Estudio primario

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Pandemia COVID-19: impacto sobre la tasa de conjuntivitis virales

Traducción oficial
Año 2022
Revista Archivos de la Sociedad Espanola de Oftalmologia
Enlaces DOI , Virtual Health Library , PMC , Pubmed

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OBJETIVO:

La pandemia COVID-19 condujo a España al decreto de estado de alarma con cese de actividades no esenciales el 14 de marzo de 2020 y a intervenciones de salud pública, como el confinamiento domiciliario y otras recomendaciones sanitarias para evitar la propagación del virus SARS-CoV-2: la higiene de manos y la obligatoriedad de portar mascarillas. Estos factores podrían haber influido en la tasa de conjuntivitis virales.

MÉTODO:

En este estudio descriptivo retrospectivo no intervencionista se compara la incidencia de conjuntivitis virales en un servicio de urgencias de un hospital nacional sobre dos periodos de tiempo: pre-COVID (13 de marzo a 30 de septiembre de 2019, un año antes del inicio de la pandemia) y COVID (13 de marzo a 30 de septiembre de 2020).

RESULTADOS:

En el primer periodo hubo 436 conjuntivitis, de las cuales 168 (38,5%) fueron casos confirmados de conjuntivitis viral 168 (38,5%), mientras que en el segundo periodo hubo 121 registros, de los cuales los más frecuentes fueron las conjuntivitis alérgicas y las traumáticas, con 23 casos (19% cada grupo); las conjuntivitis bacterianas, con 15 casos (12,3%), y las conjuntivitis virales, con 15 casos (12,3%). El diagnóstico de conjuntivitis viral es el que experimenta una reducción relativa más importante (48,5%), mientras que otros tipos de conjuntivitis apenas cambian su frecuencia relativa entre estos dos periodos de tiempo.

CONCLUSIONES:

La conjuntivitis viral, como patología infecciosa más frecuente del ojo, tiene una transmisión similar a la del coronavirus, por lo que las medidas implantadas podrían afectar positivamente a su incidencia.

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Estudio primario

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Azelastine eye-drops in seasonal allergic conjunctivitis or rhinoconjunctivitis.

Año 1998
Revista Allergy
Enlaces DOI

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This study was carried out to assess the efficacy of 0.025% and 0.05% azelastine eye-drops in patients with seasonal allergic conjunctivitis of >1 year's duration. A total of 151 patients received 0.025% or 0.05% azelastine eye-drops or placebo b.i.d. for 14 days according to a double-blind, randomized, placebo-controlled, parallel-dosing design; 129 patients completed the study as planned. The three target symptoms, scored on 4-point scales, were itching, lacrimation, and redness of the eyes; responders were patients whose symptom sum score decreased by >3 from a baseline score of >6 by day 3. Mean scores of these and five other symptoms were recorded also on days 7 and 14, and patients kept daily diaries of the three main symptoms and swollen eyelids. Responder rates were 73% for 0.025% (p = 0.115 V.V placebo) and 82% for 0.05% azelastine eye-drops (P=0.011 vs placebo) and 56% for placebo. The time courses of the mean (investigators' and patients') scores for the three main symptoms reflected the dose-dependent effect of azelastine eye-drops. One patient each from the two azelastine groups and three from the placebo group withdrew because of ineffieacy. Adverse drug reactions were reported by 14 and 24 patients receiving 0.025% and 0.05% azelastine eye-drops, respectively, and by eight placebo patients. These reactions were mainly slight application site reactions and taste perversion (bitter or unpleasant taste). Azelastine eye-drops are effective and well tolerated at a dose of 0.05% for the treatment of seasonal allergic conjunctivitis.

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Revisión sistemática

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Clinical inquiries. Intranasal steroids vs antihistamines: which is better for seasonal allergies and conjunctivitis?

Año 2012
Revista The Journal of family practice
Enlaces Pubmed

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Intranasal steroids provide better relief for adult sufferers, according to nonstandardized, nonclinically validated scales. Steroids reduce subjective total nasal symptom scores (TNSS)--representing sneezing, itching, congestion, and rhinorrhea--by about 25% more than placebo, whereas oral antihistamines decrease TNSS by 5% to 10% (strength of recommendation [SOR]: B, systematic review of randomized controlled trials [RCTs], most without clinically validated or standardized outcome measures). Intranasal steroids improve subjective eye symptom scores as well as (or better than) oral antihistamines in adults who also have allergic conjunctivitis (

SOR:

A, systematic review, RCTs).

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Revisión sistemática

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Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update.

Año 2005
Autores Sheikh A , Hurwitz B
Revista The British journal of general practice : the journal of the Royal College of General Practitioners
Enlaces PMC , Pubmed

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BACKGROUND:

Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).

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Revisión sistemática

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Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness.

Año 2004
Autores Owen CG , Shah A , Henshaw K , Smeeth L , Sheikh A
Revista The British journal of general practice : the journal of the Royal College of General Practitioners
Enlaces PMC , Pubmed
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BACKGROUND:

Evidence for the effectiveness of topical treatments, in providing symptomatic relief from ocular allergy, remains uncertain.

AIMS:

To assess the effectiveness and relative efficacy of topical treatments for the management of seasonal allergic conjunctivitis.

DESIGN OF STUDY:

A systematic review and meta-analysis.

SETTING:

A literature search of the Cochrane Library, Medline, and EMBASE bibliographic databases.

METHOD:

Double-masked randomised controlled trials were identified, that compared the use of topical mast cell stabilisers (sodium cromoglycate, nedocromil, lodoxamide) with placebo, topical antihistamines with placebo, and topical mast cell stabilisers with topical antihistamines.

RESULTS:

A meta-analysis of six trials showed that patients using sodium cromoglycate were 17 times (95% confidence interval [CI] = 4 to 78) more likely to perceive benefit compared with those using a placebo, although this estimate may be partially influenced by publication bias. Five trials indicated that those patients using nedocromil were 1.8 times (95% CI = 1.3 to 2.6) more likely to perceive their allergy to be moderately or totally controlled than those using a placebo. Four trials showed that those using antihistamines were 1.3 times (95% CI = 0.8 to 2.2) more likely to perceive a 'good' treatment effect than those using mast cell stabilisers, although this beneficial effect was not statistically significant. Limited evidence suggests that antihistamines might have a faster therapeutic effect compared to mast cell stabilisers.

CONCLUSION:

Overall, these findings confirm the benefit of topical mast cell stabilisers and antihistamines over placebo for the treatment of allergic conjunctivitis. There is, however, insufficient evidence to recommend the use of one type of medication over another. Treatment preferences should therefore be based on convenience of use (with reduced frequency of instillation for some preparations), patient preference, and costs, especially as important side effects were not reported with any medication.

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Estudio primario

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Exclusion of students with conjunctivitis from school: policies of state departments of health.

Año 2007
Autores Ohnsman CM
Revista Journal of pediatric ophthalmology and strabismus
Enlaces Pubmed

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PURPOSE:

To use current state department of health regulations regarding exclusion of students with conjunctivitis from school as a starting point in developing uniform recommendations for schools.

METHODS:

State departments of health were asked to state their policy regarding when a child with conjunctivitis may return to school. This information was collated and examined for trends. The results were compared with current literature on infectious conjunctivitis.

RESULTS:

Of the 43 states that responded, 7 allow children with conjunctivitis to remain in school, 8 allow their return once antibiotic treatment is initiated, 12 allow their return 24 hours after antibiotics are initiated, 13 exclude them until the disease is noncommunicable, and 16 require the approval of a physician for return to school. Seventeen states gave multiple recommendations, which were often contradictory.

CONCLUSIONS:

Although no current consensus exists among state health officials regarding students with conjunctivitis, the literature supports excluding children with conjunctivitis from school until they are asymptomatic. When patients are treated with fourth-generation fluoroquinolones, the length of exclusion may be as little as 24 hours in cases of bacterial conjunctivitis, and longer in cases of viral conjunctivitis. Following these guidelines may prevent epidemics of bacterial and viral conjunctivitis.

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Estudio primario

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Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis.

Año 1989
Revista The New England journal of medicine
Enlaces DOI , Pubmed

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Opinions differ concerning the efficacy of prophylaxis against neonatal chlamydial and gonococcal conjunctivitis. From January 1986 through June 1988, we gave all infants born at Kings County Hospital Medical Center one of three prophylactic agents -- silver nitrate drops, erythromycin ophthalmic ointment, or tetracycline ophthalmic ointment. The treatments were rotated monthly. Gonococcal ophthalmia occurred in 8 of the 12,431 infants born during the study (0.06 percent), 1 in the silver nitrate group, 4 in the erythromycin group, and 3 in the tetracycline group (P not significant). Seven of these infants were born to women who had received no prenatal care. From September 1985 through December 1987, we screened 4357 pregnant women for cervical chlamydial infection, of whom 341 (8 percent) had positive cultures. Of their offspring, 230 were evaluated for neonatal chlamydial conjunctivitis; the incidence was 20 percent in the silver nitrate group, 14 percent in the erythromycin group, and 11 percent in the tetracycline group (P not significant). We conclude that neonatal ocular prophylaxis with either erythromycin or tetracycline ophthalmic ointment does not significantly reduce the incidence of chlamydial conjunctivitis in the offspring of mothers with chlamydial infection as compared with silver nitrate, and that better management of maternal chlamydial infection is therefore required. We also conclude that there is a small but appreciable incidence of neonatal gonococcal ophthalmia that could be prevented by better prenatal screening and treatment of maternal gonococcal infection.

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Estudio primario

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Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States.

Año 2009
Autores Smith AF , Waycaster C
Revista BMC ophthalmology
Enlaces DOI , Pubmed
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BACKGROUND:

The aim of this study was to estimate both the direct and indirect annual costs of treating bacterial conjunctivitis (BC) in the United States. This was a cost of illness study performed from a U.S. healthcare payer perspective.

METHODS:

A comprehensive review of the medical literature was supplemented by data on the annual incidence of BC which was obtained from an analysis of the National Ambulatory Medical Care Survey (NAMCS) database for the year 2005. Cost estimates for medical visits and laboratory or diagnostic tests were derived from published Medicare CPT fee codes. The cost of prescription drugs was obtained from standard reference sources. Indirect costs were calculated as those due to lost productivity. Due to the acute nature of BC, no cost discounting was performed. All costs are expressed in 2007 U.S. dollars.

RESULTS:

The number of BC cases in the U.S. for 2005 was estimated at approximately 4 million yielding an estimated annual incidence rate of 135 per 10,000. Base-case analysis estimated the total direct and indirect cost of treating patients with BC in the United States at $ 589 million. One- way sensitivity analysis, assuming either a 20% variation in the annual incidence of BC or treatment costs, generated a cost range of $ 469 million to $ 705 million. Two-way sensitivity analysis, assuming a 20% variation in both the annual incidence of BC and treatment costs occurring simultaneously, resulted in an estimated cost range of $ 377 million to $ 857 million.

CONCLUSION:

The economic burden posed by BC is significant. The findings may prove useful to decision makers regarding the allocation of healthcare resources necessary to address the economic burden of BC in the United States.

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Revisión sistemática

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Safety of sublingual immunotherapy Timothy grass tablet in subjects with allergic rhinitis with or without conjunctivitis and history of asthma.

Año 2015
Revista Allergy
Enlaces DOI , Pubmed

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BACKGROUND:

Patients with asthma may be more susceptible to adverse events (AEs) with sublingual immunotherapy tablet (SLIT-tablet) treatment, such as severe systemic reactions and asthma-related events. Using data from eight trials of grass SLIT-tablet in subjects with allergic rhinitis with/without conjunctivitis (AR/C), AE frequencies were determined in adults and children with and without reported asthma.

METHODS:

Data from randomized, double-blind, placebo-controlled trials of Timothy grass SLIT-tablet MK-7243 (2800 BAU/75 000 SQ-T, Merck/ALK-Abelló) were pooled for post hoc analyses. Subjects with uncontrolled and severe asthma were excluded from the trials. Frequencies for treatment-emergent AEs (TEAEs), local allergic swelling (mouth or throat), systemic allergic reactions, and asthma-related treatment-related AEs (TRAEs) were calculated.

RESULTS:

Among adults (n = 3314) and children (n = 881), 24% and 31%, respectively, had reported asthma. No serious local allergic swellings or serious systemic allergic reactions occurred in subjects with asthma treated with SLIT-tablet. There was no evidence of increased TEAEs, systemic allergic reactions, or severe local allergic swellings in adults or children with asthma treated with grass SLIT-tablet versus subjects without asthma in or outside of pollen season. There were 6/120 asthma-related TRAEs assessed as severe with grass SLIT-tablet and 2/60 with placebo, without a consistent trend among subjects with and without asthma (5 and 3 events, respectively).

CONCLUSIONS:

In the AR/C subjects with reported well-controlled mild asthma included in these studies, grass SLIT-tablet did not increase TEAE frequency, severe local allergic swelling, or systemic allergic reactions versus subjects without asthma. There was no indication that treatment led to acute asthma worsening.

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Revisión sistemática

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A 37-year-old man referred for assistance with persistent asthma, atopic dermatitis, and chronic conjunctivitis.

Año 2014
Autores Bielory L
Revista Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
Enlaces DOI , Pubmed

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