Allergic conjunctivitis and Vernal conjunctivitis therapy. Steroid eyedrops and Cyclosporine eyedrops. 3

Allergic conjunctivitis and Vernal conjunctivitis therapy.   Steroid eyedrops and Cyclosporine eyedrops. 3

Allergic conjunctivitis and Vernal conjunctivitis therapy. Steroid eyedrops and Cyclosporine eyedrops. 3

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Allergic conjunctivitis is a frequent manifestation of allergy. There is a severe form of allergic conjunctivitis. It is called Vernal keratoconjunctivitis. What are the most effective therapy options for allergic conjunctivitis? How to treat its severe form, Vernal keratoconjunctivitis? Well, very interesting questions because Vernal keratoconjunctivitis is a rare disease in Europe, probably not so in South America or also Africa, or even the Middle East. And but what we know with ocular allergy is a common pathology. It's a common pathology because there are environmental problems, pollution, and it increases. We have very large studies for that, for example, ISAAC clinical study. And it's more than 1 million children was just studied for eye (ocular) allergy in general. But there was also Rhinoconjunctivitis (nose conjunctivitis) was also just studied. And so, we know that we have some effective pharmacological treatments for eye allergy, like anti-histamine, like mast cell stabilizers. They are useful for common seasonal and perennial ocular allergies. Then we go to severe forms of eye allergy. There are two severe forms of eye allergy in children, which are Vernal keratoconjunctivitis, the most common of them, but rare eye disease is in Europe. There is atopic keratoconjunctivitis. It is a very similar presentation to Vernal keratoconjunctivitis. But there are some differences. The most important difference is that there is atopic dermatitis ongoing on the eyelids. And we say that it's important to know the atopic keratoconjunctivitis form. Because I did this publication for that. There are differences between Vernal keratoconjunctivitis in children, of course, and atopic keratoconjunctivitis because the prognosis is different. So Vernal keratoconjunctivitis ends at adolescence or in young adult years. It goes no more usually. But atopic keratoconjunctivitis lasts all the life of the child. So this is very important because parents must know about the prognosis. And that's why it's very important. So, if we want to go to the treatment of keratoconjunctivitis, a long time ago there were only steroids. Topical steroids that were effective on Vernal keratoconjunctivitis and atopic keratoconjunctivitis also. The problem is there are complications with steroids in topical form. There is a problem of cataracts, glaucoma, and also corneal ulcers, infections like herpes. Also, there is steroid dependence. This is a real problem for the parents. Usually, they give the steroid eye drops because they knew that the child would be relieved of symptoms. But the problem is this. If you use steroid eyedrops regularly, it will be very, very problematic because there will be complications, there will be steroid dependence. So, quite a long time ago, we have another therapy for keratoconjunctivitis. The first clinical study was done by Dr. David BenEzra in 1985. They tried cyclosporine, which is the immunomodulator, as you know, generally. But cyclosporine was used in eye drops to relieve the symptoms of Vernal keratoconjunctivitis. It's a very long story. It's a very long story because in 2006 there was the first clinical study of cyclosporine in keratoconjunctivitis. We just obtained the approval of cyclosporine in 2019 or 2018. So you just look at the development of this pharmaceutical agent, and it took a long time. but cyclosporine changes completely the life of the children with atopic keratoconjunctivitis because they have cyclosporine as an everyday treatment. They need much fewer steroid eyedrops. And usually, with that, it's very good. And I'm very proud of that because it's a long way to treat children with atopic keratoconjunctivitis. Now we have an association, which is Association France Eczema in France. There is a section of allergic keratoconjunctivitis. And we plan to have that in Europe. We are planning with this association to have a day of allergic keratoconjunctivitis in France, probably in Europe, and maybe one day in the world. So it's really interesting because there is a cyclosporine treatment. And it's an underdiagnosed disease because, for Vernal keratoconjunctivitis, children are schooled. They have a very bad quality of life. And they are impaired for the vision. And with cyclosporin treatment, they recover. So it is very important. And so this is very interesting to have a treatment for allergic keratoconjunctivitis and Vernal keratoconjunctivitis every day. And not just only steroid eyedrops. You mentioned that the chronic use of steroids leads to multiple complications. But it's probably the treatment that is being overused around the world because steroid eyedrops are easy to get. Steroid eye drops are an effective short-term solution. And probably, therefore, it gets essentially abused in a chronic form for a long time leading to all the complications. I think this is important to underscore that there have to be better treatments for Vernal keratoconjunctivitis and. Cyclosporin treatment that you described is one of [treatments for atopic keratoconjunctivitis]. Yeah, I agree. Yeah. Steroid eye drops have been used over the counter. So it's really important to reduce the use of steroid eyedrops at the maximum. Sometimes we can eliminate the steroids and just get the treatment with cyclosporine eye drops. After that, we get to the relief of Vernal keratoconjunctivitis disease because it ends in adolescence. So that's nice.

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