New possibilities for diagnostics and management of inflammatory reaction in chronic inflammatory processes in the conjunctiva

Chronic conjunctivitis is a common ocular disease characterized by prolonged inflammation of the conjunctiva. Cytological analysis of the conjunctival mucosa is a valuable diagnostic tool for determining the nature of the inflammatory process, its etiology, and stage of development, which is necessary for prescribing adequate therapy and monitoring its effectiveness.

Purpose: to improve the efficiency of diagnosis and treatment of patients with chronic inflammatory diseases of the eye by managing the exudative reaction.

Material and methods. The study included patients with chronic bacterial conjunctivitis (BC) — group 1 (n = 82), with chronic toxic-allergic conjunctivitis (TC) — group 2 (n = 65), and healthy individuals — the control group (n = 25). Clinical observation of chronic inflammatory processes of the conjunctiva before treatment lasted more than 4 weeks, the total observation period was more than 3 years. Patients were examined more than 3 times to obtain material for diagnostic laboratory testing, then twice at 1 and 2 months after treatment.

Results. In the initial cytological picture of conjunctival scrapings in patients with chronic BC, neutrophils were predominant (more than 60 % of the cellular composition). Neutrophils were in various stages of activation and degeneration. The presence of bacteria both within neutrophils (phagocytized) and extracellularly was characteristic. Epithelial cells often demonstrated signs of reactive changes: an increase in the size of the nucleus, nucleoli, and vacuolation of the cytoplasm. In patients with TC (group 2), the cytologically dominant features in patients were eosinophils and mast cells, goblet cell hyperplasia, structureless substance, degenerative altered leukocytes, and naked nuclear elements. Patients in Group 1 were prescribed the aminoglycoside netilmicin (Nettacin eye drops and Nettavisc eye ointment), a broad-spectrum bactericidal antibiotic, applied behind the lower eyelid 3–4 times daily. Patients in Group 2 were prescribed loteprednol etabonate (Lotemaxin), a corticosteroid with potent anti-inflammatory activity, 1 drop in the conjunctival sac of each eye. In the next step, patients in Group 1 with chronic BC were prescribed Lotemaxin, 1 drop in each eye 4 times daily. Analysis of the ocular tissue condition and the cytological picture of inflammation before and after the use of Lotemaxin, as well as 4 weeks after its discontinuation, revealed a significant decrease in the number of eosinophils and neutrophilic leukocytes, while goblet cells and glandular epithelium were preserved. Despite the relatively long staged therapy with Lotemaxin, a rapid reduction in the tissue inflammatory response, no increase in intraocular pressure, and no cataractogenicity were observed clinically.

Conclusion. For chronic conjunctival inflammation, therapy with loteprednol etabonate (Lotemaxin) is indicated in the staged treatment of any type of chronic inflammation after etiotropic therapy.

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