30.10.2020

Treatment of allergic conjunctivitis in children

Allergic conjunctivitis in children is a common disease in modern pediatrics , which is the subject of a study of pediatric ophthalmology and allergology. Allergic conjunctivitis is characterized by inflammation of the mucous membrane that covers the sclera and the inner surface of the eyelid, due to the body’s hypersensitivity to any allergen.

In most cases, the manifestation of allergic conjunctivitis in children falls on the age of 3-4 years. Among children of school age, allergic conjunctivitis occurs in 3-5% of cases. Allergic conjunctivitis in children usually accompanies other allergic manifestations: allergic rhinitis , pollinosis , atopic dermatitis , bronchial asthma and etc.

The reasons

The basis of allergic conjunctivitis in children is increased individual sensitivity to certain environmental factors – allergens. Such exogenous factors can be allergens: household (household and library dust, mites, feather pillows, household chemicals), pollen (pollen from flowering trees and herbs), epidermal (dander and animal hair, pet food), food (food – citrus, chocolate, honey, berries, etc.), medicinal (medicines).

In some cases, the cause of allergic conjunctivitis in children are foreign bodies of the eye , as well as allergens of bacterial, viral, fungal and parasitic origin. It has been established that allergic eye diseases in young children are more often caused by genetic and social factors, and in older children, they are preceded by domestic, food, epidermal sensitization, the severity of which largely determines the severity of allergic conjunctivitis.

Classification

Taking into account the etiopathogenetic mechanisms, the following forms of allergic conjunctivitis in children are distinguished: hay (pollinous), coarsenal (hyperpapillary), drug, tuberculosis-allergic, infectious-allergic, and spring catarrh.

  • Pollinous conjunctivitis in children is an allergic eye disease caused by the pollen of herbs, grasses, and trees. It has a seasonal dependence, occurs during the flowering of those plants to which the pollen is sensitized by the body. In hay fever , children with pollinous conjunctivitis are combined with urticaria , asthmoid bronchitis , atopic or contact dermatitis , angioedema , dyspepsia, headaches.
  • Spring conjunctivitis . It occurs more often in boys aged 5-12 years. Spring conjunctivitis in children has a persistent chronic course; exacerbations occur mainly in the sunny season. Spring catarrh can occur in conjunctival, limbal and mixed form.
  • Hyperpapillary conjunctivitis. The occurrence of hyperpapillary conjunctivitis is associated with contact irritation of the conjunctiva by foreign bodies ( contact lenses , ocular prostheses , stitches). On examination of the upper eyelid conjunctiva, giant papillae (from 1 mm or more mm) are detected.
  • Medicinal allergic conjunctivitis in children develops with the use of various eye drops. Allergy can occur both on the main active ingredient and on the preservatives used in the drops; Most often, allergic conjunctivitis in children occurs when instillation of antibacterial eye drops and anesthetics.
  • Infectious-allergic conjunctivitis in children is associated with body sensitization to microbial allergens: bacterial, viral, fungal exotoxins. In this case, the pathogen itself is not detected in the conjunctiva of the eye.
  • Tuberculosis-allergic damage to the eyes proceeds according to the type of keratoconjunctivitis, with simultaneous damage to the conjunctiva and the cornea. This form of allergy is a consequence of an allergic reaction to the waste products of mycobacterium tuberculosis circulating in the blood .
Symptoms allergic conjunctivitis

Usually, the symptoms of allergic conjunctivitis in a child develop within a few minutes or one day after interacting with the allergen. At the same time both eyes are involved in a reactive inflammation at once. The eyelids of the child are swollen, the conjunctiva becomes hyperemic and edematous, a tearing occurs, and in severe conjunctivitis , photophobia.

The leading subjective symptom of allergic conjunctivitis in children is intense itching, which causes the child to constantly brush his eyes, further intensifying all manifestations of the disease. In the conjunctival cavity mucous clear (sometimes sticky or filmy) discharge is constantly accumulated. Purulent discharge with uncomplicated allergic conjunctivitis in children is usually absent, and occurs only when the infectious component joins.

Allergic conjunctivitis in children may be acute (with a rapid onset and early termination) or chronically (long, sluggish, with occasional exacerbations). The nature of the flow is determined by the cause-significant allergen and the frequency of contact with it.

Diagnostics allergic conjunctivitis

Diagnosis of allergic conjunctivitis in children is carried out by a children’s ophthalmologist and allergist-immunologist . The reliable diagnostic criteria for allergic conjunctivitis in children include: the presence of an allergic history, the relationship between the occurrence of the disease and certain external factors (flowering, contact with animals, the use of certain foods, etc.), characteristic clinical symptoms.

To confirm the diagnosis, a microscopic examination of the tear fluid is carried out, where, in allergic conjunctivitis in children, more than 10% of eosinophils are detected. With the allergic nature of the disease, an increased level of total IgE, eosinophilia is also detected as compared with the age norm . In the presence of purulent secretions, bacteriological examination of the discharge from the conjunctival cavity is carried out. The manifestation of a systemic allergic reaction necessitates a survey of the child’s gastrointestinal tract, an analysis of feces on the eggs of worms, and a scraping on enterobiosis.

Identification of the immediate cause of allergic conjunctivitis in children allows staging of skin allergy tests and blood tests for specific IgE. Differential diagnosis of allergic conjunctivitis in children is carried out with demodicosis , fungal, bacterial , autoimmune conjunctivitis.

Treatment of allergic conjunctivitis in children

A prerequisite for successful therapy are elimination measures, involving the elimination of contact with the allergen. The pathogenetic basis for the treatment of allergic conjunctivitis in children is made up of antihistamines in the form of tablets and instillations of eye drops in age dosages and concentrations. With persistent course of the disease, topical NSAIDs and corticosteroids are prescribed.

It is possible to conduct allergen- specific therapy , which is most effective in children. It involves the introduction of small doses of the allergen in increasing concentrations, which is accompanied by a gradual addiction to this allergen, a decrease or disappearance of the symptoms of allergic conjunctivitis in children.

Prognosis and prevention

When late diagnosis of allergic conjunctivitis in children, the cornea and other eye tissues may be involved in the inflammatory process, which is fraught with a decrease in visual acuity and the development of difficult to treat forms of eye diseases ( keratitis , corneal ulcers ). Identification and elimination of the allergen, as well as the conduct of specific immunotherapy helps prevent allergic relapses. Specific prevention of allergic conjunctivitis in children has not been developed. Attention should be paid to strengthening the overall immunity of the child, to conduct preventive courses of desensitization therapy during the acute seasons of the disease, to avoid contact with known allergens.

Allergic conjunctivitis in children is an inflammatory process in the conjunctival membrane of the eye, which is a reaction to a particular antigen sensitizing the body. The development of allergic conjunctivitis in children is accompanied by local swelling, itching and redness of the eyes, tearing, photophobia. Diagnosis of allergic conjunctivitis in children is carried out by a pediatric ophthalmologist and allergist; includes microscopic examination of the tear fluid, total IgE, KLA, setting skin tests. Therapy of allergic conjunctivitis in children requires the elimination of contact with the allergen, the appointment of antihistamines in the form of eye drops and inside, specific immunotherapy.

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