RU2321378C1 - Therapy and prophylaxis method for preventing blepharoconjunctivitis recurrence related to demodicosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves instilling derinate solution into eye 30 min before treating eyelid edges with acaricide preparation during the whole 3 weeks long treatment course. To prevent disease recurrence, the derinate instillation course is repeated in spring and autumn during 10-14 days after having finished treatment course.

EFFECT: reduced toxico-allergic complications frequency.

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Description

The invention relates to ophthalmology, in particular to the conservative treatment of demodectic blepharoconjunctivitis (DBK).

It is known that the proportion of demodecotic blepharoconjunctivitis among inflammatory diseases of the anterior part of the eye is from 30 to 35%, and in the etiological structure of blepharoconjunctivitis, ocular demodicosis is detected with a frequency of 81.7-92% (Gumerova E.I. Laboratory diagnostic criteria for eye demodicosis / Questions ophthalmology // Jubilee scientific and practical conference: Materials, - Omsk. 2002.- Issue 4 - p. 44-45; Rozko TE Clinical features of the diagnosis and treatment of blepharoconjunctivitis of demodectic etiology. sciences Krasnoyarsk. - 2003 - 24 p.). As a rule, systemic and local cellular immunodeficiency, violations of humoral immunity, which contribute to the transition of tick-borne invasion from obligate parasitic carriers to the state of the disease, usually lead to DBC. Under these conditions, the clinical manifestations of DBK actively provoke toxic-allergic and pathological immune reactions that occur in response to the waste products and the breakdown of ticks, as well as metabolites of damaged eyelid tissues (Maychuk, Yu.F. Parasitic eye diseases. - M .: Medicine, 1988. - 288 p .; Ilyin II, Loskutov IA Eye manifestations of demodicosis // Bulletin of Dermatology and Venereology. - 1992. - No. 2. - P.50-52).

The problem of eye demodicosis is associated not only with the widespread prevalence of this disease, but also with the existing difficulties of its treatment. The main treatment for DBK is acaricidal. But among them, both the long-known ones - zinc-thiol ointment, and modern means - ointments: glycoderm, demalon; blepharogel-2 and alcohol solutions of calendula and wormwood are not always effective enough. In addition, all acaricides, due to their toxicity, reduce the detoxifying functions of the immune system and cause local toxic-allergic reactions (Zatsepina ND, Maychuk Yu.F., Semenova G.Ya. Eye damage in demodicosis: Method. Recommendations. - M ., 1983. - 17 pp .; Yakovleva L.V., Cherednichenko L.P., Zhitenko N.A. To the diagnosis and treatment of demodectic blepharoconjunctivitis // Therapeutic methods of treatment in ophthalmology. Scientific and Practical Conf. 18-19 September 2003: Materials. / Under the editorship of V.V.Bakutkin. - Saratov, - 2003. - P.46-47).

To remove the allergic component in DBK, glucocorticoids, for example, dexon, prenacid, are prescribed topically. However, topical corticosteroids inhibit local immunity and lead to an increase in tick numbers and can also cause layering of fungal infections or bacterial superinfection (Sakuntabhai A., Timpatanaponol P; Topical steroid induced chronic demodicidoses // J. Med. Assoc / Thailand -1991 - Vol. 74. - N2. - PP.116-119.

To increase the effectiveness of treatment for DBK, it is proposed to use miramistin, which along with antibacterial and anti-inflammatory activity, has immunostimulating properties for treating the edge of the eyelids (Padalka N.A. New in the treatment of demodectic blepharoconjunctivitis // Actual problems of ophthalmology. Anniversary symposium, 2000: Abstract. - M .: Economics. - S.398-399). The disadvantages of including miramistin in complex therapy of DBK are the possibility of enhancing allergic reactions; discomfort in the eyes - burning, redness after its use; the immunotropic effects of miramistin are devoid of a pathogenetic orientation and are limited, mainly, to stimulation of the functional activity of cellular immunity, primarily at the level of its non-specific link (Chuchalina A.G., Vyalkov A.I., Belousova Yu.B., Yasnetsova V.V. the use of medicines. - Moscow, 2003, issue IY. p.577). In addition, all immunostimulating effects on the background of instability and imbalance of the relationship between the components of local immunity can lead to prohibitive inhibition and exhaustion in any pathological process (K. Lebedev, I. Ponyakina, I. Immune insufficiency. Moscow. Medical book. N. Novgorod, Publishing House of the Novosibirsk State Medical Academy, 2003. - p. 354). The closest analogue - the prototype of the proposed method is a method of treating DBK with phased local use of acaricidal agents (zinc-ichthyol ointment and alcohol tincture of wormwood) and an immunostimulating drug - propolis (Aznabaev A.G., Malkhanov V.B., Gumerova E.I. Demodecosis of the eyes. - Ufa, 2004. p. 68), which consists in the fact that after a ten-day local treatment of the edges of the eyelids with zinc ichthol ointment and alcohol tincture of wormwood for the next 14 days, the treatment of the eyelids continues with alcohol tincture of propolis, which provides immunostimulating her action. After completion of this treatment regimen, treatment of the eyelids with propolis is repeated 1 time per week for one year. However, this method of immunostimulating treatment with propolis as part of the complex therapy of DBK has several disadvantages:

1. The possibility of developing allergic reactions under the influence of propolis tincture, since this bee vital product contains resins, essential oils, plant pollen with allergenic properties (Borisevich S.N., Zvinevich V.I. Allergic dermatitis after external use of propolis. Health Care in Belarus . 1977. - p. 78-79).

2. The need for an additional sensitivity test before prescribing propolis (Aznabaev MT, Malkhanov VB, Gumerova EI Demodecosis of the eyes. - Ufa. 2004. p. 68).

3. Propolis does not increase the activity of detoxifying systems of local nonspecific immunity, therefore tick toxins and toxic metabolites of damaged eyelid tissues are not excreted, which are the main allergenic factors in DBK.

4. The possibility of developing chronic aseptic inflammation of the conjunctiva of the edge of the eyelids under the influence of prolonged use (for 1 year) of the alcohol-containing component of propolis tincture.

5. The occurrence of relapse of DBK in almost 20% of patients.

Objective: to offer a method for the comprehensive treatment of DBK. The technical result is an increase in the quality of treatment and the prevention of relapses of the disease by using an immunomodulating drug - derinate in the conservative therapy regimen. Derinat has the immunological ability to modulate local immunity - to increase the initially low and reduce the increased level of immune activity and normalize the activity of detoxifying immunity systems (Kaplina E.N. in the book. Derinat - a unique Russian immunomodulator. 2004. 40c.).

The technical result is achieved by the fact that 30 minutes before acaricidal treatment of the edges of the eyelids, for example, with zinc-ichthyol ointments, "Demalon" 1-2 drops of a 0.25% solution of derinate are installed in the eyes. The treatment procedure is performed 1-2 times a day, daily for 3 weeks. Subsequently, for the prevention of recurrence of DBK during the year of instillation into the eye of derinate, 2 times a day are repeated in courses of 10 days in spring and autumn, when there is a seasonal decrease in the activity of immune defense mechanisms.

The advantages of the proposed method:

- the detoxifying potential of the immune system of the eyes increases, which reduces the intensity of local intoxication and autointoxication;

- significantly reduces the risk of allergic reactions to both used acaricides, and to the vital products of ticks and toxic metabolites of damaged eye tissues;

- reduced the time to stop signs of inflammation by 4-7 days;

- decreases the frequency of relapse of DBK by 5 times.

To study the effectiveness of the proposed method of treatment was formed 3 groups of patients with DBK of 15 people (30 eyes each). In the 1st group of patients, the eyelid edges were treated with zinc-ichthyol ointment and an alcoholic solution of wormwood with recommendations to subsequently continue the treatment of the eyelids with propolis once a week continuously for one year. In patients of the 2nd group, eyelids were treated with zinc-ichthyol ointment, with installations in the eye 30 minutes before treatment with a 0.25% solution of derinate. The duration of treatment is 3 weeks. Subsequently, over the course of a year, patients were recommended course (10-14 days) instillation in the eye of 0.25% solution of derinate in early spring (March-April) and late autumn (October-November). In patients of the 3rd group, the ciliary edge of the eyelids was treated with the Demalon acaricidal eye ointment for 3 weeks in combination with derinate installations in the same sequence, mode and duration as in the 2nd observation group. The observation period is 1.5-2 years.

A comparative analysis of the treatment results is presented in table No. 1

Analysis of the obtained data confirms the advisability of including installations in the eye of a 0.25% solution of derinate to increase the therapeutic efficacy of acaricides, reduce allergic side effects and the frequency of relapses of DBK.

Example No. 1. Patient K., 68 years old, was denied surgical treatment of age-related mature cataracts due to the presence of severe clinical manifestations of DBK and the risk of postoperative inflammation and decreased vision. Over the course of the year, the patient received repeatedly various acaricidal treatment regimens: treatment of the eyelid edge with demalon ointment and calendula alcohol solution; zinc-ichthyol ointment in combination with an alcoholic solution of wormwood and propolis. Relapses occurred every 2-3 months after any treatment. To prepare for the operation and stop the clinical manifestations of DBK, the patient was treated with the ointment "Demalon" in combination with installations in the eye of a 0.25% solution of derinate in the eyelids for 3 weeks. As a result of treatment, there was a complete relief of the phenomena of DBK. In September 2005, a week after the end of the course of treatment, the patient was successfully performed cataract extraction surgery with implantation of an artificial lens. In the postoperative period (November 2005 and March 2006), she received repeated courses of anti-relapse treatment only with derinate. With a follow-up period (up to 10 months), recurrence of DBK is not registered.

Example No. 2.

Patient S., 27 years old. For 1.5 years, he suffers from chronic DBK with a constant exacerbation of the disease despite repeated treatment with acaricides (zinc-ichthyol ointment, metragil solution, alcohol solutions of calendula, propolis, Oftagel-2, Demalon ointment). Upon treatment, it was revealed: thickening and hyperemia of the edges of the eyelids, hyperemia of the conjunctiva of the eyelids and eyeball, serous-mucous discharge. Biomicroscopic point defects of the epithelium on the cornea. Subjectively expressed corneal syndrome. The treatment was carried out: the edges of the eyelids were treated with Demalon ointment 1 time per day and instillation of 0.25% derinate into the eyes — the frequency of installations was increased to 2 times per day. After 3 weeks - signs of inflammation of the conjunctiva and the edges of the eyelids, the corneal syndrome disappeared, the integrity of the corneal epithelial layer was restored. Over the next year (in spring and autumn), the patient repeated course treatment only with derinate. With a follow-up period of 1.5 years, recurrence of DBK did not occur.

Table number 1
Comparative analysis of the effectiveness of the use of complex (acaricidal and immunomodulating) treatment of demodectic blepharoconjunctivitis. No. Observation groups Number of eyes Treatment results Terms for stopping signs of inflammation Allergic reactions,% Annoying effect,% Relapse rate of DBK within 1 year after
treatment% one. 1st group: (zinc-ichthyol ointment, (alcohol solutions of wormwood and propolis) thirty 16-17 days 13 21 33.3 2. 2nd group: (zinc-ichthyol ointment, derinat). thirty 10-12 days - - 6.6 3. 3rd group: ointment "Demalon", derinat. thirty 10-13 days - - 6.6

Claims (1)

A method for the treatment and prevention of relapses of demodectic blepharoconjunctivitis, including topical use of acaricidal agents and immunomodulators, characterized in that 30 minutes before the eyelid edge treatment with demalon ointment, 0.25% derinate solution is instilled into the eyes for 3 weeks, after which the end of treatment with derinate instillation is repeated in courses of 10-14 days in spring and autumn during the year.