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   Table of Contents      
ARTICLES
Year : 1985  |  Volume : 33  |  Issue : 3  |  Page : 151-153

Role of disodium cromoglycate in vernal conjunctivitis


Department of Ophthalmology Gandhi Medical College and Associated, Hamidia Hospital Bhopal, India

Correspondence Address:
Rasik Vajpayee
R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 3939423

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How to cite this article:
Vajpayee R, Kumar S, Sharma M. Role of disodium cromoglycate in vernal conjunctivitis. Indian J Ophthalmol 1985;33:151-3

How to cite this URL:
Vajpayee R, Kumar S, Sharma M. Role of disodium cromoglycate in vernal conjunctivitis. Indian J Ophthalmol [serial online] 1985 [cited 2019 Oct 14];33:151-3. Available from: http://www.ijo.in/text.asp?1985/33/3/151/30810

Table 1

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Table 1

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The treatment of Vernal Keratoconjunc­tivitis remains problematic. Corticoste­roids are useful but on a long term basis their side effects are well known.

In atopy there is an IgE mediated mast cell degradation, resulting in release of hista­mine which is responsible for various symp­toms, like itching, redness etc. Abelson et al[1] found a four times increase in the level of histamine in tears of patients suffering from Vernal Catarrh, than that of normal indivi­duals. Similarly the number of mast cells in Vernal Catarrh is slightly but significantly more than normal subjects (9000/Cum.m. against 5400/Cum.m.).

Disodium cromoglycate a membrane sta­bilizer acts by blocking calcium channels in the mast cell membrance, thus prevents mast cell rupture and release of histamine and other autocoids, in IgE mediated immune reactions[2],[3]. It has been introduced in the treatment of Vernal Catarrh, but its clinical usefulness remains controversial.

Tabbara and Arafat[4] found statistically significant difference between sodium cromo­glycate treated eyes and placebo group,while carrying out a double masked coded trial to evaluate local 2% cromoglycate. Hennawi[5] reported that Sodium cromoglycate drops are superior to Antistine and as effective as steroids and further more it could replace or reduce steroid therapy in vernal keratocon­junctivitis.

Jay[6] has reported improvement in symp­toms and reduction in ocular inflammation but without complete resolution of physical signs.

In Israel, Baryishak et al[7] found this drug useful in the treatment of vernal keratocon­junctivitis.

A double blind trial using 4% disodium crologlycate ointment 3 times a day was carried out by Bansal, et al[8] in Indian patient of vernal keratoconjuctivitis and they found no difference in the treated and the control group. Another study by Hyams et al[9] found no significant beneficial effect of drug on Vernal Catarrh.


  Methods Top


28 cases of of Vernal Keratoconjunctivitis were studied in a double blind fashion.

On the initial visit ocular symptoms, their nature, duration and periodicity were noted. Any general complaints and past or family history suggestive of atopic disease like bronchial asthma, hay fever, eczema etc. were noted. Thorough general examination and detailed occular examination including slit lamp biomicroscopy was done. The symptoms and signs were graded from 0 to +++. The symptoms and signs were recor­ded by two observers independently. Periphe­ral blood film and conjunctival scrapings were taken and studied for eosindphils.

All the patients clinically diagnosed as having vernal catarrh were given antibiotic drops for 7 days to act as placebo and elimi­nate any infective element.

Patients were then given 2% W/V diso­dium cromoglycate drops to instilled in each eye four times a day for 6 weeks. At each visit symptoms and signs were noted and graded as shown above. Patients were weekly followed and Final assessment was made after six weeks.


  Observations Top


Among the 28 patients of Vernal Catarrh 18 were males and 10 females, ranging bet­ween the ages 4 years to 25 years with the mean age of 12.32 years.

Twenty out of 28 patients had a definite history of seasonal recurrence. i.e. in summer months every year, the duration of disease ranging from one to eight years. 12 Patients had a history of other atopic disease like allergic rhinitis, bronchial asthma or eczema. Not a single patient gave a family history of disease

Only 7 out of 28 patients had involvement of palpebral conjuntiva. Out of these only 2 suffered from the palbebral variety of vernal catarrh alone while the rest were of the mixed variety. Remaining majority (21 cases) had rare limbal form of disease. [Table - 1]

At the end of first week when the patients come after instilling antibiotic drops, no significant change was observed in the symp­toms or signs.

On completion of trial after 6 weeks of using 2% drops of Sodium cromioglycate only 18 patients complained of itching as compared to 26 cases on first visit, 18 patient had redness as against 26 initially. Photopho­bia, watering and ropy discharge were now complained by 10, 15 and 9 cases respectively as against 13, 22 and 13 cases, initially.

Objectively congestion was seen in 20 cases (24 cases initially). gelatinous thickening at the limbus in 13 cases. (24 cases initially). Percentage of patients having cobble stone papillae remained same. Number of patient now having tranta's spots and pannus increa­sed from 16 and 10 to 20 and 11 respectively.


  Discussion Top


Contrary to the classical behief that the palpebral variety of vernal catarrh is commo­ner than limbal variety, we found only two cases had palpebral variety, 5 cases had mixed type and 21 cases nad limbal variety of the disease without palpebral lesion. This confirms the findings of Bansal et al[7] in a study of Indian patients of vernal catarrh and also as quoted by Duke-elder[10] "coloured races are more prone to limbal form of the diseases".

Seasonal variation was found in 20 cases. This is in contrast to that described by Tobgy[11] that it persists round the year in hot countries.

At the end of treatment with antibiotic drops, except for some reduction in Redness and watering possibly because of eradication of superadded infection, no significant change in symptoms or signs was observed.

At the completion of trial, though impro­vement in symptoms was observed, no reduc­tion in signs occurred except lessening of congestion. This is in contrast to the obser­vations of Tabbara et. al.[4]

The observation shows that 2% sodium cromoglycate drops used 4 day is useful only in relieving symptoms in cases, of vernal catarrh but signs persist. Easty et al(13), Hennavi[5] and Jay[6] have found the drug to be useful in occular atopy, Tabbara[4] found it useful in Limbal variety, while Hyams et al[9] and Bansal et al[7] found the drug ineffective. Our observation reveals that sodium cromo­glycate is useful in Vernal Catarrh in giving symptomatic relief only. It will be interesting to study the use on a long term basis, specia­lly to see if the signs are affected by disodium cromoglycate therapy in spring catarrh.


  Summary Top


2% W/V Sodium Cromoglycate drops were tried in 28 patients of Vernal Catarrh.

We observed that 2% Sodium Crimogly­cate produced significant reduction in symp­toms of Vernal Catarrh, specially itching and redness within a week. The improvement was progressive over first four weeks of treatment and well sustained after that.

Though symptoms were relieved, there was no objective improvement. Since the mechanism of the drug is essentially prophy­lactic, it is suggested that known cases of Vernal Catarrh should be instilled topical Sodium Cromoglycate before the precipitating season starts, and should continue it till the season ends.


  Acknowledgement Top


We are thankful to Dr. Kalamogre, MD. MCPS, Director, Medical division, Unique Pharmaceuticals who provided us with the drug[12].

 
  References Top

1.
Abelson, M.B., Baird R.S. and Allensmith, M.R, 1980, Ophthalmology; 87: 812  Back to cited text no. 1
    
2.
Altounyn, R.E.C. 1967, ACTA. Allergy (kbh); 51:667.  Back to cited text no. 2
    
3.
Cox, J.S.G., Beach. JE, Blair, AM, Clark A.J,. Kug J , and Lee J.B. et al , 1970, Adv. Drug Res J ; 115: 196  Back to cited text no. 3
    
4.
Tabbara, K. F. and Arafat N T., 1977, Arch Ophthalmol; 95; 2184  Back to cited text no. 4
    
5.
Medhat-el-Hennawi : 1980, Br J. Ophthalmol; 64 : 483  Back to cited text no. 5
    
6.
Jay J.L, 1981, Brit. J. Ophthalmol; 65; 335.  Back to cited text no. 6
    
7.
Baryshak Y.P. et al , 1982; Br J. Ophthalmol; 66 : 118  Back to cited text no. 7
    
8.
Bansal, S.L, Dhir S.P. and Jain I.S , 1980, Ind. J. Ophthalmol; 28:  Back to cited text no. 8
    
9.
Hyams S.W, Bralik M.S. and Neumann E. 1975, J. Paed. Ophthalmol ; 12: 116  Back to cited text no. 9
    
10.
Duke Elder, 1974, System of Ophthal­mology ; VIII : 476.  Back to cited text no. 10
    
11.
Tobgy, R., 1933, Folia Ophthal. orient, 1:168  Back to cited text no. 11
    
12.
Easty, D.L., Rice, N S C. and Jones B.R.: 1972, clin, Allergy; 2 : 99  Back to cited text no. 12
    



 
 
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