Treatment of pollinous conjunctivitis

A feature of the pathology is the frequent inability to comply with the main principle of the treatment of allergic diseases – the exclusion of contact with the allergen, since pollen is always present in the air and spreads very far.

For the treatment of this allergic condition, a large number of methods are used, used both in the acute period to relieve symptoms and in remission to prevent exacerbations.

Despite the inability to completely limit the contact of the patient with the pollen of plants, there are measures to significantly reduce the amount of allergen entering the body.

The following treatments are most common:

• Antihistamine therapy. The administration of general and local antihistamines is the leading method for the treatment of the acute form of allergic inflammation of the conjunctiva of the eye. Antihistamines reduce the sensitivity of tissues to the contents of mast cell granules, due to which the manifestations of the disease become less pronounced. With a confirmed diagnosis, it is recommended that prophylactic administration of these drugs during the flowering of ambrosia, cereals and other plants.
• Anti-inflammatory and vasoconstrictor agents.  In case of severe pathology, local preparations (eye drops) based on hydrocortisone and adrenaline hydrochloride are used. They effectively reduce the severity of inflammation, facilitating the course of the disease and reducing the risk of complications.
• Mast cell membrane stabilizers.  These medicines can be used in the period of exacerbation (local) or during remission for the purpose of prevention. Derivatives of cromoglicic acid reduce the activity of tissue basophils and reduce the severity of allergic manifestations.
• Allergen-specific immunotherapy  (ASIT). It is practically the only etiotropic method of treatment of pollinous conjunctivitis, can be made only after an accurate determination of the allergen. Insignificant amounts of the substance provoking the reaction are administered to the patient to develop immunological tolerance. The duration of therapy may be from 3-5 months to several years.

During the flowering period of plants that are dangerous in allergic terms, the patient should avoid prolonged exposure to air, especially in dry, windy weather, when pollen particles are able to stay suspended for a long time. Walking is better to plan early in the morning or after a little rain – moisture contributes to the settling of pollen.

It is not recommended to open windows at home; it is better to use an air conditioner or special devices that clean incoming air. It is necessary to carry out wet cleaning regularly. To prevent cross-allergy, certain foods should be eliminated from the diet – you can get advice on this from your allergist.

Pollinous conjunctivitis  is a condition with a characteristic seasonal course – exacerbations mainly in the spring-summer period, in some cases in the autumn. The peak of the incidence is during the period of flowering of allergen plants, therefore by the time of onset of symptoms a possible allergen can be indirectly identified. The proportion of pathology in the overall structure of allergic eye diseases is almost half of the cases (45-48%), which makes it the most common allergy of this type. Pollinosis (allergy to pollen) in about 15% of cases is manifested only by conjunctivitis, in other cases inflammation of the conjunctiva is accompanied by rhinitis, laryngitis and other allergic lesions. The condition can occur at any age, women suffer more often than men.

Causes of pollinous conjunctivitis

Allergic damage to the conjunctiva is a manifestation of a first-type hypersensitivity reaction. Allergens are in the composition of plant pollen, the particles of which have a size of about 20-30 microns and spread through the air over considerable distances. The reasons for which intolerance of individual substances with the development of a violent reaction occurs are not known for certain, the influence of heredity and the characteristics of the reactivity of the organism are assumed.

There are a number of predisposing factors of external and internal nature, contributing to or facilitating the development of an allergic reaction:

• Individual predisposition. The presence of allergic diseases (bronchial asthma, food allergies) several times increases the risk of the appearance of symptoms of pollinous conjunctivitis. The influence of the genetic factor has been proved – if the parents suffer from allergic diseases, the likelihood of their development in the child is high.
• Ecological factors.  Among the patients is dominated by residents of cities. It is believed that this is due to the pollution of the urban environment with various chemicals (exhaust fumes, emissions from factories), which increases the reactivity of the organism.
• Biological environment.  Manifestations of pollinosis are caused by pollen of wind-pollinated plants – trees (birch, alder, maple), cereals (wheat, barley, rye) and some weeds (ambrosia, quinoa). The presence of parks, squares, flower beds, fields and wastelands with these plants in the vicinity of the patient’s residence leads to a seasonal exacerbation of the disease.
• Climatic factors.  Humidity, the magnitude and frequency of precipitation, and the force and direction of the wind have a decisive influence on the distribution of pollen. The probability of occurrence of the disease increases with dry weather – then pollen particles remain in the air for a long time, they can be transported over long distances.

Pollen particles suspended in the air are able to settle on the open mucous membranes of the body, mainly in the nasal cavity and conjunctiva of the eyes. Usually their number is insignificant, for most people the process of sedimentation occurs unnoticed.

When the body is sensitized, the ingress of these motes on mucous membranes causes an inflammatory reaction with characteristic allergic manifestations.

Pathogenesis of pollinous conjunctivitis

The development of pollinous conjunctivitis is typical of an anaphylactic allergic reaction. At the first contact of the organism with the allergen, which is part of the pollen, its immunological recognition and sensitization of the organism occur – the appearance of memory cells that trigger the immune response during subsequent ingress of irritating substances.

In the case of repeated contacts with these cells, the release of a large number of specific immunoglobulins E (IgE) or reagins is stimulated. The latter are able to activate tissue basophils (mast cells), causing the release of compounds of their granules – histamine, serotonin and several other biologically active substances.

Histamine and other substances in its range dilate blood vessels, cause tissue swelling and other inflammatory manifestations. In the case of pollinosis, this occurs in the place of direct contact with the allergen – pollen accumulates on the conjunctiva of the eye, provoking its inflammation, penetrates into the upper respiratory tract.

A more rare pathogenetic mechanism of this condition is the so-called cross-allergy – sensitization occurs under the influence of food or other irritating substances, but intolerance also occurs on the components of pollen. This process can also have a reverse course – the occurrence of allergic conjunctivitis sometimes cross-links urticaria and other reactions to food or household dust.

Symptoms of pollinous conjunctivitis

Pathology is characterized by a pronounced seasonal flow caused by the flowering period of the plant, the pollen of which acts as an allergen. About a third of patients suffer from ocular manifestations of hay fever in the spring (April-May), which coincides with a massive pollen release by wind-pollinated trees (birch, oak, alder). Another seasonal peak of the disease occurs at the end of summer and the beginning of autumn, the time when weeds bloom (quinoa, ambrosia).

During the first half of summer, pollen particles of wild-growing and cultivated cereal plants (wheat, barley, wheatgrass) can cause pathology. In cities, the autumn form of conjunctivitis is more common – this is due to the widespread spread of weeds (in flowerbeds, parks, squares) and light contact with the allergen.

The lesion of the eyes is bilateral, it starts quite sharply, usually in the first hours after a walk in the open air, a trip to the countryside. The first manifestations of pathology are itchy eyes and lacrimation, photophobia (photophobia) may develop. As the inflammation progresses, there is swelling of the eyelid skin, burning, redness of the sclera. Itching becomes very severe, forcing the patient to rub his eyes, which only increases the severity of other symptoms and increases the risk of secondary infection. Corneal lesions and ulcers in pollinated conjunctivitis are usually not observed, but may be due to infection or mechanical damage due to rubbing.

The entire period of the disease is recorded abundant mucous or serous discharge from the eyes, sometimes acquiring a purulent character – this indicates the accession of a bacterial infection. The actual ocular manifestations may be accompanied by other symptoms of pollinosis – allergic rhinitis, nasal congestion, sore throat, cough. On the mucous membrane of the eyes revealed small follicular formation, sharply injected blood vessels.

The duration of the acute period of the disease ranges from 2-5 days to several weeks. The decisive role is played by the duration of contact with the allergen, depending on the duration of the flowering period of the plant – the source of pollen, the lifestyle of the patient, climatic and geographical factors.

Complications of pollinous conjunctivitis

The most common complication of pollinous conjunctivitis is bacterial infection and purulent inflammation of varying severity – from insignificant secretions to the involvement of the eyelids, cornea (keratitis) and deep structures of the eye in the process. Systemic allergic reactions (angioedema, anaphylactic shock) are extremely rare.

The pathology can be complicated by the so-called “pollen intoxication” – headache, weakness, loss of appetite, nausea. With improper treatment, the transition of the allergic process into a chronic form, the development of cross-forms of allergy, exacerbation of existing diseases are possible.

Diagnosis of pollinous conjunctivitis

The determination of pollinous conjunctivitis is carried out on the basis of anamnesis, physical examination by an ophthalmologist, skin allergy tests. Particular attention is paid to the time of the first symptoms – it can be compared with the data on the flowering of certain plants in a particular area and, thereby, significantly narrow the list of possible allergens.

Laboratory research – a complete blood count, determination of the level of specific IgE, and microscopy of conjunctival scraping play a supporting role in the diagnosis.

The diagnostic algorithm includes the following steps:

1. History taking, physical examination. The specialist finds out when the symptoms of pathology first appeared, whether they had occurred earlier, whether there were other allergic diseases, whether similar conditions were observed in the parents. On examination, edema and hyperemia of the conjunctiva, skin of the eyelids, abundant discharge of mucous character are detected.
2. Lab tests. In the initial stages of the KLA, unchanged, after 4-5 days, insignificant eosinophilia is determined. The level of immunoglobulin E over 100 IU. Conjunctival microscopy reveals eosinophils, which indicates the allergic nature of inflammation.
3. Allergological tests. By comparing the time of onset of conjunctivitis and the period of flowering of provoking plants, the range of possible allergens that are introduced to the patient during the application, scarification and other allergy tests is determined. After the end of the acute period, a conjunctival challenge test can be performed to confirm the diagnosis of allergy. The presence of the reaction (redness, itching, edema) allows you to accurately determine the cause of the pathological condition.

Prognosis and prevention of pollinous conjunctivitis

The prognosis of pollinous conjunctivitis is most often favorable, when properly prescribed treatment or termination of contact with an allergen substance, the manifestations of pathology pass without consequences.

If the doctor’s prescriptions are not followed, each seasonal exacerbation may be more severe than the previous one – other manifestations of pollinosis (rhinitis, allergic laryngitis) often join the inflammation of the conjunctiva. This is the reason for the importance of preventive measures in the remission of pathology.

Often, observation by an allergist-immunologist is required, since against this background other allergic diseases can occur – cross-food allergies, bronchial asthma.