重视变态反应性结膜炎治疗中非甾体抗炎药物的应用

Consideration of application of non-steroidal anti-inflammatory drugs in the treatment of allergic conjunctivitis

近年来随着工业化进程的加快,变态反应性结膜炎的发生率逐渐升高.目前,变态反应性结膜炎的治疗以眼局部治疗为主,主要目的在于针对病因,减轻症状和预防并发症.变态反应性结膜炎的治疗药物包括抗组胺药、肥大细胞稳定剂、双效作用药物（稳定肥大细胞/抗组胺）、非甾体抗炎药（NSAIDs）、糖皮质激素及免疫抑制剂六大类.抗组胺药、肥大细胞稳定剂、双效作用药物的主要作用是减轻眼部瘙痒、结膜充血等症状和体征,也可用于急性变态反应性结膜炎患者,而NSAIDs、糖皮质激素及免疫抑制剂则用于症状严重患者或慢性病例.糖皮质激素类药物治疗变态反应性结膜炎效果显著,可作用于过敏反应的多个环节,但是长期应用可能会导致眼压升高、视力障碍、视野缺损和后囊下白内障,有角膜溃疡的患者更应谨慎使用.免疫抑制剂具有抑制免疫的作用,可抑制局部或机体异常的免疫反应,但由于价格较高及局部刺激性强等不良反应,故也不宜长期应用.NSAIDs具有良好的抗炎效果,作用温和,刺激性小,目前在眼表变态反应性结膜炎中广泛应用.

Allergic conjunctivitis is a very common pathology and its incidence has increased in developing countries with the development of industrialization.At present,the therapy of allergic conjunctivitis is mainly the use of topical eyedrops to eliminate causative factors,relieve symptoms and prevent complications.The drugs used in allergic conjunctivitis have 6 groups,including antihistamine,mastocyte stabilizer,drugs with dual effects （antihistamine and mastocyte stabilizer）,non-steroidal anti-inflammatory drugs （NSAIDs）,glucocorticoids and immunosuppressors.The goals of topical use of antihistamine,mastocyte stabilizer and drugs of dual effects are to remove the itching and hyperaemia of eye or to treat the patients with acute allergic conjunctivitis; while NSAIDs,glucocorticoids and immunosuppressors are used for the patients with severe or chronic allergic conjunctivitis.The glucocorticoid drugs are more effective because of their arresting effects in several links of the allergic response.Nevertheless,the long-term use of glucocorticoids probably results in ocular hypertension or posterior subcapsular cataract,furthermore,glucocorticoid drugs should be more cautionary in the application of the patients with corneal ulcer.Immunosuppressors inhibit abnormal immune responses,but these drugs should not be used for a long term because of higher cost and adverse effects.NSAIDs have a good anti-inflammatory effect and less irritant,so the topical use of NSAIDs for allergic conjunctivitis appears to be a better choice nowadays.