there are no other treatment options. You should always be very careful when treating with corticosteroid hormonal drugs, follow the dosage and course of treatment prescribed by your doctor, and discontinuation of the drug should be gradual.
The doctor may also prescribe topical non-steroidal anti-inflammatory drugs -.
If the patient experiences constant relapses of allergic conjunctivitis, the doctor may consider options for specific immunotherapy.

Treatment of seasonal conjunctivitis - hay fever

It is unrealistic to avoid the flowering of weeds, cereal plants, and almost all trees; therefore, in both children and adults, hay fever most often begins acutely with burning, photophobia, itching and lacrimation. What to do to treat allergic conjunctivitis? Treatment is as follows:

Instillation of Allergodil and Spersallerg eye drops. Within 15 minutes, relief of symptoms occurs, especially with Spersallerg, since it also contains a vasoconstrictor.
At the beginning of allergies, drip 3-4 times a day, then 2 times a day. If the allergy is very severe, oral antihistamine tablets may be used.
For such subacute or chronic conjunctivitis, the doctor also prescribes drops for allergic conjunctivitis, such as Cromohexal and Alomide 3-4 times a day.
Vasoconstrictor drops - Visin alert,

Treatment of chronic allergic conjunctivitis

This is the most common variant of the development of conjunctivitis, because if the patient has a tendency to allergic reactions, he will find “his allergen” everywhere. In a chronic process, the symptoms are not so pronounced, but burning and itching of the eyelids and tearing are also observed.

Usually the causes are food allergies, pollen, animal dander, fish food, medications and chemicals in household and cosmetic products.
The doctor may prescribe Alomid drops, Cromohexal 2-3 times a day, as well as Spersallerg 1-2 times a day, drops with dexamethasone.

Treatment of vernal keratoconjunctivitis

Most often, this disease occurs in children 3-7 years old, it occurs more often in boys, the course of conjunctivitis is chronic, affecting both eyes. A distinctive feature is the papillary growth of the eyelid cartilage on the conjunctiva of the eye. Most often, the papillae are small, but they can also be large, leading to deformation of the eyelid. Symptoms of allergic keratoconjunctivitis intensify in the spring and become dull in the fall.

Standard drops for allergic conjunctivitis - Cromohexal and Alomide - effectively help, but doctors sometimes prescribe them together with dexamethasone - Maxidex.
If corneal changes appear - erosions, epitheliopathy, infiltrates, keratitis, then Alomide should be used 2-3 times a day by instillation.
For acute allergic manifestations, Allergodil can be used 2 times a day simultaneously with Maxidex drops.
For a complex systemic effect, you can use oral antihistamines - Cetrin, Claritin, Zodak, etc., as well as immunotherapy in the form of a course of 6-10 injections of histoglobulin.

Treatment of allergic reactions in infectious conjunctivitis

Numerous studies by ophthalmologists claim that with any infectious and viral conjunctivitis - herpetic, adenoviral, chlamydial, fungal, acute bacterial, allergies manifest themselves in the clinical picture of any of these diseases. Moreover, it is believed that all chronic conjunctivitis is allergic in nature.

For any bacterial or viral conjunctivitis, therapy with a mass of antibiotics, antiseptics, and antiviral agents creates a powerful toxic background in the conjunctiva and in the body as a whole.
Therefore, any antibacterial therapy for infectious or other conjunctivitis - adenoviral, chlamydial, herpetic - should be supplemented with antihistamine eye drops.
For acute infectious conjunctivitis - Allergodil and Spersallerg 2-3 times a day, for chronic conjunctivitis Alomide or Cromohexal 2 times a day.

Treatment of drug-induced allergic conjunctivitis

Often, all the drugs that a person uses to treat a lot of diseases are essentially foreign, hostile agents for the immune system and its natural reaction is justified. In 30% of all allergic conjunctivitis, the cause is the use of various medications. Even with topical use of creams, ointments, gels, and even more so with internal use, the development of allergic conjunctivitis is possible.

Allergies can be caused by eye drops and ointments themselves, and not only by the conjunctiva, but also by the cornea and eyelid skin. An allergy also develops to a preservative included in eye drops, and it can appear only after 2-4 weeks when using provocative medications.
This condition should be treated with the initial elimination of the provoking drug. Urgently prescribe an oral antihistamine - Cetrin, Loratadine, Claritin 1 time per day and eye drops Allergodil, Spersallerg 2-3 times per day, for non-acute and chronic allergic conjunctivitis Alomide and Cromohexal 2-3 times per day.

The rapid spread of allergies among the Russian population is frightening. Nowadays, it is difficult to find a person who has never experienced an allergic reaction - dust, food, plant flowering, animal fur, alcohol, tobacco smoke, household chemicals and cosmetics, sun and cold.

Allergies can manifest themselves on human skin (dermatitis), affect the functioning of the digestive tract and the functions of the respiratory system, manifested by allergic conjunctivitis and runny nose.

Treating allergies is not an easy task, because the mechanism of its occurrence is complex, and modern medicine is not able to correct the changes that have occurred in the immune system, but can only alleviate its symptoms.

How is allergic conjunctivitis treated?

Allergic conjunctivitis– one of the forms of allergic reaction of the human body to external irritants.

Symptoms of allergic conjunctivitis can be permanent (all year round) or seasonal. The disease can occur subacutely, acutely or chronically

Treatment for chronic conjunctivitis is based on three main principles:

Isolation from allergen;

Treatment with immunotherapy;

The use of eye drops - antihistamines, with mast cell stabilizers; in particularly severe cases, corticosteroids are instilled.

The disease is treated with antihistamines - allergy tablets.

In children and adults, allergic conjunctivitis can occur in the following forms:

Atopic keratoconjunctivitis in adults

Chronic allergic conjunctivitis

Vernal keratoconjunctivitis

Drug-induced conjunctivitis

Hay conjunctivitis

Allergic conjunctivitis in children: symptoms

The severity of signs of allergic conjunctivitis upon contact with an allergen depends on the body’s reaction and the concentration of the allergen. Therefore, the period for the reaction to occur can vary from half an hour to 1-2 days from the moment the allergy-provoking substance enters the body.

Allergic conjunctivitis is most often accompanied by allergic rhinitis, that is, eye irritation is complemented by a runny nose and sneezing.

Itching, burning under the eyelids and in the eyes, and lacrimation appear.

Children constantly scratch their eyes, and this provokes a secondary infection, which is why ophthalmologists often recommend antimicrobial drops and ointments for long-term illness in children.

The itching can be so intense that a child or adult has to endlessly rub their eyes.

Most often, discharge from the eyes is mucous, transparent, less often viscous, thread-like.

The addition of a secondary infection is indicated by the accumulation of purulent discharge in the corners of the eyes.

The child complains of a feeling of sand in the eyes, dryness of the mucous membrane of the eyes, and photophobia occurs.

Adults and children experience redness and eye fatigue.

Due to decreased tear production, the conjunctiva of the eye atrophies (especially in older people and adults).

Sometimes, at the beginning of the disease, in children, on the contrary, there is an increase in tear production.

Perennial allergic conjunctivitis is caused by

that an adult or child is constantly in contact with an allergen,

most often represented by wool

pets, house dust or household chemicals.

With seasonal, periodic conjunctivitis, signs of the disease appear only at a certain time when the plants are blooming.

In case of contact conjunctivitis, the cause of the development of the disease can be the use of solutions for contact lenses, ointments, creams, and cosmetics.

Before prescribing specific treatment, it is necessary to accurately determine the allergen, which is not always easy to do.

Sometimes the help of an ophthalmologist alone will not be enough; the patient has to contact an allergist and dermatologist to identify the allergen that has become the causative agent of a reaction unusual for a healthy body.

To familiarize yourself with the types of allergic conjunctivitis and its symptoms, we suggest that you familiarize yourself with the following table:

Types of allergic conjunctivitis	Seasonality of changes		Inflammation of the cornea, eyelids	Discharge from the eyes	Tearing
Hay fever, chronic (if six months to a year)	Seasonal disease. Accompanied by an allergic runny nose when trees, flowers, and weeds bloom			mucous discharge	Present, and significant
Drug		any age	Cornea, eyelid skin, optic nerve, retina, choroid
Vernal keratoconjunctivitis	Exacerbation in spring and summer	It is more often observed after 14 years of age, but can also occur in children from 3 years of age	cornea	Sticky, viscous discharge	Absent or very intense
Atopic keratoconjunctivitis		over 40 years old		various

Allergic conjunctivitis: treatment

As mentioned earlier, the most accurate and reliable way to treat this disease is to exclude the allergen, which is not always possible. Then local and systemic antihistamine therapy is carried out; in some cases, it is possible to prescribe specific immunotherapy and symptomatic drug therapy; if the allergic reaction lasts for a long time, the patient is prescribed antimicrobial agents.

Drops and tablets for allergic conjunctivitis

The following drugs are prescribed as drug therapy for allergic conjunctivitis: Telfast, Zyrtec, Cetrin, Claritin, Loratadine. Not everything on this list is allowed for children to take antihistamines - only tablets marked “for adults and children.”

Antihistamine, antiallergic eye drops - “Opatanol”, “Lecrolin”, “Allergodil”, “Histimet” (contraindicated in children under 12 years of age).

Eye drops with mast cell stabilizers - represented by cromoglycic acid derivatives that block the production of histamine - “Krom-Allerg”, “Lecrolin”, “Cromo-Hexal”, “Lodoxamide” (contraindicated in children under 2 years of age), Hi-Krom (contraindicated in children up to 4 years).

In older people, it is possible to develop dry eye syndrome, when tear production stops completely or is reduced. In this case, treatment with the use of tear substitutes is recommended - “Systane”, “Vizin”, “Oftogel”, “Vidix”, “Oftolik”, “Oxial”, “Inoxa”. If damage to the cornea of the eye is observed, vitamin-containing eye drops “Ujala”, “Khrustalin”, “Vita-Yodurol”, “Catalin”, “Quinax”, “Emoxipin”, “Taufron”, “Katachrome” are prescribed.

In severe cases of the disease, the doctor prescribes corticosteroid ointments and drops, which consist of hydrocortisone or dexamethanose. Treatment with hormones is a last resort when other treatment options are not suitable. When treating with hormonal corticosteroids, you must always be extremely careful, follow the course of treatment and dosage prescribed by your doctor, and discontinuation of the drug should be gradual.

The doctor may also prescribe non-steroidal topical anti-inflammatory drugs - eye drops with diclofenac.

Specific immunotherapy is prescribed by a doctor in cases where the patient experiences frequent relapses of allergic conjunctivitis.

Treatment of hay fever - chronic seasonal conjunctivitis

It is unrealistic to protect a person from almost all allergens during the flowering of trees, cereal plants and weeds, so in adults and children, hay fever conjunctivitis begins abruptly with lacrimation, itching, photophobia, and burning in the eyes.

Treatment is based on the following:

Instillation of eye drops "Spersallerg" and "Allergodil". After 15 minutes, the patient’s condition improves. The drug “Spersallerg” is considered especially effective, since it contains a vasoconstrictor.

At the beginning of the disease, drops are taken 3-4 times a day, then 2 times a day. In severe cases of allergies, oral antihistamine tablets are recommended.

For chronic or subacute hay fever, the doctor prescribes drops for allergic conjunctivitis - “Alomid” and “Cromohexal” 3-4 times a day.

Treatment of chronic allergic conjunctivitis

Chronic allergic conjunctivitis– the most common variant of the disease, since for a patient who has a tendency to allergic reactions, there will always be “their allergen.”

Symptoms during the chronic process are not so pronounced, but tearing, itching and burning of the eyelids can be traced.

The causes are usually food allergies, animal dander, pollen, fish food, household chemicals, cosmetics and medications.

Drops with dexamethanosis, “Spersallerg” 1-2 times a day, “Cromohexal” and “Alomid” 2-3 times a day are prescribed.

Treatment of vernal keratoconjunctivitis

The highest incidence of the disease is in children 3-7 years old, especially among boys. The disease affects both eyes, and the course of conjunctivitis is chronic. A distinctive symptom is the papillary growth of cartilaginous tissue on the conjunctiva of the eye. The papillae are most often small, but there are also large ones, in which case they deform the eyelids. Signs of allergic conjunctivitis become dull in the fall and intensify in the spring.

Eye drops "Alomid" and "Cromohexal" help effectively, but doctors prescribe drops with dexamethasone - "Maxidex".

If corneal changes occur - keratitis, infiltrates, epitheliopathy, erosion, it is necessary to take Allomide instillations 2-3 times a day.

For a complex effect, oral antihistamines - Zodak, Claritin, Cetrin - are added to therapy, and immunotherapy is carried out with a course of 6-10 injections of histoglobulin.

Treatment for conjunctivitis of infectious etiology

Numerous studies by ophthalmologists have proven that with any viral and infectious conjunctiva - fungal, chlamydial, acute bacterial, adenoviral, herpetic, allergies manifest themselves in the symptoms of these diseases. It is believed that all chronic conjunctivitis is allergic in nature.

The use of a large number of antiseptics, antibiotics and antiviral agents for any viral or bacterial conjunctivitis creates a powerful toxic background in the body and locally in the conjunctiva.

Therefore, antibacterial therapy for herpetic, chlamydial or adenoviral conjunctivitis should be supplemented with antihistamine eye drops.

For acute infectious conjunctivitis, Spersallerg and Allergodil are prescribed 2-3 times a day; for chronic conjunctivitis, Cromohexal and Alomide are prescribed 2 times a day.

Drug-induced allergic conjunctivitis: treatment

Most of the medications that people use to treat many diseases are hostile, foreign agents to the immune system, and its inadequate reaction in the form of an allergy is justified. According to statistics, 30% of allergic conjunctivitis occurs due to taking various medications. Even the use of gels, ointments, creams, and even more so the internal use of medications can cause an allergic reaction.

Eye ointments and drops themselves can contribute to the development of allergies, affecting not only the conjunctiva, but also the skin of the eyelids and cornea. In this case, an allergy can develop to the preservative that is included in the drops, and the reaction sometimes occurs only several weeks after taking provocative medications.

This condition should begin to be treated with the elimination of the provoking drug. The patient should be urgently prescribed an oral antihistamine - "Loratadine", "Cetrin", "Claritin" once a day and eye drops "Spersallerg" and "Allergodil", for subacute development of allergic conjunctivitis - "Cromohexal" and "Alomimid" 2-3 times a day.

Advice from Dr. Komarovsky, video:

is a reactive inflammation of the conjunctiva caused by immune reactions in response to contact with an allergen. With allergic conjunctivitis, hyperemia and swelling of the eye mucosa, itching and swelling of the eyelids, lacrimation, and photophobia develop. Diagnosis is based on collecting an allergic history, performing skin tests, provocative allergy tests (conjunctival, nasal, sublingual), and laboratory tests. In the treatment of allergic conjunctivitis, antihistamines (orally and locally), topical corticosteroids, and specific immunotherapy are used.

ICD-10

H10.1 Acute atopic conjunctivitis

General information

Allergic conjunctivitis occurs in approximately 15% of the population and is a significant problem in modern ophthalmology and allergology. Allergic damage to the organ of vision in 90% of cases is accompanied by the development of conjunctivitis, less often - allergic blepharitis, eyelid dermatitis, allergic keratitis, uveitis, iritis, retinitis, neuritis. Allergic conjunctivitis occurs in both sexes, mainly young people. Allergic conjunctivitis is often combined with other allergies - allergic rhinitis, bronchial asthma, atopic dermatitis.

Causes

What is common in the etiology of all forms of allergic conjunctivitis is increased sensitivity to various environmental factors. Due to the peculiarities of the anatomical structure and location of the eyes, they are most susceptible to contact with exogenous allergens. Depending on the etiology there are:

Seasonal allergic conjunctivitis. Hay fever, pollen allergy) caused by pollen allergens during the flowering of grasses, trees, and cereals. Exacerbation of hay fever conjunctivitis is associated with the flowering period of plants in a particular region. Seasonal allergic conjunctivitis in 7% of patients worsens in the spring (late April - late May), in 75% - in the summer (early June - late July), in 6.3% - in the off-season (late July - mid-September), which accordingly, it coincides with the pollination of trees, meadow grasses and weeds.
Spring conjunctivitis. The etiology of spring conjunctivitis has been little studied. The disease worsens in spring - early summer and regresses in autumn. This form of allergic conjunctivitis usually resolves spontaneously during puberty, which suggests a certain role of the endocrine factor in its development.
Large papillary conjunctivitis. The main development factor is considered to be the wearing of contact lenses and ocular prostheses, prolonged contact of the mucous membrane with a foreign body of the eye, the presence of sutures that irritate the conjunctiva after cataract extraction or keratoplasty, calcium deposits in the cornea, etc. With this form of allergic conjunctivitis, the inflammatory reaction is accompanied by the formation of upper centuries of large flattened papillae.
Drug-induced conjunctivitis develops as a local allergic reaction in response to topical (90.1%), less often systemic (9.9%) use of drugs. The occurrence of drug-induced allergic conjunctivitis is facilitated by self-medication, individual intolerance to the components of the drug, polytherapy - a combination of several drugs without taking into account their interaction. Most often, drug-induced allergic conjunctivitis is caused by the use of antibacterial and antiviral eye drops and ointments.
Chronic allergic conjunctivitis. Accounts for more than 23% of cases of all allergic eye diseases. With minimal clinical manifestations, the course of chronic allergic conjunctivitis is persistent. Direct allergens in this case are usually house dust, animal hair, dry fish food, feathers, fluff, food products, perfumes, cosmetics and household chemicals. Chronic allergic conjunctivitis is often associated with eczema and bronchial asthma.
Atopic keratoconjunctivitis. It is an allergic disease of multifactorial etiology. It usually develops during systemic immunological reactions, therefore it often occurs against the background of atopic dermatitis, asthma, hay fever, and urticaria.

Pathogenesis

The pathogenesis of allergic conjunctivitis is based on an IgE-mediated hypersensitivity reaction. The triggering factor for allergic conjunctivitis is direct contact of the allergen with the conjunctiva, leading to degranulation of mast cells, activation of lymphocytes and eosinophils and a clinical response followed by an inflammatory-allergic reaction. Mediators released by mast cells (histamine, serotonin, leukotrienes, etc.) cause the development of characteristic symptoms of allergic conjunctivitis.

The severity of allergic conjunctivitis depends on the concentration of the allergen and the reactivity of the body. The rate of development of a hypersensitivity reaction in allergic conjunctivitis can be immediate (within 30 minutes from the moment of contact with the allergen) or delayed (after 24-48 or more hours). This classification of allergic conjunctivitis is practically significant for the choice of drug therapy.

Classification

Allergic eye lesions can occur in the form of hay fever conjunctivitis, vernal keratoconjunctivitis, large papillary conjunctivitis, drug conjunctivitis, chronic allergic conjunctivitis, atopic keratoconjunctivitis. Allergic conjunctivitis can be acute, subacute or chronic; by time of occurrence - seasonal or year-round.

Symptoms of allergic conjunctivitis

Allergies usually affect both eyes. Symptoms develop within a few minutes to 1-2 days from the moment of exposure to the allergen. Allergic conjunctivitis is characterized by severe itching of the eyes, burning under the eyelids, lacrimation, swelling and hyperemia of the conjunctiva; in severe cases – development of photophobia, blepharospasm, ptosis.

The itching in allergic conjunctivitis is so intense that it forces the patient to constantly rub his eyes, which, in turn, further intensifies other clinical manifestations. Small papillae or follicles may form on the mucosa. The discharge from the eyes is usually mucous, transparent, sometimes viscous, thread-like. When the infection develops, a purulent secretion appears in the corners of the eyes.

In some forms of allergic conjunctivitis (vernal and atopic keratoconjunctivitis), damage to the cornea occurs. In case of drug allergies, damage to the skin of the eyelids, cornea, retina, choroid, and optic nerve may occur. Acute drug-induced conjunctivitis is sometimes aggravated by anaphylactic shock, Quincke's edema, acute urticaria, and systemic capillary toxicosis.

In chronic allergic conjunctivitis, the symptoms are poorly expressed: complaints of periodic itching of the eyelids, burning of the eyes, redness of the eyelids, lacrimation, and a moderate amount of discharge are typical. Chronic allergic conjunctivitis is said to occur if the disease lasts 6-12 months.

Diagnostics

In the diagnosis and treatment of allergic conjunctivitis, coordinated interaction between the treating ophthalmologist and the allergist-immunologist is important. If the history shows a clear connection between conjunctivitis and exposure to an external allergen, the diagnosis is usually not in doubt. To confirm the diagnosis, the following is carried out:

Ophthalmological examination. Detects changes in the conjunctiva (edema, hyperemia, papillary hyperplasia, etc.). Microscopic examination of conjunctival scrapings in allergic conjunctivitis reveals eosinophils (10% and above). In the blood, an increase in IgE of more than 100-150 IU is typical.
Allergy examination. To determine the cause of allergic conjunctivitis, tests are carried out: elimination, when against the background of clinical manifestations, contact with the suspected allergen is excluded, and exposure, which consists of repeated exposure to this allergen after the symptoms subside. After the acute allergic manifestations of conjunctivitis subside, skin allergic tests (application, scarification, electrophoresis, prick test) are performed. During the period of remission, they resort to provocative tests - conjunctival, sublingual and nasal.
Laboratory examination. In case of chronic allergic conjunctivitis, examination of eyelashes for demodex is indicated. If an eye infection is suspected, a bacteriological examination of a smear from the conjunctiva for microflora is carried out.

Treatment of allergic conjunctivitis

The basic principles of treatment of allergic conjunctivitis include: elimination (exclusion) of the allergen, local and systemic desensitizing therapy, symptomatic drug therapy, specific immunotherapy, prevention of secondary infections and complications. In case of large papillary conjunctivitis, it is necessary to stop wearing contact lenses, eye prostheses, remove postoperative sutures or remove a foreign body.

For allergic conjunctivitis, oral antihistamines (claritin, ketotifen, etc.) and the use of antiallergic eye drops (levocabastine, azelastine, olopatadine) 2-4 times a day are prescribed. Topical use of cromoglycic acid derivatives (mast cell stabilizers) in the form of drops is also indicated. When dry eye syndrome develops, tear substitutes are prescribed; if the cornea is damaged, use eye drops with dexpanthenol and vitamins.

Prognosis and prevention

In most cases, once the allergen is identified and eliminated, the prognosis for allergic conjunctivitis is favorable. In the absence of treatment, an infection may occur with the development of secondary herpetic or bacterial keratitis, and a decrease in visual acuity. In order to prevent allergic conjunctivitis, contact with known allergens should be avoided whenever possible. In case of seasonal forms of allergic conjunctivitis, preventive courses of desensitizing therapy are necessary. Patients suffering from allergic conjunctivitis should be observed by an ophthalmologist and an allergist.

Allergic conjunctivitis is an acute inflammation of the conjunctiva, which is caused by the body's immune reactions to an allergen. According to official statistics, the disease is diagnosed in 15% of the world's inhabitants. Most often, the disease affects children and young people. But for older people the disease is no exception.

Etiology

The first and most common cause of allergic conjunctivitis is the body's reaction to an allergen. In addition, the following etiological factors can be identified:

long-term wearing of eye prostheses and contact lenses;
the body's reaction to medications;
pollen allergy;
consequences of eye surgery;
systemic immunological reactions.

But it should be noted that the etiology of this disease has not been fully studied.

Kinds

Today in official medicine it is customary to distinguish the following types of allergic conjunctivitis:

hay fever;
drug;
spring;
atopic.

According to the nature of development, allergic conjunctivitis is distinguished as follows:

periodic (seasonal manifestation of the disease, especially during the flowering period of plants);
year-round;
contact.

In general, the symptoms are the same for each subtype. Due to the nature of the symptoms, allergic conjunctivitis is quite difficult to confuse with any other disease.

General symptoms

The period of manifestation of symptoms depends on the concentration of the allergen itself that enters the body and the state of the immune system of the affected person. Most often this is a period from 30 minutes to 1–2 days.

For allergic conjunctivitis, the symptoms are:

lacrimation for no apparent reason;
burning in the eyes, redness;
runny nose;
photophobia;
cutting pain when trying to move the eyes.

If the disease was provoked by an infection, then a purulent process may develop. In view of this, the patient may experience purulent accumulations in the corners of the eyes after sleep.

Allergic conjunctivitis in a child can be accompanied by the following symptoms:

the child constantly rubs his eyes;
the baby may complain of sand in the eyes;
increased eye fatigue.

Due to the fact that children rub their eyes with their hands, a secondary infection may occur. Therefore, doctors prescribe not only drops, but also special antimicrobial ointments. Almost always, both in children and adults, general symptoms are supplemented by a chronic runny nose.

If allergic conjunctivitis becomes chronic, the symptoms practically disappear. Patients may only complain of occasional eye burning and fatigue. There are no other symptoms with this form of the disease.

Allergic rhinoconjunctivitis

Separately, it is worth highlighting allergic rhinoconjunctivitis. This disease can be considered a complication of allergic conjunctivitis. Unlike the latter disease, with allergic rhinoconjunctivitis, severe chronic runny nose is observed. The symptom is especially pronounced during the flowering period of plants.

Allergic rhinoconjunctivitis is diagnosed most often in young people. Moreover, women suffer from the disease more often than men.

Diagnostics

If you have the above symptoms, you should consult an ophthalmologist. In most cases, further diagnosis and treatment are carried out together with an allergist.

Most often, the clinical picture does not raise doubts about the diagnosis. But in order to establish the cause of the development of the inflammatory process and prescribe the correct treatment, diagnostic procedures should be carried out.

During the examination, the doctor should find out the patient's personal and family history. After this, the specialist can prescribe the following laboratory and instrumental tests:

microscopic examination of conjunctival scraping;
exposure and elimination test;
prick test;
other allergic skin tests.

Such research methods allow not only to accurately establish a diagnosis, but also to identify the suspected allergen. If there is a suspicion of infection, a bacteriological examination of a smear of conjunctival scraping is carried out. Only on the basis of the obtained tests can the correct treatment of the patient be prescribed.

Treatment

Unfortunately, it is impossible to completely cure this disease. But, if you accurately identify the allergen and prevent it from entering the human body, then the person will not be bothered by the disease.

It is especially important to prescribe the correct treatment if allergic conjunctivitis is diagnosed in children.

Conventionally, the treatment program can be divided into the following stages:

exclusion of the allergen in the human body;
carrying out local and systemic therapy aimed at reducing symptoms (use of drops, sprays, anti-inflammatory drugs);
symptomatic drug therapy;
immunotherapy;
prevention of possible complications and secondary relapse of the disease.

As for drug treatment, the doctor can prescribe drugs with the following spectrum of action:

antiallergic eye drops;
antihistamines;
drops of cromoglycic acid;
topical corticosteroids in the form of drops;
eye drops containing diclofenac.

The main course of treatment consists of topical medications. The drops are well accepted by the inflamed eye, so they have an almost instant effect.

If the main allergen is lenses or eye prostheses, you should immediately stop using them. In the event that the cause of the development of the inflammatory process is a foreign body, then surgical intervention is possible. In this case, the surgeon removes the foreign body itself or scars from a previous operation.

Treatment should only be prescribed by a competent specialist. Unauthorized use of drops, ointments, and anti-allergenic agents is unacceptable. You can use even the simplest drops only after consulting an ophthalmologist or allergist.

Traditional medicine

Traditional medicine offers many recipes for the treatment of allergic conjunctivitis. But before treating the disease in this way, it is still better to consult a doctor. The use of even seemingly safe folk remedies can only make the situation worse.

herbal teas for washing eyes;
compresses made from yogurt and herbal infusions;
Castor oil.

As for herbal decoctions, folk remedies include the following herbs and berries:

chamomile;
elderberries;
barberry root;
fennel;
yarrow.

Such folk remedies, as a rule, give a positive effect in treatment if they are used in combination with drug therapy - drops and anti-inflammatory drugs.

In addition, a fairly common folk remedy is a compress with tea. A warm tea bag should be applied to the sore eye. This kind of compress brings relief within 10–15 minutes.

In any case, you should not self-medicate. For effective treatment, you need to know the exact diagnosis and the cause of the development of the pathological process. Therefore, if you have symptoms, it is better to consult a doctor for advice.

Prevention

For those people who have already been diagnosed with allergic conjunctivitis or have a history of the disease, preventive measures are mandatory. Especially before the start of the season of exacerbation of the disease. The doctor may prescribe anti-allergy medications orally or topical drops.

In general, to prevent this type of disease, eye injury and infection should be avoided. If the disease makes itself felt, you should immediately seek qualified medical help.

Forecast

With timely treatment, allergic conjunctivitis does not pose a threat to human vision and normal life.

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