Beware of allergic eye diseases in spring

This is the 4234th article of Da Yi Xiao Hu

Spring has arrived as promised. We wandered in the sea of ​​flowers. Look at this one, it's beautiful. Look at that one, it's also beautiful. The beautiful sea of ​​flowers has different expressions and various shapes: hundreds of bees are buzzing on the flowers, butterflies of all sizes are flying around... The beautiful scenery of spring makes people linger, but various seasonal allergic diseases also come with it. Today we will talk about this annoying spring allergic eye disease. When the skin around the eyelids and the conjunctiva on the surface of the eye come into contact with certain allergenic particles suspended in the air, an allergic reaction can occur. These allergenic substances are medically called "allergens." After these allergens enter the eyes, they combine with mast cells in the conjunctiva, causing mast cells to release histamine, resulting in symptoms of redness, swelling, and itching. If you get rid of the allergens in time, the symptoms can be relieved or even disappear. If you continue to contact, other cells in the skin around the eyelids and conjunctiva will also participate in the allergic reaction, causing the patient's symptoms to persist or worsen. This article introduces two common spring allergic eye disease prevention and treatment tips for readers.

1. Spring keratoconjunctivitis

It is a seasonal recurrent immune conjunctivitis, also known as spring catarrhal conjunctivitis. It attacks in spring and summer and eases in autumn and winter. It is more common in children and adolescents under 20 years old, more common in males, and often affects both eyes. It occurs every year and can last for 5 to 10 years. It is self-limiting.

1. Causes

Allergens may be pollen, microorganisms, animal feather powder, dust mites, mold, animal dander, cosmetics, cotton and linen products, etc. It may be the result of the combined effects of type I and IV hypersensitivity reactions.

2. Clinical manifestations

The main symptoms are itchy eyes, photophobia, tearing, foreign body sensation, and a large amount of sticky secretions. The symptoms are aggravated at night. There may be a family history of allergies. There are three clinical types: palpebral conjunctival type, limbal type, and mixed type.

1. Palpebral conjunctival type The lesions are mainly located in the upper palpebral conjunctiva. At the beginning, it is manifested as congestion with a small amount of mucous secretions; later, typical flat and thick papillae of the palpebral conjunctiva may appear, resembling cobblestones. The bulbar conjunctiva is typically dark red.

2. Limbal type: Small papillae appear on both the upper and lower eyelid conjunctiva. The important manifestation is the presence of yellow-brown or dirty red colloid hyperplasia at the limbus, which is more obvious at the upper limbus.

3. Mixed type: The above two manifestations exist at the same time.

All types of corneal lesions may cause corneal damage to varying degrees, manifested as punctate epithelial defects, shallow corneal ulcers in a few cases, and pannus in some cases.

3. Diagnosis and differential diagnosis

The diagnosis can be made based on ① the disease is more common in young males, with seasonal recurrences and extreme itching; ② the hyperplasia of the conjunctival papillae of the upper eyelid presents as flat cobblestone-like growths or colloid hyperplasia of the corneal margin; and ③ the presence of more than 2 eosinophils per high-power field of view in the conjunctival scraping under a microscope.

Differential diagnosis:

Giant papillary conjunctivitis: There are giant papillae on the palpebral conjunctiva, with a history of wearing contact lenses, and no seasonality.

4. Treatment

1. There is no cure for this disease, but it is self-limiting.

2. Use glucocorticoid eye drops, but be careful about glucocorticoid glaucoma caused by long-term use.

3. Use mast cell membrane stabilizers, such as 4% sodium cromoglycate eye drops, 4 times a day.

4. Use immunosuppressant eye drops, such as 1% cyclosporine A eye drops.

5. The use of non-steroidal hormones, such as diclofenac sodium eye drops, etc.

6. If accompanied by skin allergic inflammation, apply corticosteroid ointment.

7. Apply cold compress twice a day to relieve symptoms.

5. How to prevent allergic conjunctivitis?

First, we should improve the living environment, thoroughly clean the indoor environment, reduce dust, pay attention to indoor ventilation, change bed sheets and pillowcases frequently, and avoid keeping pets to reduce the impact of allergens. For those who are allergic to outdoor antigens such as pollen, try to reduce outdoor activities or use goggles in the season with a lot of pollen. Secondly, we should exercise, strengthen our physical fitness, have a regular life and work schedule, and pay attention to a healthy and appropriate diet, which can increase the body's potential to fight allergic attacks and reduce and slow down allergic attacks. Patients with seasonal allergic conjunctivitis can use some mast cell stabilizer eye drops, such as sodium cromoglycate, before the arrival of spring and summer, which can play a preventive role.

2. Bubble keratoconjunctivitis

It is common in infants and adolescents, and often occurs in children who are weak, malnourished, living in a poor environment, or recovering from a fever. It mainly occurs in spring and summer. Bubble keratoconjunctivitis is a delayed allergic disease caused by microbial protein. It is characterized by repeated infiltration of nodular cells under the epithelium of the conjunctiva and corneal limbus, ulcers formed after the central lesion falls off, and local congestion around the nodules. The disease can heal itself, but it is very easy to relapse. Especially for patients with both eyes, the lesions alternate and recur, which can last for months or even years. The prognosis is generally good. When the lesion is located in the central part of the cornea, it can cause varying degrees of visual impairment.

1. Causes

Follicular conjunctivitis is a conjunctival lesion caused by the body's delayed immune response to microbial proteins. The most common microorganisms causing this disease are Mycobacterium tuberculosis and Staphylococcus aureus, followed by Staphylococcus epidermidis, Candida albicans, etc.

2. Clinical manifestations

1. Symptoms

(1) It is more common in children with malnutrition and weak constitution. At the onset, there are irritating symptoms such as foreign body sensation and tearing.

(2) If small bubbles are formed on the cornea, there may be severe symptoms such as photophobia, tearing, and blepharospasm.

2. Physical signs

The bulbar conjunctiva appears gray-red, 1 to 4 mm in diameter, with surrounding congestion, slightly raised solid blisters, the top of which is prone to festering and forming ulcers.

When the cornea is affected, localized opacities may form. Repeated attacks of herpes may progress to the center of the cornea, and new blood vessels will grow in, which is called fascicular keratitis.

3. Diagnosis

The diagnosis can be made based on the typical small round solid nodular vesicles at the corneal limbus or conjunctiva, and localized congestion around the lesions.

4. Treatment

1. Apply topically 0.1% rifampicin eye drops or 0.5% streptomycin eye drops and 0.05% dexamethasone eye drops alternately, and add glucocorticoid eye ointment at night.

2. Take vitamin B, cod liver oil, calcium supplements, etc. orally.

3. Actively look for the cause of the disease and treat it accordingly.

4. Pay attention to physical exercise, strengthen your physical fitness, and improve nutrition and personal hygiene to help recover from the disease.

5. For stubborn recurrent cases, 1% cyclosporine and antibiotic eye drops can be used in combination with eye drops.

5. Prevention of bullous keratoconjunctivitis

Bubble keratoconjunctivitis is a conjunctival lesion caused by delayed immune response to microbial proteins. It is characterized by the formation of conjunctival bubble nodules and is more common in malnourished and weak children. Its prevention should include strengthening nutrition, adjusting diet, getting more sunlight and fresh air, and paying attention to physical exercise to strengthen physical fitness. Desensitization treatment can be used for stubborn cases that are prone to recurrence.

Author: Xu Guoxing , Professor of Ophthalmology (Doctoral Supervisor) at the First Affiliated Hospital of Fujian Medical University, Director of Fujian Eye Research Institute, State Council Government Special Allowance Expert, Minjiang Science Communication Scholar