The treatment of allergic conjunctivitis includes
1.General treatment
Removal from the allergen is the most desirable treatment, but sometimes it is difficult to do. Contact with possible allergens should be avoided as much as possible. For example, remove rags and blankets from the room, pay attention to bed hygiene, use insecticides to eliminate insect mites in the room, avoid staying in the countryside during the pollen spreading season, avoid contact with grass as much as possible, stop using or replace quality contact lenses with care solutions, etc.
Cold compresses on the eyelids can provide temporary relief. Rinsing the conjunctival sac with saline can neutralize the pH of the tears and dilute the antigens in the tear fluid. Wearing dark glasses to reduce sunlight irritation; staying in air-conditioned cold rooms and in areas with cool, dry climates or high latitudes during the hot season can be helpful in the treatment of chunka and atopic keratoconjunctivitis. Patients are advised not to rub their eyes so as not to cause mast cell degradation and corneal epithelial damage.
2.Drug treatment
(1) antihistamines: mainly for histamine H1 receptors and play a role, its efficacy is usually better than mast cell stabilizers, especially in the allergic conjunctivitis episodes, commonly used drugs are: 0.1% emetine, 0.05% levocabastine 0.1% olopatadine, etc. If there are extraocular symptoms, you can take oral anti-allergy drugs, but its effect is not as good as local medication. Commonly used drugs for oral administration are benadryl, paracetamol, promethazine, etc., but attention should be paid to side effects.
The combination of antihistamines and vasoconstrictors is more effective, and there are already some antihistamines and vasoconstrictors in combination, such as R&J, Nadazo, etc.
(2) Mast cell stabilizer: it works by inhibiting cell membrane calcium channels. It can prevent the release of inflammatory mediators caused by the cross-linking of antigen with IgE on the mast cell membrane. Commonly used drugs such as sodium colored glycolate and nedolomide. The overall efficacy is less than that of antihistamines, but they seem to be more effective in suppressing tearing. The onset of action is relatively slow and the treatment is less effective in patients who have already had an attack. However, the drug usually has no significant side effects and can be used for a longer period of time if the condition requires.
(3) NSAID: It is an inhibitor of cyclooxygenase, which can inhibit the production of prostaglandins and the chemotaxis of eosinophils, etc. It can be used in both the acute and intermittent phases of allergic disease attacks. It has shown some efficacy in relieving ocular signs and symptoms such as itchy eyes, conjunctival congestion, and tearing. Commonly used drugs include anti-inflammatory pain, diclofenac sodium, aspirin, etc.
(4) vasoconstrictors: local use of vasoconstrictors (such as epinephrine, nemetazoline, oxymetazoline, tetrahydrozoline, etc.) can inhibit mast cells and eosinophils degranulation, target cells release bioactive substances, thereby improving ocular discomfort and reducing ocular surface congestion, but should not be used for a long time.
(5) Glucocorticoids: Local use of glucocorticoids can inhibit the release of mast cell mediators, block the chemotaxis of inflammatory cells, reduce the number of mast cells and eosinophils in the conjunctiva, inhibit phospholipase A2, thus preventing the production of arachidonic acid and its metabolites, and other functions. It also has a good inhibitory effect on the delayed hypersensitivity reaction.
Glucocorticoids should not be used for too long to avoid complications such as cataract, glaucoma, herpes simplex virus infection, fungal infection and delayed healing of corneal epithelium, etc. The commonly used ones are dexamethasone, betamethasone and flumetron, among which flumetron is relatively less likely to cause high intraocular pressure.
(6) Immunosuppressants: mainly cyclosporine A and FK506. local application of cyclosporine A can quickly control local inflammation and reduce the amount of hormone use. FK506 can inhibit IL-2 gene transcription and IgE synthesis signaling pathway. Experimental studies have shown that topical application of FK506 before the onset of allergic conjunctivitis can reduce the occurrence of allergic conjunctivitis and inhibit mast cell degranulation.
3.Desensitization therapy
This method is mainly used for seasonal allergic conjunctivitis, and its therapeutic effect is often not satisfactory for other subtypes of allergic conjunctivitis. Therefore, it is rarely used.
4.Cryotherapy
It is mainly used for spring conjunctivitis. It can lead to the degradation of a large number of mast cells thus allowing the condition to calm down over a period of time. Commonly used on the upper lid conjunctiva to lower the temperature to -80°C – 30°C for 30 seconds. Cryotherapy can be repeated 2-3 times.
5. Psychotherapy
Ocular allergic disease is an acute or chronic recurrent disease, and thorough treatment is often very difficult. Therefore, it causes greater psychological stress to some patients (especially children), and some psychological disorders may occur, which should be noted and, if necessary, a psychiatrist should be consulted.
6.Treatment of complications
Hereditary allergic keratoconjunctivitis often leads to conjunctival fibrosis and lid adhesions, and these can be treated to some extent by mucosal transplantation and fornix reconstruction. Some spring keratoconjunctivitis and ectopic keratoconjunctivitis can produce serious corneal complications that can jeopardize vision and can be treated with corneal transplantation if necessary.