Year : 1985 | Volume
: 33 | Issue : 3 | Page : 151--153
Role of disodium cromoglycate in vernal conjunctivitis
Rasik Vajpayee, Salil Kumar, Mithilesh Sharma
Department of Ophthalmology Gandhi Medical College and Associated, Hamidia Hospital Bhopal, India
R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-110029
|How to cite this article:|
Vajpayee R, Kumar S, Sharma M. Role of disodium cromoglycate in vernal conjunctivitis.Indian J Ophthalmol 1985;33:151-153
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Vajpayee R, Kumar S, Sharma M. Role of disodium cromoglycate in vernal conjunctivitis. Indian J Ophthalmol [serial online] 1985 [cited 2021 Jun 15 ];33:151-153
Available from: https://www.ijo.in/text.asp?1985/33/3/151/30810
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 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,. It has been introduced in the treatment of Vernal Catarrh, but its clinical usefulness remains controversial.
Tabbara and Arafat 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 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 has reported improvement in symptoms and reduction in ocular inflammation but without complete resolution of physical signs.
In Israel, Baryishak et al 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 in Indian patient of vernal keratoconjuctivitis and they found no difference in the treated and the control group. Another study by Hyams et al found no significant beneficial effect of drug on Vernal Catarrh.
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.
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.
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 in a study of Indian patients of vernal catarrh and also as quoted by Duke-elder "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 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.
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 and Jay have found the drug to be useful in occular atopy, Tabbara found it useful in Limbal variety, while Hyams et al and Bansal et al 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.
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.
We are thankful to Dr. Kalamogre, MD. MCPS, Director, Medical division, Unique Pharmaceuticals who provided us with the drug.
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