变应性结膜炎的诊疗策略

doi:10.6040/j.issn.1673-3770.0.2017.174

摘要/Abstract

摘要： 变应性结膜炎是临床上常见的眼部疾病,患病率高达15%~40%,包括季节性变应性结膜炎、常年性变应性结膜炎、春季卡他性角结膜炎、特应性角结膜炎以及巨乳头结膜炎等。变应性结膜炎可影响患者的生活质量,严重者甚至可能致盲。近年来,泪液细胞学检查和泪液特异性蛋白检测为变应性结膜炎的诊断提供了新的手段。新型免疫抑制剂滴眼液在重症变应性结膜炎治疗中取得良好效果,变应原特异性免疫治疗在季节性和常年变应性结膜炎治疗中有良好前景。

关键词: 诊断, 治疗, 变应性结膜炎

Abstract: Allergic conjunctivitis is a common ocular disease, including seasonal allergic conjunctivitis(SAC), perennial allergic conjunctivitis(PAC), vernal keratoconjunctivitis(VKC), atopic keratoconjunctivitis(AKC), and giant papillary conjunctivitis(GPC). Allergic conjunctivitis can affect patients’ qualify of life and might even lead to blindness in severe conditions. Recently, many studies have reported new strategies for the diagnosis of allergic conjunctivitis, which include tear cytology and detection of allergen-specific IgE in tears, as well as other molecular tests. New types of immunomodulators are of great help in treating severe cases, and allergen-specific immunotherapy is gaining momentum for the management of SAC and PAC.

Key words: Diagnosis, Allergic conjunctivitis, Treatment

中图分类号:

R777.31

接英,卢红双. 变应性结膜炎的诊疗策略[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 31-36.

JIE Ying, LU Hongshuang. Allergic conjunctivitis: diagnosis and treatment.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(3): 31-36.

参考文献

[1] La Rosa M, Lionetti E, Reibaldi M, et al. Allgergic conjunctivitis: a comprehensive review of the literature[J]. Ital J Pediatr, 2013, 39(1):18.
[2] Rosario N, Bielory L. Epidemiology of allergic conjunctivitis[J]. Curr Opin AllergyClin Immunol, 2011, 11(15):471-476.
[3] Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its impact on Asthma(ARIA)2008 update(in collaboration with the World Health Oraganization, GA(2)LEN and AllerGen)[J]. Allergy, 2008, 63(Suppl 86):8-160.
[4] Wong AH, Barg SS, Leung AK. Seasonal and perennial conjunctivitis[J]. Recent Pat Inflamm Allergy Drug Discov, 2009, 3(2):118-127.
[5] Butrus S, Portela R. Ocular allergy:diagnosis and treatment[J]. Ophthalmol Clin North Am, 2005,18(4):1019-1032.
[6] La Rosa M, Lionetti E, Reibaldi M, et al. Alllergic conjunctivitis:a comprehensive review of the literature[J]. Ital J Pediatr, 2013, 39:18.
[7] Leonardi A, De Dominicis C, Motterle L. Immunopathogenesis of ocular allergy: a schematic approach to different clinical entities[J]. Curr Opin Allergy Clin Immunol, 2007, 7(5):429-435.
[8] Kari O, Saari KM. Diagnostics and new developments in the treatment of ocular allergies[J]. Curr Allergy Asthma Rep, 2012, 12(3):232-239.
[9] Leonardi A, Lazzarini D, Motterle L, et al. Vernal Keratoconjunctivitis-like disease in adults[J]. Am J Ophthalmol, 2013, 155(5):796-803.
[10] Saboo US, Jain M, Reddy JC, et al. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care centre[J]. Indian J Ophthalmol, 2013, 61(9):486-489.
[11] Jun J, Bielory L, Raizman MB. Vernal conjunctivitis[J]. Immunol Allergy Clin North Am, 2008, 28(1):59-82.
[12] Sangwan VS, Jain W, Vemuganti GK, et al. Vernal keratoconjunctivitis with limbal stem cell deficiency[J]. Cornea, 2011, 30(5):491-496.
[13] Guglielmetti S, Dart JK, Calder V. Atopic keratoconjunctivitis and atopic dermatitis[J]. Curr Opin Allergy Clin Immunol, 2010, 10(5):478-485.
[14] Bielory B, Bielory L. Atopic dermatitis and keratoconjunctivitis[J]. Immunol Allergy Clin North Am, 2010, 30(3):323-326.
[15] Power WJ, Tugal-Tutkun I, Foster CS. Long-term follow-up of patients with atopic keratoconjunctivitis.[J]. Ophthalmol, 1998, 105(4):637-642.
[16] Joseph J, Chen MD, Danielle S, et al. Atopic keratoconjunctivitis: A review[J]. J Am Acad Dermatol, 2014, 70(3):569-575.
[17] Leonardi A. Allergy and allergic mediators in tears[J]. Exp Eye Res, 2013, 117:106-117.
[18] Mimura T, Usui T, Yamagami S, et al. Relation between total tear Ig E and severity of acute seasonal allergic conjunctivitis[J]. Curr Eye Res, 2012, 37(10):864-870.
[19] Mimura T, Yamagami S, Kamei Y, et al. Specific IgE in tear fluid and features of allergic conjuntivitis[J]. Curr Eye Res, 2013, 38(9):917-925.
[20] Anderson DF, MacLeod JD, Baddeley SM, et al. Seasonal allergic conjunctivitis is accompanied by increased mast cell numbers in the absence of leucocyte infiltration[J]. Clin Exp Allergy, 1997, 27(9):1060-1066
[21] Leonardi A, Palmigiano A, Mazzola EA, et al. Identification of human tear fluid biomarkers in vernal keratoconjunctivitis using iTRAQ quantitative proteomics[J]. Allergy, 2014, 69(2):254-260.
[22] Pattnaik L, Acharya L. Acomprehensive review on vernal keratoconjunctivitis with emphasis on proteomics[J]. Life Sci, 2015, 128:47-54.
[23] Fujishima H, Okada N, Matsumoto K, et al. The usefulness of measuring tear periostin for the diagnosis and management of ocular allergic diseases[J]. J Allergy Clin Immunol, 2016, 138(2):459-467.
[24] OBrien TP1. Allergic conjunctivitis: an update on diagnosis and management[J]. Curr Opin Allergy Clin Immunol, 2013, 13(5):543-549.
[25] Mahvan TD, Buckley WA, Hornecker JR. Alcaftadine for the Prevention of Itching Associated with Allergic Conjunctivitis[J]. Ann Pharmacother, 2012, 46(7-8):1025-1032.
[26] Yaylali V, Demirlenk I, Tatlipinar S, et al. Comparative study of 0.1% olopatadine hydrochloride and 0.5% ketorolac tromethamine in the treatment of seasonal allergic conjunctivitis[J]. Acta Ophthalmol Scand, 2003, 81(4):378-382.
[27] Kari O, Saari KM. Updates in the treatment of ocular allergies[J]. J Asthma Allergy, 2010, 3:149-158.
[28] Pacharn P, Vichyanond P. Immunomodulators for conjunctivitis[J]. Curr Opin Allergy Clin Immunol, 2013, 13(5):550-557.
[29] Akpek EK, Dart JK, Watson S, et al. A randomized trial of topical cyclosporine 0.05% in topical steroid-resistant atopic keratoconjunctivitis[J]. Ophthalmol, 2004, 111(3):476-482.
[30] Daniell M, Constantinou M, Vu HT, et al. Randomised contraolled trial of topical ciclosporin A in steroid dependent allergic conjunctivitis[J]. Br J Ophthalmol, 2006, 90(4):461-464.
[31] Virtanen HM, Reitamo S, Kari M, et al. Effect of 0.03% tacrolimus ointment on conjunctival cytology in patients with severe atopic blepharoconjunctivitis:a retrospective study[J]. Acta Ophthalmol Scand, 2006, 84(5):693-695.
[32] Labcharoenwongs P, Jirapongsananuruk O, Visitsunthom N, et al. A double-masked comparison of 0.1% tacrolimus ointment and 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis in children[J]. Asian Pac J Allergy Immunol, 2012, 30(3):177-184.
[33] Amin HS, Liss GM, Bernstein DI. Evaluation of near-fatal reactions to allergen immunotherapy injections[J]. J Allergy Clin Immunol, 2006, 117(1):169-175.
[34] Vadlamudi A, Shaker M. New developments in allergen immunotherapy[J]. Curr Opin Pediatr, 2015, 27(5):649-655.
[35] Calderon MA, Penagos M, Sheikh A, et al. Sublingual immunotherapy for treating allergic conjunctivitis[J]. Cochrane Database Syst Rev, 2011, 7: CD007685. doi: 10.1002/14651858.CD007685. pub2.

相关文章 15

[1]	吴静,刘业海. 头颈部鳞状细胞癌的靶向治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 97-102.
[2]	沈勤峰,沈小燕,朱荣强,蒋斐斐,郎军添. 鼻内镜下中鼻甲功能性部分切除治疗慢性鼻窦炎76例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 82-85.
[3]	朱明娟,邢凯,亢泽峰,刘健. 甲状腺相关性眼病的诊断及治疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 110-113.
[4]	王坛,武珂,李连庆,宫丽丽. 皮下免疫治疗注射后出现全身不良反应的伴发因素及处理[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 71-74.
[5]	代亚错,李靖,万保罗,臧艳姿,黄颖铭. 个体化治疗咽喉部海绵状血管瘤二例[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 110-112.
[6]	刘义平,林远超. 负压引流防治腮腺术后涎瘘112例[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 65-67.
[7]	陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[8]	张桂敏,林鹏. 慢性鼻-鼻窦炎的内在型:从基础到临床[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 14-17.
[9]	覃纲,梁灼萍. 变应性真菌性鼻-鼻窦炎免疫治疗现状[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 23-26.
[10]	吴湘萍. 患者管理方式对变应性鼻炎舌下含服粉尘螨滴剂疗效的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 68-72.
[11]	王仙,李颖,赵博军. 息肉样脉络膜血管病变诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 103-106.
[12]	钟建文,刘大波,罗向前,黄振云,仇书要,程超,杨李强,易新华,曾锦鸿. 可穿戴设备在儿童阻塞性睡眠呼吸暂停诊断中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 30-33.
[13]	高进良,年婉清,李烁. 鼻内镜手术联合鼻用糖皮质激素治疗腺样体肥大性[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 38-42.
[14]	吕丹,李明霞,马兰枝,张馨元,肖浩,陈飞,刘均,李珍. 累及纵膈的头颈部丛状I型神经纤维瘤病两例[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 82-86.
[15]	李俏丽,李超,王薇,蔡永聪,孙荣昊,周雨秋,税春燕, 黄璐,涂静. 术后放化疗后复发并侵及侧颅底的原发性腮腺鳞状细胞癌一例[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 87-88.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed