Sodium cromoglycate in management of vernal and chronic allergic conjunctivitis

This study was planned to find out whether there is any beneficial effect in adding the SCG drops in the treatment of patients with vernal or chronic allergic conjunctivitis. Fifty-eight patients, 12 with vernal and 46 with chronic allergic conjunctivitis, who had used basal solutions, local steroids and peroral antihistamines to manage their symptoms were given SCG drops four times daily in addition to the previous treatment. Fifty-three patients became symptomfree and stayed so when local steroids were tapered off. All but three of these 53 patients have been able to discontinue SCG drops after varying treatment periods, but some 10 to 15 patients probably will need medication during the next pollen season.SCG is not the first choice of local treatment in chronic allergic reactions, because many patients' symptoms can be managed with basal solutions and occasional local steroids if the patients are taught the importance of avoidance of allergens and irritating agents. SCG is indicated whenever the allergic symptoms bother the patient continuously and either the causative factor cannot be identified or it cannot be avoided.In vernal conjunctivitis the effect of SCG drops was so marked in every patient that SCG can be recommended as the basic medication of vernal conjunctivitis.Among ophthalmologists both vernal and chronic allergic conjunctivitis are usually considered to be local problems and the general management of allergic reactions gets too little attention. For permanent results the patient has to learn how to manage both the prevention and the treatment of symptoms and in both these aspects SCG was found helpful.     

Tear and serum soluble leukocyte activation markers in conjunctival allergic diseases

PURPOSE: To measure markers of leukocyte activation in patients with an exclusively ocular inflammatory or bacterial disease. METHODS: Neutrophil myeloperoxidase, eosinophil cationic protein, eosinophil neurotoxin, and soluble interleukin-2 receptor were measured in serum and tears of 17 patients with allergic vernal keratoconjunctivitis, seven with atopic keratoconjunctivitis, 11 with seasonal allergic conjunctivitis, seven with giant papillary conjunctivitis, 13 with rosacea blepharokeratoconjunctivitis, seven with bacterial conjunctivitis, and 13 normal subjects as controls. RESULTS: In serum of patients with vernal and atopic keratoconjunctivitis, levels of eosinophil cationic protein, eosinophil neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects but were not correlated with the severity of ocular symptoms. In tears of patients with vernal and atopic keratoconjunctivitis and seasonal allergic conjunctivitis, as well as in the nonallergic diseases, rosacea blepharokeratoconjunctivitis and bacterial conjunctivitis, levels of eosinophil cationic protein, neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects. The highest values of these markers were found in vernal keratoconjunctivitis samples. Neutrophil myeloperoxidase was significantly increased in vernal and atopic keratoconjunctivitis, rosacea blepharokeratoconjunctivitis, and bacterial conjunctivitis. In vernal keratoconjunctivitis, tear markers were correlated to the clinical score of the disease, but not with cytology. CONCLUSIONS: Tear histamine was measured in 10 allergic patients after allergen challenge. Although none of the above markers can be considered specific to a single disease, their measurement may still be useful for the quantification of local cell activation in ocular inflammatory diseases.     

Allergic conjunctivitis and contact lenses: experience with olopatadine hydrochloride 0.1% therapy

OBJECTIVE: The efficacy of Patanol, a topically applied anti-allergic agent, was evaluated in a group of patients with allergic conjunctivitis due to contact lens wear (GROUP I) and a group comprised of seasonal allergic conjunctivitis patients, vernal conjunctivitis patients and atopic keratoconjunctivitis patients (GROUP II). METHODS: One drop of Patanol was administered to each eye twice daily. Signs and symptoms were assessed 7, 14, and 28 days after initiation of drug therapy. RESULTS: Itching/burning, tearing, hyperemia and papillary reaction were reduced to scores of 0/1 (absent/mild) in 85%, 90%, 81% and 62%, respectively, of GROUP I patients at Day 28. The allergic conditions in GROUP II patients also improved with Patanol treatment. Itching/burning, tearing, hyperemia and papillary reactions were absent/mild in 60%, 76%, 96% and 90%, respectively, of these patients at Day 28. CONCLUSION: Patanol treatment effectively and rapidly alleviated the signs and symptoms of allergic conjunctivitis due to contact lens wear as well as vernal conjunctivitis, atopic keratoconjunctivitis and the common seasonal allergic conjunctivitis. Patanol allowed allergic patients to be more comfortable while permitting them to continue using contact lenses.     

充分认识儿童过敏性结膜炎的干眼症问题

儿童过敏性结膜炎以春季角结膜炎为主。儿童过敏性结膜炎合并的干眼症的发生与泪膜稳定性降低有关。嗜酸性粒细胞活化、炎性因子释放以及结膜上皮细胞和杯状细胞受损、丢失，粘液层缺乏，导致泪膜稳定性下降及干眼症。此种干眼症的症状以瞬目次数增加为主，其次是眼痒、眼红和畏光。诊断儿童过敏性结膜炎时应考虑是否合并干眼症，给予恰当的处理可避免其引起的严重眼表损害。     

Immunotherapy in allergic conjunctivitis.

Eighty patients with allergic conjunctivitis were treated with immunotherapy employing specific allergens. Sixty-two percent of these showed beneficial response. In cases of vernal conjunctivitis needing topical steroid preparations frequently for control of symptoms, immunotherapy is worth attempting to cause remission of symptoms.     

Aspirin therapy in vernal conjunctivitis

Prostaglandin D2 is a secondary mast cell mediator that causes redness, chemosis, mucous discharge, and eosinophil chemotaxis in the eye. It may play an important role in allergic ocular disease. Although histamine is a key mediator of allergic inflammation, antihistamine therapy provides only symptomatic relief. We added aspirin therapy to the treatment regimen of three patients with vernal conjunctivitis. Aspirin acetylates the enzyme cyclooxygenase, thereby preventing the formation of prostaglandin D2. Within two weeks after initiation of aspirin therapy, we noted dramatic improvement in conjunctival and episcleral redness and resolution of keratitis and limbal infiltration. We recommend a trial of oral aspirin as adjunctive therapy for intractable cases of vernal conjunctivitis.     

地塞米松短期冲击滴眼联合盐酸奥洛他定维持滴眼治疗慢性过敏性结膜炎

目的探讨地塞米松短期冲击滴眼联合盐酸奥洛他定维持滴眼治疗慢性过敏性结膜炎的临床疗效。方法回顾性分析16例(32眼)慢性过敏性结膜炎(巨乳头性结膜炎12眼,春季性结膜炎20眼)的临床资料,32眼均局部采用1g·L-1地塞米松短期冲击滴眼治疗10d,再采用1g·L-1盐酸奥洛他定和人工泪液维持滴眼治疗42d,观察患者疗效。结果 1个疗程后,32眼中显效20眼(包括巨乳头性结膜炎12眼,病程在2～3a的春季性结膜炎8眼),好转10眼,无效2眼。对于疗效不满意的12眼再进行1个疗程治疗后,显效4眼,好转8眼。结论地塞米松短期冲击滴眼联合盐酸奥洛他定维持滴眼治疗慢性过敏性结膜炎,可显著改善巨乳头性结膜炎和病程较短的春季性结膜炎眼部症状和体征,但对病程较长的春季性结膜炎的疗效还需进一步观察和评价。     

青少年糖皮质激素性青光眼10例临床分析

目的:回顾性分析近2a内10例20眼激素性青光眼的发病原因和相关治疗情况,对激素性青光眼做到早期发现,及时治疗。方法:对我院2008-01/2010-07诊断的10例20眼激素性青光眼进行分析。结果:青少年激素性青光眼的病因分为过敏性结膜炎5例10眼(50%),春季卡他性结膜炎2例4眼(20%),LASIK术后3例6眼(30%),使用激素点眼的原因已过敏性结膜炎最多。使用时间为3wk～18mo,有开角型青光眼的临床表现。结论:引起激素性青光眼的发病机制较为复杂,青少年对眼压的耐受性高,贻误诊断则视功能损伤严重,预防和早期诊断该病是挽救患者视力的重要途径。     

Ocular allergy: causes and therapeutic options

Ocular allergic eye conditions are among the most common anterior eye problems encountered in optometric practice. There are six common forms of ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunc‐tivitis, atopic keratoconjunctivitis, contact lens associated papillary conjunctivitis and contact ocular allergy. Here, we review the current understanding of the pathophysiol‐ogy underlying ocular allergic conditions and describe the different causes and forms of allergic eye disease and different treatment options.     

Management of severe allergic conjunctivitis with topical cyclosporin a 0.05% eyedrops

PURPOSE: To evaluate the efficacy of topical cyclosporin A 0.05% in the management of severe allergic conjunctivitis. METHODS: Seven patients with severe allergic conjunctivitis who were not responding to topical steroids, antihistamines, and mast cell stabilizers were given topical cyclosporin A 0.05%. All patients had an active disease when they were included in the study. Signs and symptoms were recorded before and after treatment. RESULTS: Seven patients, 6 boys and 1 girl, 6-14 years old, 6 with vernal keratoconjunctivitis and 1 with atopic keratoconjunctivitis, were enrolled in the study. Treatment with topical cyclosporin A 0.05% decreased the severity of symptoms and clinical signs significantly after 6 months (P < 0.05, Wilcoxon signed rank test). In addition, the need for steroids was reduced or even stopped. The patients experienced no side effects during the follow-up periods (mean, 14.0 +/- 2.1 months; range, 8-18 months). CONCLUSIONS: Topical cyclosporin A is an effective treatment in the management of severe allergic conjunctivitis with a benefit as a steroid-sparing agent.     

Conjunctival deposition of eosinophil granule major basic protein in vernal keratoconjunctivitis and contact lens-associated giant papillary conjunctivitis

To investigate the role of the eosinophil in vernal keratoconjunctivitis and contact lens-associated giant papillary conjunctivitis, we assessed the presence of eosinophil granule major basic protein in conjunctival tissues by immunofluorescence. Biopsy specimens of conjunctiva were taken from nine patients with vernal keratoconjunctivitis, seven patients with giant papillary conjunctivitis, and five control subjects. We performed a masked semiquantitative assessment of immunofluorescence on sections from each specimen. The vernal keratoconjunctivitis and giant papillary conjunctivitis groups had significantly (P less than .05) more major basic protein deposition than controls. No significant correlation between severity of disease and degree of major basic protein deposition was found. We found extracellular eosinophil granules in one of three vernal keratoconjunctivitis specimens examined by transmission electron microscopy. Thus, eosinophil degranulation commonly occurs in vernal keratoconjunctivitis and giant papillary conjunctivitis with release of eosinophil granule major basic protein and presumably other toxic granule proteins onto affected tissues. These cationic proteins are potent cytotoxins and are able to stimulate mast cell degranulation.     

Ocular allergy: diagnosis and treatment

Ocular allergy is a common hypersensitivity disorder that affects 15%-20% of the population in developed nations. This disorder can be divided into several categories: seasonal and perennial allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and drug-induced allergic conjunctivitis. Giant papillary conjunctivitis often is included among these classifications of allergy; however, it is not a true allergy, but rather the result of a chronic mechanical irritation. This article reviews these subtypes of ocular allergy, with particular emphasis on the pathophysiology, diagnosis, and treatment of seasonal and perennial allergic conjunctivitis. These are the most common varieties, representing more than 95% of the ocular allergy cases in the United States.     

Epidemiological study of 134 subjects with allergic conjunctivitis

At times it is difficult to distinguish among the subtypes of chronic allergic conjunctivitis. A prospective study with 134 patients was carried out. Patients were diagnosed with vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC) or perennial allergic conjunctivitis (PAC). Demographic information was also collected including, age at symptom onset, sex, history of non-ocular allergy, and history of family allergy. Forty-six percent were diagnosed with VKC, 40% with AKC, 8% with PAC, and 6% were not specifically diagnosed. This distribution information as well as the demographic information collected demonstrates that there are patterns within each subgroup of chronic ocular allergy sufferers. These findings will be helpful in the diagnosing and proper classification of ocular allergic conditions.     

Treatment of common ocular allergic disorders; a comparison of lodoxamide and NAAGA

BACKGROUND/AIMS—Lodoxamide tromethamine and N-acetyl-aspartyl glutamic acid (NAAGA) are mast cell stabilisers, both of which have been shown to be effective in the treatment of allergic conjunctivitis. The aim of this study was to compare the two compounds in patients with common ocular allergic disorders.
METHODS—73 patients participated in a double masked, randomised multicentre study. Diagnoses were chronic allergic conjunctivitis, vernal conjunctivitis, seasonal and atopic conjunctivitis. 36 patients were treated with lodoxamide 0.1% and 37 with NAAGA 4.9%, the drops being instilled four times daily for up to 56 days.
RESULTS—The overall opinion of the physicians and the patients was in favour of lodoxamide at day 10 of the study. At this time, 86% of lodoxamide treated and 49% of NAAGA treated patients considered they had improved. The patients' opinion favoured lodoxamide at day 28 and both physicians' and patients' evaluations were in favour of lodoxamide at day 42. Evaluation of signs and symptoms indicated superiority of lodoxamide at days 42 and 56. Both treatments were well tolerated.
CONCLUSION—While both lodoxamide and NAAGA treatments are associated with clinical improvements in patients with allergic conjunctivitis, lodoxamide may have an earlier onset of action.

Keywords: allergic conjunctivitis; lodoxamide; NAAGA; topical therapy     

Perilimbal bulbar conjunctival pigmentation in vernal conjunctivitis: prospective evaluation of a new clinical sign in an Indian population

OBJECTIVES: To prospectively evaluate the occurrence of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis and normal controls; to document the location, extent, density, and color of such pigmentation; and to correlate these changes with disease severity. METHODS: Prospective, noninterventional case-control study. Demographic data, disease symptoms and duration, clinical signs of disease severity and extent, and characteristics of the perilimbal pigmentation were recorded. RESULTS: Twenty-five patients with vernal conjunctivitis and 30 controls were studied. The mean age of the patients (21 M, 4 F) and controls (18 M, 12 F) was 7.5 +/- 3.7 years and 10.3 +/- 3.1 years, respectively. Perilimbal pigmentation was seen in all patients with vernal conjunctivitis and in none of the controls. The palpebral conjunctival changes and patient symptoms correlated with the severity of the disease in patients with vernal conjunctivitis. However, the extent of perilimbal pigmentation did not correlate with the symptoms and signs of vernal conjunctivitis or the density of palisadal pigment. CONCLUSIONS: Perilimbal bulbar conjunctival pigmentation appears to be a consistent finding in patients with vernal conjunctivitis that is both specific and sensitive. It is also present in eyes with inactive disease and hence is a useful clinical sign that aids diagnosis in patients with mild or quiescent disease. Further studies are required to establish the histopathologic correlation of this finding and its etiopathogenesis. It is also important to establish whether this finding occurs with the same frequency in eyes of whites, as this study was performed in a cohort of Asian patients who have greater limbal pigmentation and a higher incidence of limbal changes in vernal conjunctivitis.     

Allergic ocular disorders: a spectrum of diseases.

Allergic eye disease is commonly encountered in clinical practice. The external eye is exposed to a host of environmental, cosmetic, and pharmacologic antigens. Although individual responses show a wide range of variability, a number of distinctive syndromes have emerged to define the spectrum of allergic eye disease. They consist of seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), giant papillary conjunctivitis (GPC), and contact allergies involving the conjunctiva.     

Detection by brush cytology of mast cells and eosinophils in allergic and vernal conjunctivitis.

The presence of eosinophils in the conjunctival epithelium is indicative of allergies, and detection is currently performed by cotton swab scrapings. Although mast cells are thought to be chemotactic for eosinophils and thus presage their accumulation, the former's use as early indicators of allergy has heretofore been hindered by poor detection methods. The recent development of a special brush now makes it possible to collect many cells with less disturbance of the conjunctival epithelium. In the present study, we have used this brush for conjunctival scraping in 18 patients with vernal and allergic conjunctivitis, and 10 patients serving as controls. The superior and inferior tarsal conjunctiva in both eyes were examined, and the specimens were stained using Hansel's method. Mast cells were observed in at least one of the tarsal conjunctivae in all cases of vernal and allergic conjunctivitis, whereas eosinophils were so observed in only eight cases (44.4%). Neither mast cells nor eosinophils were present in the conjunctivae of the normal group. Although treatment by mast cell stabilizers produced clinical remissions, they induced disappearance of mast cells in only 10 cases (55.6%), whereas in six cases (33.3%) the mast cells increased, and in two cases they were unchanged (11.1%). Six cases (33.3%) each showed disappearance of, increase in, and no change in eosinophils, reflecting even less of a response of these allergic cells to the treatment. The presence of mast cells and eosinophils, as determined by our cytologic method, was found to be correlated with the early detection, but not the clinical severity, of allergic conjunctivitis.     

Ophthalmic disodium cromoglycate

Disodium cromoglycate has recently been approved for ophthalmic treatment of certain types of conjunctivitis in the United States. This mast cell inhibitor is effective in the treatment of vernal keratoconjunctivitis, allergic conjunctivitis, chronic conjunctivitis, and giant papillary conjunctivitis, especially when a history of atopic disorders or moderately low blood IgE levels are present. This literature review provides a foundation for understanding the balance between the therapeutic efficacy, clinical benefits and side effects in treating IgE-mediated conjunctivitis with disodium cromoglycate.     

Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis compared and contrasted.

We compared quantitative histologic counts of ten subjects with vernal conjunctivitis to counts of 15 subjects with contact lens-associated giant papillary conjunctivitis and to counts of 15 normal subjects. Both vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis subjects had abnormalities of mast cells in the epithelium, and eosinophils and basophils in epithelium and substantia propria. No normal individuals had these abnormalities. An additional 28 subjects with ocular inflammatory conditions had tissue evaluation for abnormalities of mast cells, eosinophils, and basophils. A few eosinophils were found in four subjects. The histologic abnormalities of vernal conjunctivitis are shared by contact lens-associated giant papillary conjunctivitis but not by conjunctival inflammation in general. Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis may represent different subtypes of a general category of conjunctival abnormality characterized by giant papillae.     

Serum allergen specific immunoglobulin E levels in patients with allergic conjunctivitis

PURPOSE: To evaluate serum allergen specific immunoglobulin E (IgE) levels in patients with various types of allergic conjunctivitis. METHODS: Twenty-five patients with seasonal allergic conjunctivitis (SAC), 17 patients with perennial allergic conjunctivitis (PAC), and 10 patients with vernal conjunctivitis (VC) were included in the study. Specific IgE levels to Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), mixed grass pollens, and animal epithelia were measured using Pharmacia CAP system (Pharmacia Diagnostic AB, Uppsala, Sweden). RESULTS: The percentage of subjects with specific IgE against Dp and Df was statistically higher in VC (30%) compared to PAC (5.9%) and SAC (0%) (p=0.03). Specific IgE against mixed grass pollens was found in 30% of VC and 40% of SAC, whereas 10% of VC and 8% of SAC patients were found to be hypersensitive to animal epithelia. CONCLUSIONS: Allergic reaction against house dust mites and pollens was common in VC, whereas specific IgE against grass pollens was remarkable in SAC. IgE levels specific to various antigens might be measured by UNICAP system, which is a rapid and practical technology.