Clodifen eye drops for treatment of herpetic and adenoviral keratoconjunctivities

This article represents the results of Clodifen eye drops use in treatment of herpetic and adenoviral keratoconjunctivitis. Clodifen like all other nonsteroidal anti- inflammatory drugs (NSAIDs), inhibit prostaglandin synthesis and therefore lessen conjunctiva hyperemia, edema and pain. Clodifen possess marked anti-inflammatory and pain killing effects, it is very important that it doesn’t interfere with reparative processes that take place in eye tissues. This characteristic is crucial in case of treating long lasting herpetic corneal ulcers and adenoviral infiltrations.

Treatment was conducted in 27 patients with herpetic keratoconjunctivitis and 12 patients with adenoviral keratoconjunctivitis. The patients were being observed for 1.5-2 years. Each patient during primary visit was examined by standard ophthalmologic examining methods: visometry, biomicroscopy, ophthalmoscopy, eye swab for bacteriologic and virology studies, blood sample for viruses, consultation of virologist with attributable antiviral prescriptions.

Majority of the patients with herpetic ophthalmia, blood immunohistochemical analysis revealed HSV1 infection with various proportions of IgG and IgM. In patients with adenoviral infection blood and eye sample also revealed Adenovirus.

In herpetic cases topical antiviral, lubricating and NSAIDS (Clodifen 0.1 % eye drops 4 times/day for 14 days) medications were used. Each patient for pain relieve and anti- inflammatory activity were given once daily intramuscular injections of Clodifen (75 mg/ml for three days), then 2 injections with day after day interval, total 5 injections.

The patients after such treatment regimen, mentioned subjective improvement of general well being, pain cessation, free eye opening, improved visual acuity. The following were regarded as improvement criteria: pain relieve, edema and hyperemia cessation, corneal epithelization.

It is well known that herpetic ophthalmia is a chronic disease with frequent exacerbations, necessitating continuous ophthalmologist observation.

In our trial, during appearance of firs signs (pain, hyperemia, patchy infiltrations over corneal opacities) of disease recurrence we conducted the treatment plan described above, that reduced disease recurrences. During 2 year observation period: 9 patients had 3 exacerbation episodes, 5 patients-2 episodes and 13 patients only once.

Treatment of adenoviral keratoconjunctivitis is associated with certain difficulties, because antiviral medications are usually ineffective. The following symptoms are characteristic of adenoviral infection: hyperemia, discharge, eyelid edema, various pink plaques on the conjunctiva, corneal infiltrations.

According to treatment regimen for adenoviral keratoconjunctivitis, for purpose of rapid resolution of pain, hyperemia, corneal infiltrates, Clodifen instillation 4 times/day was given for 10 days. After 1-2 days of treatment patients mentioned reduction of pain, hyperemia and blepharospasm, since 3rd treatment day –marked improvement of general well being, expressed in increased visual acuity, pain and hyperemia cessation.

We regarded, pain and hyperemia relieve, cessation of conjunctival discharge, resorption of corneal infiltrates and increased visual acuity as objective criteria of convalescence.

Conclusion:

Clodifen 0.1% eye drop use is recommended for treatment of herpetic and adenoviral keratoconjunctivitis, for purpose of hyperemia and edema relive.

Clodifen 0.1% eye drops doesn’t interfere with tissue reparative processes that take place during long-standing herpetic keratoconcunctivitis and also doesn’t interfere corneal ulcer epithelization. Side effects were not observed in majority of the patients.

NINO KARANADZE, MD, PhD, Assistant Professor Tbilisi State Medical University

Department of Eye Diseases