Possibility of non-steroidal treatment in allergic conjunctival diseases

Abstract

ABSTRACT In a recent epidemiological study, 15-20% of the population in Japan was estimated to have allergic conjunctivitis. Allergic conjunctival diseases (ACD) have a wide spectrum of clinical severity and the treatment strategy depends on the severity and duration of the disease. Most cases of the non-proliferative type of ACD, such as seasonal or perennial allergic conjunctivitis, can be treated with topical anti-allergic drugs. Of the ACD, vernal keratoconjunctivitis (VKC) is characterized by typical proliferative lesions, such as giant papillae and severe corneal lesions. Corticosteroid eye drops should be used in combination with anti-allergic eye drops when an anti-allergic drug is insufficient in cases of VKC and atopic keratoconjunctivitis with proliferative lesions. In spite of the high effectiveness of corticosteroid eye drops, they have important side-effects, such as elevation of intraocular pressure leading to glaucoma. Immunosuppressive agents and non-steroidal anti-inflammatory drugs (NSAIDs) are alternative topical agents to corticosteroids. Topically administered immunosuppressive agents, such as ciclosporin and tacrolimus, have antifibroblastic actions by inhibiting remodeling-inducing cells and act as a controller in the treatment of ACD. Non-steroidal antiinflammatory drug eye drops can be used to inhibit remodeling in ACD because of their excellent antiinflammatory and antifibroblastic effects, next to corticosteroids and immunosuppressive agents. Substitution of the topical treatment with corticosteroids by these agents in ACD not only spares the use of corticosteroids and decreases the risk of side-effects, but also brings about a more favorable effect in the long-term control of proliferative-type ACD.