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Bakhritdinova Fazilat Arifovna, MD, Ph D., professor of the ophthalmology department of Tashkent Medical Academy E-mail: [email protected] Mirrakhimova Saidakhon Shukhratovna, MD, Ph D., associated professor of the ophthalmology department of Samarkand State Medical Institute Safarov Jahongir Oripovich, assistant of of the ophthalmology department of Bukhara State Medical Institute Narzikulova Kumrijon Islomovna, MD, Ph D., associated professor of the ophthalmology department of Tashkent Medical Academy
FEATURES OF CLINICAL MANIFESTATIONS AND TREATMENT OF ALLERGIC LESIONS OF THE EYE IN UZBEKISTAN
Abstract. Has been studied the clinical course of allergic eye diseases in the Bukhara region and a new treatment method of 68 patients, that prevents severe disease has been developed.
According to the research results in 50% of the examined patients experienced acute allergic edema of the conjunctiva (34 patients), which is the most common form of eye damage in allergic diseases in the Bukhara region, 16 (23.6%) patients had follicular conjunctivitis, 9 (13.2%) - blepharoconjunctivitis and 9 (13.2%) - papillary. Due to the long period of allergization, according to the flowering of herbs in the region, allergic conjunctivitis has a long course (february-november).
Treatment of patients with allergic diseases of the eye with the drug cromoviz gives a pronounced therapeutic effect in 87% of cases.
Keywords: allergic conjunctivitis, Bukhara region, cromoviz, acute allergic edema of the conjunctiva.
Relevance. The global experience of recent years shows erywhere registered changes in the structure, dynamics and
not only the widespread prevalence of allergic diseases, but nature of human pathology are determined not so much by
also a steady upward trend. Every year, about 35% of the geographical, climatic, natural focal features, as global tech-
world's population seek for medical care with the clinical nological transformations, somehow causing environmental
manifestations of allergy. One of the main reasons for the in- pollution [1; 2; 11].
crease in the incidence of this pathology is the living condi- The presence in the Republic of Uzbekistan of enterprises
tions of the modern person, which change the reactivity of the of the chemical, electrical industry, construction industry, me-
organism. These conditions usually include: environmental chanical engineering and metalworking causes the presence in
pollution, the widespread use of chemicals in everyday life the atmosphere at elevated concentrations of various specific
and others. The main sources of air pollution in the city are pollutants [2].
motor vehicles and industrial enterprises [1; 2; 4; 8; 9; 10]. According to expert estimates, the entire territory of the
In addition, almost 50% of patients with systemic allergies Bukhara region falls into a zone of very high environmental
(after 2-3 years of transformation of the allergophon due to pressure, that so-called "uncomfortable". Annually, from 200
the underlying disease) inevitably develop allergic conjuncti- to 700 kilograms of the total flow of dust and salts fall on the
vitis as a concomitant pathology [7; 12; 13; 14]. territory of the region, negatively affecting on state of atmo-
In modern conditions, the active relationship between spheric air and causing enormous damage to water, soil, animal
human and the environment leads to its significant change and and plant life. All because of the ecological crisis of the Aral Sea
complication. Complexes of natural and social factors acquire region. Sand and salt from the dried part of the once one of the
new qualities that affect on the health of the population. Ev- largest seas on the planet extends up to 500 kilometers from
Section 2. Medical science
the epicenter. Bukhara region is a transboundary region: on the one hand, emissions from industrial enterprises of Navoi and Kashkadarya regions, on the other hand, harmful, carcinogenic substances of industrial enterprises ofthe neighboring Republic of Turkmenistan. Another transboundary problem is the pollution of the Zarafshan River by the waste and drainage waters of the Samarkand and Navoi regions.
In modern conditions, research aimed at studying and timely diagnosing of the state of the environment and the incidence of the population is largely dependent on the creation and functioning of environmental-medical monitoring. Until recently, issues of organizing and improving allergic care to the population were solved in isolation from a comprehensive analysis of environmental, social, hygienic and other factors leading to the development of allergic diseases [3; 5; 6]. Uzbekistan is characterized by an abundance of vegetation; the period of flowering of plants covers a rather wide range (February-November). All this undoubtedly contributes to the development of sensitization and the emergence of allergic conjunctivitis.
In this regard, the purpose of this study was to study the characteristics of the clinical manifestation of allergic eye diseases in the Bukhara region, and the development of new methods of treatment that prevent severe disease.
Materials and research methods. Under our supervision, there were examined 68 patients with allergic conjunctivitis aged 18 to 60 years with a disease duration from 2 months to 8 years. Among the surveyed men prevailed - 48 patients, 20 patients were women.
For their examination, general ophthalmological and special methods of research were used, including the determination of allergic and immunological status.
Research results indicate the presence of clear seasonality of manifestations of clinical symptoms in 57 patients (86.2%). According to our data, weed pollen was the most common cause of eye lesions - 18 patients (26.7%), 26 patients (39.3%) were allergic to edge pollen allergens (almonds, Chinara, etc.), 13 patients (19.6%) - to meadow grass pollen. Polyallergy occurred in 35.5% of cases.
The clinical picture is due to allergic inflammation of the conjunctiva, nose, nasopharynx, trachea and bronchi, less often the skin and nervous system.
The most common clinical manifestations of allergic lesions are the combination of allergic rhinosinusitis and conjunctivitis.
According to research results, 50% of the examined patients experienced acute allergic edema of the conjunctiva (34 patients), which is the most common form of eye damage in allergic diseases in the Bukhara region, in 16 (23.6%) patients - follicular conjunctivitis, in 9 (13.2%) - blepharoconjunctivitis and 9 (13.2%) - papillary conjunctivitis.
In the Bukhara region, in conditions of a dry and hot climate, allergic eye lesions had a rather severe course. This is an acute sudden onset, accompanied by severe itching and burning in the eyes.
Acute allergic edema of the conjunctiva was characterized by a marked conjunctiva chemosis of the eyelids and eyeball, and abundant mucous discharge.
Follicular conjunctivitis manifested lesion of the mucous membrane of the eyeball, eyelids and limbus. The follicles initially appeared on the conjunctiva of the upper transitional fold, then passed to the lower one.
The clinical picture of patients with blepharoconjunctivitis was characterized by changes in the conjunctiva of the eyeball with damage of the eyelashes edges and eyelids skin.
The group of patients constituting papillary conjunctivitis resembled spring catarrh. In the area of the upper cartilage of the eyelids, diffuse papillary infiltration was observed against the background of the pale conjunctiva.
The effectiveness of the treatment of allergic eye lesions depends primarily on the timely identification of the allergen and its elimination.
However, antiallergic drugs and drugs of symptomatic therapy occupy an important place in the treatment of allergic blepharoconjunctivitis.
The classical method of prophylactic specific immunization is the most effective in the treatment of allergic conjunctivitis during the period of allergies. The method is available and is widely used in allergology in the remission of the disease, before the flowering season of plants, at certain time intervals, extracts of the corresponding pollen allergens are given sub-cutaneously in increasing doses. Treatment begins with the lowest dose in the autumn-winter period in the absence of signs of allergy and other intercurrent diseases.
Depending on the treatment, the patients were divided into 2 homogeneous groups. In the control group, patients were used "EYECROL" eye drops 4%, World Medicine Oph-thalmics, UK, per 2 drops in the conjunctival sac of the affected eye 4 times for 7 days, amid desensitization therapy. In the main group, the drug Cromoviz ophthalmic drops 4% (manufactured by ASEPTICA LLC, Uzbekistan) was used in a similar pattern. Cromoviz is a domestic antiallergic drug that contains cromoglycic acid disodium salt. The therapeutic effect is the membrane stabilizing action of cromoglycic acid, which prevents mast cell degranulation and the release of histamine, bradykinin, leukotrienes (including anaphylaxis), prostaglandins and other biologically active substances from them. According to the results of our clinical studies, the drug is approved by the Pharmacological Committee of Uzbekistan for use in the ophthalmic practice of the republic.
Prior to the study, the leading complaint of patients in both groups was significant irritation of the conjunctiva in 56.7% of cases, tearing was less pronounced and accounted for 38.8% and 40%, respectively, itchy eyes were observed in 43.7% and 42% of cases, respectively in the main and control groups. Re-examination of patients marked positive dynamics in all parameters of subjective complaints. After treatment, all observed patients showed a significant positive trend. The effectiveness of the treatment was 96.7% in the main group and 98% in the control group. The drug was well tolerated by patients with local instillation and contributed to a favorable outcome of the disease. In the control group of patients, the results of treatment were comparable in all parameters.
Thus, the examination of patients with allergic eye lesions at the present level of allergological knowledge will help in a timely manner to identify the cause of the disease and prescribe an effective treatment, which will reduce the number of complications.
Conclusions: 1. Due to the long period of allergization, because of the flowering of herbs (February-November) in the region, allergic conjunctivitis has a long course.
2. Allergic eye lesions in the region are manifested in the following clinical forms: acute allergic conjunctival edema, follicular conjunctivitis, papillary conjunctivitis, and blepha-roconjunitis.
3. Treatment of patients with allergic diseases of the eye with the drug cromoviz gives a pronounced therapeutic effect in 87% of cases.
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