The past decade has seen a marked increase in the frequency of different forms of allergies in children, including allergic inflammation of the mucous membrane of the eye (conjunctiva).Allergic conjunctivitis can be a year-round, seasonal or related to exposure to irritants and allergens.However, regardless of its form, the symptoms of conjunctivitis (tearing or dry eyes, burning, pain, itching, redness) causing a lot of suffering children and require treatment involving removal of the allergen to prevent further contact with the allergen and the prescription of medicines.
for medical treatment of allergic conjunctivitis used two groups of drugs: drugs and the common action of local dosage forms (eye drops and ointment). Content
Of the total drug in the treatment of allergic conjunctivitis used antihistamine ketotifen and the first, second and third generations.
Ketotifen (Zaditen, ketasma, ketof) in the form of a syrup for oral administration (allowed from 6 months) and tablets (6 years) is used to eliminate and prevent itching caused by allergic conjunctivitis.Ketotifen is contraindicated in case of hypersensitivity to it.Because of side effects of the drug often caused drowsiness, dizziness, fatigue, dry mouth, abdominal pain, nausea and vomiting.Rarely are allergic reactions, anxiety and convulsions (especially in infants), urinary disorders.
From antihistamines in pediatric practice most commonly prescribed:
Antihistamines are appointed in all types of allergic conjunctivitis, and can eliminate or reduce the severity of symptoms such as swelling of the eyelids, itching and watery eyes.But they are often not used in isolated allergic conjunctivitis, while hay fever and other allergic diseases (asthma, atopic dermatitis), accompanied by the addition of symptoms of conjunctivitis.In infants suprastin applied (with the month, it has a calming and sedative side effects) and Zyrtec (from six months) in children older than one year can be used as Claritin and Aerius syrup.For children older than 6 years more convenient to use pills.
For topical use in the form of eye drops, gels and ointments are used: K
artificial tear preparations include:
Drugs in this group are the aqueous solutions of the biologically inert polymers, which, after the instillation of the eye to form a film.The film is formed not only the preparation, but also the elements of his own tears, which is held polymer.Artificial tears have a high viscosity due to which they do not drain immediately after instillation, and for some time covered the cornea and conjunctiva (up to 45 minutes after instillation), protecting the eyes from exposure to the allergen and moisturizing it.
Artificial tears facilitate or eliminate symptoms such as:
In addition, they take irritating other eye drops, and some of them are able to accelerate epithelization (healing) of the surface of the eye tissue - when microdefects erosion and trophic changes of the cornea.Effect of preparations of artificial tears develop within 3-5 days after the start of application.
Children officially permitted and optimal use of the drug in Lakrisin possessing all positive qualities of artificial tears and devoid of such shortcomings, as a violation of the tear film stability and blurred vision in a short time after instillation.Similarly, action the eye drops and eye gel sisteyn Vidisik.
Of the other drugs used:
But these drugs, unlike Lakrisin contain benzagesoniya chloride, which violates the stability of the tear film and is therefore not recommended for children who use soft contact lenses.
contraindication to artificial tear preparations are individual reactions of intolerance.Because side effects may experience eye irritation, discomfort, blurred vision.
dekognestantam To apply the eye drops:
Dekognestanty or vasoconstrictors - are drugs that cause constriction of blood vessels, thereby removed symptoms of allergic conjunctivitis such as red eye and eyelid edema, reduce the burning, itching and watery eyes.Vasoconstrictors topical have strict age limits and restrictions on the dosage and frequency of administration.Drugs in this group can not be used in children younger than 6 years of age, they are assigned by 2-4 times a day for 5-7, a maximum - 10 days.
In children under 6 years vasoconstrictors can be assigned under certain circumstances, but only by a doctor - with caution and under strict control.And, as vasoconstrictors only relieve some symptoms of allergies, but no effect on histamine and other allergic inflammatory actives, drugs with vasoconstrictor effect administered in combination with antihistamines in common and (or) the local action.
From vasoconstrictor most rapid and long-lasting effect is oxymetazoline (pupate).
Side effects of vasoconstrictors:
for topical application in the form of eye drops, antihistamines are available as follows:
Antihistamines local action - one of the most effective drugs for the treatment of seasonal and perennial allergic rhinitis.Eye drops containing antihistamines are given by a positive effect, markedly suppressing or completely eliminating all manifestations of allergic conjunctivitis (swelling, redness, itching, burning, dryness, tearing, etc.).Drops relieve the itching is very good (more than 90% of patients), so conjunctivitis, accompanied by severe itching, their appointment is necessary.Furthermore, eye drops reduce symptoms of allergic rhinitis, as the drug after the instillation through the lacrimal duct is flagged in the nasal cavity.
Unlike antihistamines systemic effects (tablets and syrups), eyedrops devoid of undesirable side effects (drowsiness and others.).The effect of the drug develops within 3-5 minutes after instillation and remains until 10 hours.
contraindications to the use of drops with antihistamines is the only individual intolerance of components and age restrictions (levocabastine - 2 years, prescribed by a doctor and possibly earlier; azelastine - 4 years).Because of side effects occasionally observed transient burning sensation.
Stabilizers fat cell membranes, along with topical antihistamines - the most popular drugs for the treatment of allergic conjunctivitis.Paediatric use:
Medicinal substances prevents the mediators (bioactive substances responsible for the allergy) from mast cells.The effect of the use of stabilizers in the form of membranes to remove or reduce the major symptoms of conjunctivitis develops slowly (within 3-4 days), but lasts longer than the effect of antihistamines.
Membrane Among the side effects in the form of eye drops may occur giperchuvstvtielnost (redness, swelling, burning and foreign body sensation in the eyes).The development of hypersensitivity reactions require immediate discontinuation of the drug, and is a contraindication to its further use.Restricts the use of membrane stabilizers and age Indications: The preparation of sodium cromoglycate and kromogesal not recommended for use in children younger than 4 years old, Lodoxamide allowed from 2 years.Several drops of the same trade name but from different manufacturers, may contain as a preservative benzalkonium chloride: such drugs can not be buried in the period of wearing soft contact lenses.
In allergic conjunctivitis used drops containing the drug to multilateral action - anti-allergic (antihistamine), membrane-stabilizing and anti-inflammatory:
Allergodil blocks H-1 and H-2 histamine receptors, inhibits mast cell degranulation and the release of these inflammatory mediators.The maximum effect developed after 5 days of use.Not recommended for children up to 4 years.Contraindications Individual hypersensitivity.
Nedocromil primarily used to treat itching associated with allergic conjunctivitis.Permitted 2 years.Side effects are rare (swelling, feeling of irritation).Contraindications Hypersensitivity.
Olopatadin - is a leader in the use of the frequency of allergic diseases of the eye.It has immediate effect immediately after instillation, continued for 8 hours.Approved 3 years.Occasionally olopatadina application may be accompanied by a sense of light burning.
Cyclosporin A a positive effect in the treatment of severe allergic eye diseases (vernal keratoconjunctivitis and atopic keratoconjunctivitis).It is also used in cases where an allergic eye disease can not be any other therapy.The drug is contraindicated in the presence of hypersensitivity to it;in the case of additional bacterial infection (purulent conjunctivitis);If the kidney function, liver;with hypertension.It may give severe side effects (tremor, weakness, headache, adverse effects on the kidneys, high blood pressure, etc.).
NSAIDs do not belong to the basic anti-allergic drugs, and are not always used.However, they are able to eliminate itching and pain in the eyes caused by allergies, to reduce the swelling.In Pediatrics officially not allowed due to insufficient knowledge of the action on the child's body, but still used - mainly for the integrated treatment of severe keratoconjunctivitis spring.According to the testimony of the individual child to the ophthalmologist may prescribe the drug diclofenac sodium in the form of eye drops (naklof).
Side effects: burning sensation, itching, redness, blurred vision after instillation, with prolonged use, the formation of corneal ulcers.Naklof contraindicated in the presence giperchuvstvtitelnosti to diclofenac and aspirin.
Corticosteroids for local use is very effective in the treatment of allergic diseases.They have high anti-inflammatory atkivnostyu, but are the first drugs in the treatment of allergic conjunctivitis due to side effects (increased intraocular pressure, joining infections). topical corticosteroids in children in the form of eye drops and ointments are assigned in case of failure of other drugs and chronic allergic eye diseases.
preparations of topical corticosteroids in pediatric ophthalmology:
Children corticosteroid drugs are used only on prescription, and in the case of prolonged use (10 days) is recommended periodic eye exam to control intraocular pressure.
These include drops, providing admission to the cornea and other eye tissues of vitamins and other essential nutrients, thereby accelerating the healing process of micro traumas, erosions and ulcers.
Children most often used emoksipin.
Eye drops and ointments containing an antibacterial drug is prescribed only in the case of secondary bacterial infection and the development of purulent conjunctivitis.The most popular are the following tools:
For the treatment of allergic conjunctivitis produced a lot of combination products containing several active substances and have thus simultaneously multiple actions.The effect of the combined drugs and side effects caused by their constituents.Below is a look at some of the drugs.
allergoftal - eye drops with vasoconstrictor (due nafazolina hydrochloride) and antihistamine (due antazoline phosphate) action.Contraindicated in early childhood (up to 6 years) with hypertension, heart disease, the presence of intolerance to one of the components.
spersallerg - eye drops containing a vasoconstrictor (tetrazolina hydrochloride) and an antihistamine (antazoline hydrochloride).Can be used in young children (for annotations - 2 years for other purposes ophthalmologist possibly earlier).
Kromozil (drop) - their composition includes a vasoconstrictor drug (tetrazolina hydrochloride) and mast cell stabilizer (cromolyn sodium).It has a minimum of side effects, and is used with virtually no restrictions.Compatible with soft contact lenses.
Nafkon A (drop) - includes a vasoconstrictor (nafazolina hydrochloride) and an antihistamine (pheniramine maleate).Allowed to 12 years.
Garazon (drop) - contains corticosteroids (beclomethasone) and an antibiotic (gentamicin).Permitted 2 years.
Okumetil (drop) - contains a vasoconstrictor (naphazoline), antihistamines (diphenhydramine) and antiseptic (zinc sulfate).Permitted 2 years.
treatment regimen, the dosage, frequency of administration, and duration of use are determined individually for each child.Appointments must do allergist or ophthalmologist, ideally desirable consultations (including re) both professionals.
Generally speaking, for the treatment of moderate seasonal allergic conjunctivitis in children are most effective and relatively safe following scheme:
treatment of allergic conjunctivitis in a child should only be undertaken by a doctor's appointment, after inspection and survey when allergic origin conjunctivitis will be confirmed.A prerequisite is to identify the cause and significant allergen and activities for its elimination (elimination), because in many cases, it is sufficient for the recovery of the child, and medical treatment is not required, or the amount it will be reduced.