“Suddenly my eyes hurt”: how to deal with inflammation
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Doctors named modern methods of treating conjunctivitis
Many common eye diseases are accompanied by inflammation. In addition, patients who have undergone operations on the organs of vision often experience inflammatory processes in the eyes. Treatment of such conditions is often accompanied by side effects, which makes life difficult for both patients and doctors. Ophthalmological experts spoke at a round table held in Moscow about how to effectively relieve inflammation and what new methods of therapy have appeared.
Conjunctivitis is one of the most common ophthalmological diseases. This is an inflammation of the mucous membrane of the eye caused by a virus, bacteria or allergic reaction, which is associated with noticeable discomfort and redness of the eyes. At the first visit, a patient with these characteristic symptoms is prescribed an antibiotic, corticosteroid, or nonsteroidal anti-inflammatory drug (NSAID). A follow-up visit is scheduled in a week – by this time the therapy should have an effect. If, at the first visit, damage to the cornea is noted, the patient cannot be released for seven days – a smear from the conjunctiva and culture are performed in order to detect keratoconjunctivitis. If such a diagnosis is made, the specialist will prescribe an antibiotic, NSAIDs and a restorative drug, but corticosteroids are not used. According to the head of the department of therapeutic ophthalmology of the Federal State Institution National Medical Research Center “MNTK” Eye Microsurgery ” named after. acad. S.N. Fedorov” of the Ministry of Health of the Russian Federation Dmitry Maichuk, treatment regimens for these diseases are currently changing. This is due to the presence of soft steroids in the arsenal of ophthalmologists and the emergence of combination drugs that contain both a steroid and an antibiotic. These drugs are easier to tolerate than older generations of steroids and can even be used in children as young as two years of age. And new drugs can be used both in the treatment of bacterial conjunctivitis and in the treatment of conjunctivitis of mixed etiology, which combines an infectious and allergic component and lasts a long time.
Another common inflammatory eye disease is uveitis. This inflammation of the choroid occupies up to 15% of the structure of all ophthalmological diseases. The cause of uveitis can be an infectious or systemic process, and inflammation can develop in any part of the choroid and spread to the retina and optic nerve. The prevalence of this disease can be up to 50–100 cases per 100 thousand population, with about 5–10% of cases occurring in children.
Chronic uveitis is more common than acute uveitis (in 50–60% of cases). In the chronic course of the disease, glucocorticosteroid therapy is most often used. “Many doctors are afraid to use steroid drugs for a long time. But we must remember that medicine is always a balance: either we remove all treatment and risk a severe exacerbation with irreversible complications, or we try to find a drug that will curb inflammation and at the same time have minimal side effects. Of these, we are most afraid of increased intraocular pressure, since it can lead to irreversible atrophy of the optic nerve of glaucomatous origin,” said Elena Drozdova, professor, head of the department of ophthalmology at the South Ural State Medical University of the Ministry of Health of the Russian Federation. According to her, in cases where uveitis activity is moderate or weak, treatment can begin with a mild steroid; and if there is intense inflammation, the doctor may prescribe an older generation of steroids as a first step, and then switch the patient to new ones, since they are less likely to cause an increase in intraocular pressure.
If a patient develops drug withdrawal syndrome during treatment, according to Professor Drozdova, it is necessary to return to steroid therapy and increase its volume at least twice, and discontinue it gradually. Once inflammation is minimized, your doctor may prescribe a non-steroidal anti-inflammatory drug for another month. To prevent recurrent uveitis, systemic therapy of the original disease is necessary – rheumatological or antiherpetic treatment, since it is impossible to cure chronic uveitis only with local therapy, eye drops, without eliminating the root cause.
Experts also paid attention to the topic of hypotensive operations – these are performed on patients, as a rule, with glaucoma, to preserve maximum vision if conservative treatment methods have stopped working. As Vadim Nikolaenko, professor of the Department of Otorhinolaryngology and Ophthalmology of the Faculty of Medicine of St. Petersburg State University, Deputy Chief Physician for Ophthalmology of St. Petersburg State Budgetary Institution “City Multidisciplinary Hospital No. 2” said, despite the emergence of new instruments (glaucoma drainages, shunts and valves), the leading surgical method in ophthalmology throughout the world remains filter-type operations, during which it is important to maintain a healthy ocular surface. Therefore, it is very important that the preparations contain excipients that ensure their high tolerability and preservation of the ocular surface.
Newspaper headline:
Look – the inflammation has gone
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