Allergic seasonal blepharoconjunctivitis therapy optimization in conditions of dry eye and meibomian glands dysfunctions

Purpose: to evaluate the effectiveness of various therapeutic approaches to the treatment of seasonal allergic blepharoconjunctivitis (SABC) in patients with dry eye syndrome (DES) and meibomian gland dysfunction (MGD). Material and methods. 80 patients with SABC, DES and MGD were examined; 1^st-group patients (40 people) received 0.1% olopatodine hydrochloride (2 times a day, 5 weeks), 0.18% sodium hyaluronate (3 times a day, from the 8^th day of therapy, 4 weeks) instillations and eyelid hygiene (EH, 2 times a day) — Blefarogel cleansing (5 weeks), Blefarogel-1 (from the 8th day of treatment); 2^nd group patients only antiallergic and tear replacement therapy were prescribed. The integral indicators of the conjunctiva and eyelids objective state (C-OS; E-OS), the proportion of MGD and patients with lipid deficiency (LD), OSDI, tear film breakup time (TBUT), the lower tear meniscus heigh (LTMH) and Bijsterveld’s xerosis index (XI) were evaluated before and after therapy. Results. Patients in both groups showed C-OS, E-OS, OSDI, TBUT and XI significant positive changes as a result of therapy. In 1st group patients E-OS, OSDI, TBUT and XI dynamics were significantly more pronounced. Conclusion. In SABC patients in DE and MGD conditions, the approach that included EH in addition to antiallergic and tear replacement therapy turned out to be more effective in influencing the condition of the ocular surface (EOS, OSDI, TBUT, XI), in comparison with the approach based on antiallergic treatment and tear replacement only, which was, probably, associated with a significant decrease in the proportion of MGD and LD as the EH result.

1. Maychuk Yu.F. Seasonal pollinosis conjunctivitis is the most common form of eye allergosis. Part I. Epidemiology, etiology, pathophysiology, clinic, diagnostics. Russian ophthalmological journal. 2010; 3 (1): 37–41 (In Russ.).

2. Neroev V.V., Vakhova E.S. Allergic conjunctivitis. In: Avetisov S.E., Egorov E.A., Moshetova L.K., et al., eds. Ophthalmology: National Guide. 2nd ed. Moscow: GEOTAR-Media; 2018: 442–56 (In Russ.).

3. Brozek G, Lawson J, Szumilas D, Zejda J. Increasing prevalence of asthma, respiratory symptoms, and allergic diseases: four repeated surveys from 1993–2014. Respir Med. 2015; 109: 982–90. http://dx.doi.org/10.1016/j.rmed.2015.05.0100954-6111

4. Miyazaki D, Kazumi Fukagawa K, Okamoto S, et al. Epidemiological aspects of allergic conjunctivitis. Allergology International. 2020; 69 (4): 487–95. https://doi.org/10.1016/j.alit.2020.06.004

5. Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol. 2011; 11 (5): 471–6. https://doi:10.1097/ACI.0b013e32834a9676

6. Kovalevskaya M.A., Filina L.A. Clinical forms of allergic eye manifestations: prospects of therapy. Russian ophthalmological journal. 2020; 13 (1): 94–101 (In Russ.). https://doi.org/10.21516/2072-0076-2020-13-1-94-101

7. Maychuk D.Yu. Modern possibilities of therapeutic treatment of allergic conjunctivitis. Overview. Ophthalmology. 2014; 2: 19–26 (In Russ.).

8. Jani E.V., Pozdnyakova V.V., Seliverstova K.E. New opportunities of the therapy of medicinal ophthalmic allergies. Russian ophthalmological journal. 2017; 10 (3): 108–12 (In Russ.). https://doi.org/10.21516/2072-0076-2017-10-3-108-112

9. Labib BA, Chigbu DI. Therapeutic targets in allergic conjunctivitis. Pharmaceuticals (Basel). 2022; 15 (5): 547. https://doi:10.3390/ph15050547

10. Tariq f. Allergic conjunctivitis: review of current types, treatments, and trends. Life (Basel). 2024; 14 (6): 650. https://doi:10.3390/life14060650

11. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. The Ocular Surface. 2017; XXX: 1–11. https://doi:10.1016/j.jtos.2017.08.003

12. Stapleton F, Optom MC, Alves M, et al. TFOS DEWS II Epidemiology Report. The Ocular Surface. 2017; 15: 334–365. https://doi:10.1016/j.jtos.2017.05.003

13. Brzhesky V.V., Egorova G.B., Egorov E.A. Dry eye and ocular surface diseases. Moscow: GEOTAR-Media. 2016 (In Russ.).

14. Sakhnov S.N., Yanchenko S.V., Malyshev A.V., et al. Dry eye epidemiology in patients before refractive operations. Ophthalmology in Russia. 2018; 15 (1): 92–101 (In Russ.). https://doi.org/10.18008/1816-5095-2018-1-92-101

15. Bahritdinova F.A., Mirrahimova S.Sh., Narziculova K.I., et al. Dry eye treatment optimization in allergic conjunctivitis. Ophthalmological journal. 2020; 2: 30–35 (In Russ.). https://www.ozhurnal.com/sites/default/files/ua-2020-2-5.pdf

16. Maychuk D.Yu., Chilingaryan L.B. Tear replacement therapy for allergic eye conditions. Ophthalmology. 2012; 2 (9): 72–6 (In Russ.).

17. Vorontsova T.N., Zaitseva M.V., Chramtsova M.A. Our experience of olopatadine treatment of allergic conjunctivitis in children. Ophthalmology in Russia. 2021; 18 (2): 361–7 (In Russ.). https://doi.org/10.18008/1816-5095-2021-2-361-367

18. Liu L, Yang J, Ji W, Wang C. Assessment of meibomian gland (MD) impairment among seasonal allergic conjunctivitis (SAC) patients. Med Sci Monit. 2022 Apr 5; 28:e935359. https://doi:10.12659/MSM.935359

19. Sakhnov S.N., Yanchenko S.V., Malyshev A.V., et al. Ocular surface changes in allergic blepharoconjunctivitis and dry eye syndrome: diagnosis and therapy possibilities. Russian ophthalmological journal. 2024; 17 (1): 55–61 (In Russ.). https://doi.org/10.21516/2072-0076-2024-17-1-55-61

20. Polunin G.S., Polunina E.G. From dry eye to team film disease. Ophthalmology in Russia. 2012; 9 (2): 4–7 (In Russ.). https://doi:10.18008/1816-5095-2012-2-4-7

21. Sakhnov S.N., Yanchenko S.V., Malyshev A.V., et al. Therapeutic hygiene of eyelids in dry eye disease prior to cataract phacoemulsification. Vestnik Oftal’mologii. 2023; 139 (1): 46–54 (In Russ.). https://doi:10.17116/oftalma202313901146

22. Trubilin V.N., Polunina E.G., Markova E.Yu., et al. Therapeutic hygiene of the eyelids in algorithms for the prevention and treatment of diseases of the eye surface. Р. 1. Оphthalmology in Russia. 2016; 13 (2): 122–7 (In Russ.). https://doi:10.18008/181650952016212212

23. Yanchenko S.V., Malyshev A.V., Teshaev Sh. J., et al. Acaricidal therapy in chronic demodex blepharitis and meibomian gland dysfunctions. Vestnik oftal’mologii. 2023; 139 (5): 46–54 (In Russ.). https://doi:10.17116/oftalma202313905136

24. Guillon M, Maissa C, Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye and contact lens. 2012 Sep; 38 (5): 306–12. doi:10.1097/ICL.0b013e3182658699

25. Wang Da-Hu, Liu Xin-Quan, Hao Xiao-Jun, et al. Effect of the meibomian gland squeezer for treatment of meibomian gland dysfunction. Cornea. 2018 October; 37 (10): 1270–8. https://doi:10.1097/ICO.0000000000001682

26. Yanchenko S.V., Malyshev A.V., Sakhnov S.N., et al Novel complex therapy of autumnal allergic blepharoconjunctivitis. Ophthalmology in Russia. 2014; 11 (3): 74–79 (In Russ.).

27. Yanchenko S.V., Malyshev A.V., Sakhnov S.N., et al. Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery. Vestnik Oftal’mologii. 2016: 5: 83–8 (In Russ.). https://doi.org/10.17116/oftalma2016132586-92

28. López García JS, García Lozano I, Martínez Garchitorena J. Estimación del grosor de la capa lipídica lagrimal mediante colores interferenciales en distintos tipos de ojo seco [Measure of the fatty layer thickness of precorneal tear film by interference colours in different types of dry eye]. Arch Soc Esp Oftalmol. 2003 May; 78 (5): 257–64 (In Spanish).

29. Van Bijesterveld OP. Diagnostic tests in the sicca syndrome. Arch. Ophthalmol. 1969 Jul; 82 (1): 10–4. doi:10.1001/archopht.1969.00990020012003

30. Korb DR. The tear film – its role today and in future. In: The tear film, structure, function and examination. Butterworth — Heimann; 2002.

31. Nichols KN, Foulks GN, Bron AJ, et al. The International Workshop on Meibomian Gland Dysfunction: Executive Summary. IOVS. Special Issue. 2011; 52 (4): 1923–9. https://doi:10.1167/iovs.10-6997a

32. Yanchenko S.V., Malyshev A.V., Teshaev Sh.Zh., et al. Efficacy and safety of chronic blepharitis treatment. Ophthalmology in Russia. 2023; 20 (4): 772–9 (In Russ.). https://doi.org/10.18008/1816-5095-2023-4-772-779

33. Shpak A.A. Issues of the statistical analysis in the Russian ophthalmological journals. The Fyodorov Journal of Ophthalmic Surgery. 2016; 1: 73–7 (In Russ.). https://doi:10.25276/0235-4160-2016-1-73-77

34. Riffenburgh RH. Statistics in medicine. 2012; Academic Press: 690. https://doi.org/10.1016/C2010-0-64822-X

35. Hynnekleiv L, Magno M, Vernhardsdottir RR, et al. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol. 2022; 100: 844–60. https://doi:10.1111/aos.15159

36. Lee HS, Ji YS, Yoon KC. Efficacy of hypotonic 0.18% sodium hyaluronate eye drops in patients with dry eye disease. Cornea. 2014 Sep; 33 (9): 946–51. doi:10.1097/ICO.0000000000000165

37. Wen Y, Zhang X, Chen M, Han D. Sodium hyaluronate in the treatment of dry eye after cataract surgery: a meta-analysis. Ann Palliat Med. 2020; 9 (3): 927–39. https://doi:10.21037/apm-20-695

38. Yanchenko S.V., Malyshev A.V., Sakhnov S.N. The choice of dry eye therapy depending on ocular surface condition. Ophthalmology in Russia. 2021; 18 (2): 346–54 (In Russ.). doi: 10.18008/1816-5095-2021-2-346-354