Differential Diagnostic Indicators for the Appointment of Non-Steroidal Anti-Inflammatory Therapy in the Treatment of Red Eye Syndrome at the Stage of Primary Outpatient Admission. Part 1
https://doi.org/10.18008/1816-5095-2023-2-332-340
Abstract
Every practicing ophthalmologist, regardless of the scope of their clinical and scientific interests, is faced with a dilemma — what treatment to prescribe to a patient who applied for a primary outpatient appointment with signs of red eye syndrome? Prescribing an adequate amount of pathogenetically substantiated therapy will reduce the potential risk of developing complications associated with drug therapy.
Purpose: to study the effectiveness of the treatment the blepharoconjunctivitis, episcleritis and keratitis, the regimen of which included the non-steroidal anti-inflammatory drug Okofenac 0.09 % (Otisipharm, Russia), the main active component of which is bromfenac, showed that the average term for stopping the inflammatory process in in all groups of patients included in the study, was 7–14 days, which indicates a high level of effectiveness of the treatment. At the same time, the maximum amount of drug therapy — more than two groups of drugs was prescribed to patients with keratitis. The quality of life according to the SPEED questionnaire, which reflects the symptoms characteristic of dry eye syndrome, was significantly lower in patients in the keratitis group, which suggested a relationship between the amount of drug therapy and the onset of dry eye syndrome in the long-term period — 1 month. This assumption was confirmed by a correlation analysis, which revealed a direct correlation between the number of prescribed drugs at the beginning of treatment and the quality of life according to the SPEED questionnaire after 1 month in all three groups of patients included in the study. Since this study was aimed at studying the effectiveness of anti-inflammatory therapy in the treatment of different, not only in terms of pathogenesis, but also the localization of the process, it only revealed certain trends in the relationship between the number of prescribed drugs at the beginning of treatment and the development of dry eye signs in the long-term period. Therefore, further research is needed to study the above trend in detail.
In addition, as the analysis of literature data has shown, there are currently no indications for prescribing one or another type of drug therapy in the complex treatment of inflammatory diseases related to the “red eye syndrome”. In order to form criteria that take into account the history data — somatic status, duration of the inflammatory process, complaints of patients characterizing the inflammatory process, as well as biomicroscopic signs of inflammation, to select one or another pharmaceutical group of drugs, a survey of expert ophthalmologists was conducted. Based on the data of the survey, an algorithm for rational therapy of one of the most common pathologies included in the group of diseases red eye syndrome — conjunctivitis was formed. The above algorithm will be presented in the second part of this article.
About the Authors
V. N. TrubilinRussian Federation
Trubilin Vladimir N. - МD, Professor, head of the of Ophthalmology department
Gamalei str., 15, Moscow, 123098, Russian Federation
E. G. Poluninа
Russian Federation
Poluninа Elizabet G. - MD, Professor of the of Ophthalmology department
Gamalei str., 15, Moscow, 123098, Russian Federation
A. A. Kozhukhov
Russian Federation
Kozhukhov Arseniy A. - MD, Professor of the of Ophthalmology department
Gamalei str., 15, Moscow, 123098, Russian Federation
V. V. Kurenkov
Russian Federation
Kurenkov Vyacheslav V. - МD, Professor, chief of Clinic Dr. Kurenkov
Rublevskoe highway, 48, Moscow, 121609, Russian Federation
N. V. Moreva
Russian Federation
Moreva Nadezhda V. - ophthalmic surgeon of the Department of eye microsurgery
Verkhnevolzhskaya embankment, 21, Nizhny Novgorod, 603005, Russian Federation
A. V. Trubilin
Russian Federation
Tubilin Alexander V. - PhD, Associate Professor of the of Ophthalmology department
Gamalei str., 15, Moscow, 123098, Russian Federation
K. V. Chinenova
Russian Federation
Chinenova Ksenia V. - PhD., ophthalmologist
Rublevskoe highway, 48, Moscow, 121609, Russian Federation
References
1. Zhang XY, Wang ZQ, Zhang Y, Sun XG. [Clinical manifestations of 172 patients with blepharokeratoconjunctivitis]. [Zhonghua yan ke za Zhi] Chinese Journal of Ophthalmology. 2016 Mar;52(3):174–179. doi: 10.3760/cma.j.issn.0412-4081.2016.03.006. PMID: 26979113.
2. O’Gallagher M, Bunce C, Hingorani M, Larkin F, Tuft S, Dahlmann-Noor A. Topical treatments for blepharokeratoconjunctivitis in children. Cochrane Database Syst Rev. 2017 Feb 7;2(2):CD011965. doi: 10.1002/14651858.CD011965.pub2.
3. Zhao L, Sun YJ, Pan ZQ. Topical Steroids and Antibiotics for Adult Blepharokeratoconjunctivitis (BKC): A Meta-Analysis of Randomized Clinical Trials. J Ophthalmol. 2021 Jan 8;2021:3467620. doi: 10.1155/2021/3467620. PMID: 33520297; PMCID: PMC7817233.
4. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23;310(16):1721–1729. doi: 10.1001/jama.2013.280318. Erratum in: JAMA. 2014 Jan 1;311(1):95.
5. Grzybowski A, Brona P, Kim SJ. Microbial flora and resistance in ophthalmology: a review. Graefes Arch Clin Exp Ophthalmol. 2017 May;255(5):851-862. doi: 10.1007/s00417-017-3608-y.
6. Kasparova EvgA. Modern treatments for purulent corneal ulcers. Vestnik Oftalmologii. 2016;132(5):125–135. (In Russ.). doi: 10.17116/oftalma20161325125-135.
7. Maychuk DYu, Tarkhanova AA. Advantages of “Soft Steroids” in the Treatment of Inflammatory Eye Diseases. Оverview. Ophthalmology in Russia. 2021;18(4):778–783 (In Russ.). doi: 10.18008/1816-5095-2021-4-778-783.
8. Ping Duan, Yong Liu Jiawen Li, The comparative efficacy and safety of topical nonsteroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2017 Apr;255(4):639–649. doi: 10.1007/s00417-017-3599-8. Epub 2017 Jan 27.
9. Jung JW, Chung BH, Kim EK, Seo KY, Kim TI.The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1 % and Ketorolac 0.45 %, on Cataract Surgery. Yonsei Med J. 2015 Nov;56(6):1671–1677. doi: 10.3349/ymj.2015.56.6.1671.
10. Schalnus R. Topical nonsteroidal anti-inflammatory therapy in ophthalmology. Ophthalmologica. 2003 Mar-Apr;217(2):89–98. doi: 10.1159/000068563. PMID: 12592044.
11. Jones J, Francis P. Ophthalmic utility of topical bromfenac, a twice-daily nonsteroidal anti-inflammatory agent. Expert Opin Pharmacother. 2009 Oct;10(14):2379–2385. doi: 10.1517/14656560903188425. PMID: 19735215.
12. Matyukhina EN. The Use of Bromfenac Ophthalmic Solution in Clinical Practice (Literature Review). Ophthalmology in Russia. 2021;18(4):784–790 (In Russ.). doi: 10.18008/1816-5095-2021-4-784-790.
13. Dutta Majumder P, Agrawal R, McCluskey P, Biswas J. Current Approach for the Diagnosis and Management of Noninfective Scleritis. Asia Pac J Ophthalmol (Phila). 2020 Dec 7;10(2):212–223. doi: 10.1097/APO.0000000000000341. PMID: 33290287.
14. Bielory L, Meltzer EO, Nichols KK, Melton R, Thomas RK, Bartlett JD. An algorithm for the management of allergic conjunctivitis. Allergy Asthma Proc. 2013 Sep-Oct;34(5):408–420. doi: 10.2500/aap.2013.34.3695. PMID: 23998237.
15. Zhu L, Zhang C, Chuck RS.Topical steroid and non-steroidal anti-inflammatory drugs inhibit inflammatory cytokine expression on the ocular surface in the botulinum toxin B-induced murine dry eye model. Mol Vis. 2012;18:1803–1812. Epub 2012 July 3.
16. Lekhanont K, Park CY, Smith JA, Combs JC, Preechawat P, Suwan-Apichon O, Rangsin R, Chuck RS. Effects of topical anti-inflammatory agents in a botulinum toxin B-induced mouse model of keratoconjunctivitis sicca. J Ocul Pharmacol Ther. 2007 Feb;23(1):27–34. doi: 10.1089/jop.2006.0071. PMID: 17341147.
17. Gordon YJ, Araullo-Cruz T, Romanowski EG. The effects of topical nonsteroidal anti-inflammatory drugs on adenoviral replication. Arch Ophthalmol. 1998 Jul;116(7):900–905. doi: 10.1001/archopht.116.7.900. PMID: 9682703.
18. Fraser-Smith EB, Matthews TR. Effect of ketorolac on Pseudomonas aeruginosa ocular infection in rabbits. J Ocul Pharmacol. 1988 Summer;4(2):101–109. doi: 10.1089/jop.1988.4.101. PMID: 3262701.
19. Alfonso SA, Fawley JD, Alexa Lu X. Conjunctivitis. Prim Care. 2015 Sep;42(3):325–345. doi: 10.1016/j.pop.2015.05.001. Epub 2015 Jul 29. PMID: 26319341.
20. Waterbury L, Kunysz EA, Beuerman R. Effects of steroidal and non-steroidal anti-inflammatory agents on corneal wound healing. J Ocul Pharmacol. 1987 Spring;3(1):43–54. doi: 10.1089/jop.1987.3.43.
21. Barba KR, Samy A, Lai C, Perlman JI, Bouchard CS. Effect of topical anti-inflammatory drugs on corneal and limbal wound healing. J Cataract Refract Surg. 2000 Jun;26(6):893–897. doi: 10.1016/s0886-3350(00)00364-3.
22. Qu M, Wang Y, Yang L, Zhou Q. Different cellular effects of four anti-inflammatory eye drops on human corneal epithelial cells: independent in active components. Mol Vis. 2011;17:3147–3155. Epub 2011 Dec 6. PMID: 22171161; PMCID: PMC3235539.
23. Lee JS, Kim YH, Park YM. The Toxicity of Nonsteroidal Anti-inflammatory Eye Drops against Human Corneal Epithelial Cells in Vitro. J Korean Med Sci. 2015 Dec;30(12):1856–1864. doi: 10.3346/jkms.2015.30.12.1856. Epub 2015 Nov 30. PMID: 26713063; PMCID: PMC4689832.
24. Leibowitz HM. The red eye. N.Engl.Med. 2000;343(5):345–351.
25. Neroev VV, Vakhova ES. Diseases of the conjunctiva. Ophthalmology. National leadership / Edited by Avetisov SE, Egorov EA, Moshetova LK, Neroeva VV, Takhchidi KhP. Moscow: GEOTAR-Media, 2018:418.
26. Markova EYu, Polunina EG, Ioileva EE. Аllergic eye diseases in children. Modern view on pathogenesis and treatment. Ophthalmology in Russia. 2017;14(2):125–129 (In Russ.). doi: 10.18008/1816-5095-2017-2-125-129.
Review
For citations:
Trubilin V.N., Poluninа E.G., Kozhukhov A.A., Kurenkov V.V., Moreva N.V., Trubilin A.V., Chinenova K.V. Differential Diagnostic Indicators for the Appointment of Non-Steroidal Anti-Inflammatory Therapy in the Treatment of Red Eye Syndrome at the Stage of Primary Outpatient Admission. Part 1. Ophthalmology in Russia. 2023;20(2):332-340. (In Russ.) https://doi.org/10.18008/1816-5095-2023-2-332-340