Medicated conjunctivitis

Allergic eye reactions caused by drugs, referred to as adverse drug reactions or "drug-induced eye disease" (drug-induced allergic conjunctivitis), are one of the most common manifestations of allergic eye damage.

The frequency and severity of drug complications from the organ of vision are continuously increasing as the arsenal of biologically active drugs increases. Among the factors determining the high level of drug complications, the following should be noted:

1. an increase in the consumption of medications, classified as pharmacomania;
2. widespread self-medication;
3. insufficient or delayed medical information about possible drug complications;
4. polytherapy without taking into account drug interactions.

Side effects and drug complications from the eye are observed earlier and more often than from other organs, and sometimes completely isolated.

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Causes of allergic conjunctivitis

Allergic reactions caused by drugs are usually divided into three groups according to the speed of development. Acute reactions occur within the first hour after the administration of drugs (acute drug conjunctivitis, anaphylactic shock, acute urticaria, Quincke's edema, systemic capillary toxicosis, etc.). Subacute drug reactions develop within 24 hours after the administration of drugs. Protracted reactions appear over several days and weeks, usually with prolonged local use of drugs. This type of eye allergic reactions is the most common (90%).

Allergic eye lesions may occur not only with local application of drugs, but also with the introduction of various drugs internally or parenterally. Contact treatment of eye diseases (drops, ointments, films, electrophoresis, phonophoresis, contact lenses) can cause a general allergic reaction in the form of urticaria or widespread dermatitis along with local manifestations of drug allergy. At the same time, with the introduction of drugs internally or parenterally, a peaked eye lesion without a general allergic reaction may occur.

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Symptoms of drug-induced conjunctivitis

The most common clinical form of ocular drug allergy is allergic conjunctivitis, which can often be isolated. The mucous membrane of the conjunctiva is abundantly vascularized, rich in reticuloendothelial cells, is exposed to external factors and is closely related to the state of the entire organism.

Acute allergic conjunctivitis (or conjunctival edema) develops within the first 6 hours after administration of the drug in patients previously sensitized to it.

Rapidly growing vitreous chemosis of the conjunctiva of the eyelids and the eyeball is accompanied by severe itching and abundant mucous discharge. In particularly severe cases of acute drug-induced conjunctivitis, the mucous membrane of the eyelids is eroded in places. In rare cases, an allergic reaction is accompanied by membranous conjunctivitis.

The most common cause of acute conjunctivitis are antibiotics - syntomycin, monomycin, etc.

Conjunctival hyperemia - a small peripheral injection of the vessels of the eyeball with a characteristic uneven caliber of the conjunctival vessels and the episclera at the limbus - most often indicates general sensitization caused by drugs of general action. Subjective complaints of patients about itching, stinging, burning prevail over objective symptoms and are often not taken into account by ophthalmologists and therapists until signs of a general allergic reaction appear (for example, dermatitis). The vascular reaction is more violent and can be accompanied by subconjunctival hemorrhages. A similar reaction is caused by sex hormones when administered parenterally, especially prolonged-action drugs.

Papillary hypertrophy of the conjunctiva is sometimes very severe, resembling catarrh in appearance, and usually occurs only after prolonged topical use of an allergen. Having appeared against the background of drug treatment, it progressively increases, accompanied by itching, sometimes significant, and slight swelling of the mucous membrane if the allergen continues to act. Usually, the threadlike mucous discharge can be replaced by mucopurulent and resemble bacterial conjunctivitis. This most common form of conjunctivitis develops with an allergy to various drugs, but more often to antibacterial or antiviral drugs. As a rule, the allergy develops after a long (2-4 weeks) topical use of the allergen drug.

Follicular conjunctivitis is typical for an allergic reaction of the adenoid subepithelial tissue of the conjunctiva. It develops relatively slowly (weeks, months) and regresses just as slowly after the drug that caused the disease is discontinued. Subjective sensations are scanty, limited to a feeling of clogged eyes, while there is usually no itching. Often, a doctor diagnoses such a pathology during an examination, although the patient does not complain at all. There is practically no discharge, unless a bacterial infection joins. Follicles initially appear in the area of the lower transitional fold and lower cartilage, in places of greatest contact with drugs. Later, they can be found in the area of the upper transitional fold, upper cartilage, on the conjunctiva of the sclera at the limbus, and even in the limbus itself. As a rule, follicular conjunctivitis develops with sensitization to miotics (pilocarpine, fosfacol, armillum, tosmilen, eserium) and mydriatics (astrogyl, scopolamine), therefore it is often unilateral. A combination of papillary and edematous forms occurs, especially with sensitization to several simultaneously or sequentially used medications.

Treatment of drug-induced conjunctivitis

The main thing in treating drug allergies is to stop taking the “culprit” drug or switch to the same drug without a preservative.

After discontinuing the allergen, in acute cases, use Allergoftal or Sperzllerg eye drops 2-3 times a day; in chronic cases, use Alomid, Lecromin or Lecromin without preservatives 2 times a day. In severe and protracted cases, there may be a need to take antihistamines orally, 2% sodium cromoglycate solution or Alomid 4-6 times a day.