Keratitis

April 27, 2012

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Keratitis   inflammation called the cornea. This disease affects the anterior part of the eyeball often and eventually provokes a deterioration of vision in humans.

If a person appears keratitis, the symptoms of the disease arise as a consequence of infection. It could be an infection Viral . Microbial . fungal origin. Moreover, this disease is often caused by thermal . mechanical . chemical   damage, and as a result of violation of the innervation of the cornea. Keratitis can develop well in people with metabolic disorders, allergic reactions, meibomian gland hypersecretion. However, in some cases there is of unknown etiology.

Current keratitis

In the development keratitis symptoms initially appear edema   and infiltrates . Under infiltrates in some cases there is a detachment of the epithelium, due to its exfoliating often caused erosion, corneal luster disappears, appears roughness. In parallel with the development of infiltration or after the occurrence of ingrown going deep and superficial vessels   from conjunctiva   and sclera . As a rule, small infiltrates, which appear on the surface, disappear without a trace, but a consequence of deep infiltrates are of varying degrees of opacity.

If the disease is complicated purulent infection Then occurs during the development of infiltrates necrosis   corneal tissue and appear ulceration. After ulcer healing, scar tissue is formed, and subsequently manifested leukoma .

To distinguish two types of keratitis: Exogenous   and endogenous type. Exogenous   keratitis manifested as a consequence of injuries occurring after mechanical and other damage. Also, this type of keratitis is a result of infectious diseases that are of bacterial origin. Exogenous keratitis have a viral etiology, there are fungal diseases of the cornea pathologies eyelids, conjunctiva, meibomian glands.

Endogenously   forms are infectious keratitis, neurogenic keratitis and keratitis which arise when beriberi   and gipovitaminoze And those keratitis, aetiology is unsettled.

The symptoms of keratitis

Although the keratitis of various etiology, symptoms are observed predominantly general. People who become ill with this disease, complain of pain in the eye, which struck keratitis. They have been a constant tearing, visual acuity deteriorates, there is photophobia. In addition, patients manifested perikornealnaya or mixed vascular injection of the eyeball, nictitating spasm . On the cornea having ulcers or infiltrates the cornea thus can lose sensitivity. Typically, if the person develops keratitis symptoms described above take place in the complex or appear only some of them. In this case, it depends on which clinical disease is manifested in the patient.

The most significant symptom of keratitis is considered a violation of the transparency of the cornea. This phenomenon - a direct consequence of the emergence of infiltration and edema of the cellular elements. There are significant changes in the condition of the epithelium of the cornea: its luster disappears, thus there is roughness. In some cases there is a detachment and peeling of the epithelium. As a result, erosion on the surface appears.

Location infiltrates at keratitis can be varied: they have different shapes and sizes, and can be developed in different places. Often infiltrates can capture the cornea as a whole, when they are developed and as unit and as multiple infiltrates. Their localization is possible both on the surface and in the deeper layers of the cornea. Infiltrates may have different shades of that depends on the nature of the cellular elements. Thus, the presence of lymphoid cells in a patient manifested infiltrate gray; At the same time, if the purulent infiltration develops in the presence of a large number of leukocytes , Its hue is yellow.

Usually, the appearance of the surface or deep vessels occurs in corneal tissues. The development of surface blood vessels is shown if the infiltration is located in the front layers of the cornea. The transition of these vessels comes from a network of conjunctival blood vessels. For such vessels is typical tree branching and bright red. Hue deep vessels will be darker. Such vessels look like short, straight branches. They go from the deep episcleral vessels.

Depending on the measured depth of the lesion vascularization of the cornea. In this case, we can speak of the superficial or deep keratitis.

If infiltrates located superficially, later perhaps their complete resorption, and ultimately clouding does not manifest itself.

Very often it infiltrates appear ulcers, which vary widely in terms of size, and according to the depth of their location. In ulcers can be either pure or purulent bottom, wherein preferably the edges are unequal. If the edges of the ulcer to heal, and then it gradually begins to clean the bottom. The ulcer heals, the epithelium is regenerated, and a place where developed ulcers, connective tissue fills.

However, if the development of the ulcer occurs unfavorably, the cornea is sometimes destroyed to Descemet's membrane. As a consequence of this process, the patient has wall-eye That is spliced ​​to the iris. In this case, as a complication may occur in a patient secondary Glaucoma . In some cases, the consequence of the ulcer becomes flattening the cornea.

Besides these symptoms are often observed when keratitis inflammation sclera . conjunctiva . rainbow shell . tsiliarnogotela . In some cases there may be almost all the membrane inflammation eyeball. Then the patient is diagnosed keratoconjunctivitis . keratouveit . keratosklerit .

Basically after keratitis in humans appear clouding of the cornea, the different intensity. This is due to the formation of connective tissue scar. Such turbidity may have a different effect on the visual acuity of the patient. Sometimes there is a slight surface haze in which the visual acuity remained unchanged. But no less seldom gross clouding called leukoma, which dramatically reduces the visual acuity of a person.

There are several forms of keratitis with a particular clinical picture. With the development of keratitis in nesmykanii eye slit   ulcer patient appears in the lower portion of the cornea. Gradually, it goes deeper, as necrotic areas rejected. As a result, it can go into all layers of the cornea. If this is the development of a secondary infection, then this form of keratitis may be complicated by a purulent melting of the cornea.

At neuroparalytic keratitis   the patient is always sharply reduced corneal sensitivity or it is completely absent. In this form of keratitis no photophobia or lacrimation is observed. At the same time, the possibility of occurrence of intense pain of neurological character. If there are no other complications, the pathological process appears initially superficial layers of corneal opacification. In the center begins obluschivatsya epithelium, and as a result there is a saucer-shaped ulcer type. Gradually it spread over the surface of the cornea. Especially dangerous is the manifestation of a secondary infection, which is fraught with purulent inflammation. In such a case likely to develop corneal perforation or its complete destruction. This form of the disease lasts a long time.

If the patient has a place filamentary keratitis Which is shown in the background of a moderate irritation of the eyes, the main symptoms in this case are photophobia and constant itching. A little later comes a kind of discharge that contains thin strands attached to the cornea from one end. Such yarns are twisted and degenerated cells of the corneal epithelium. If you remove the thread, then this place will be a point of erosion. In this form of keratitis, corneal lesion occurs in the lower part. The cornea retains sensitivity, visual acuity is not reduced.

Furthermore, when manifest keratitis and other characteristic features. Patients feel a constant feeling of dryness in the nose, throat and mouth, it is difficult to swallow. In the end, perhaps a complex digestive disorders. In addition, when keratitis patient may develop chronic polyarthritis, begin to fall prematurely teeth. teeth.

If the occurrence of keratitis provokes   Pseudomonas aeruginosa , It will be especially difficult for. At the time when the cornea appears abscess A person suffering from severe pain. In this case there is involvement of the inner shells of the eye. This form of keratitis may be complicated in the end atrophy of the eyeball .

Diagnosis keratitis

The diagnosis "keratitis" Easy if the patient the above-described clinical symptoms. To determine the effect of exogenous factors made taking scrapings from infiltration. When it is determined by analyzing the presence of pathogenic microorganisms. In addition, a history of the patient often contains eye injury.

If you suspect an endogenous keratitis performed a series of laboratory analyzes and studies of a general nature in order to determine the etiological factor. Specialist necessarily carefully studying the history, because the endogenous keratitis is a symptom of certain diseases of a general nature.

Also in the diagnostic process is carried out biomicroscopy   using a slit lamp.

It is important to differential diagnosis of a number of degenerative phenomena in the cornea. If the patient holds the primary degeneration of the cornea is typically a two-way process, it has a chronic course, and sufficiently slow progression.

Treatment of keratitis

If a patient diagnosed with keratitis, treatment of this disease mainly produced in the hospital. It is particularly important to immediately hospitalize a patient in case of purulent keratitis and leaking badly. If the etiology of the disease is known, the therapy involves the treatment of keratitis disease provoked keratitis.

To reduce the inflammation and pain of the patient, it is assigned a reception mydriatic drugs Which also help to prevent the fusion of the pupil and imperforate.

If the patient is diagnosed with an ulcer of the cornea and bacterial keratitis, treatment of disease involves the use of antibiotics Having a wide range of effects. It is also possible the use of eye ointments antibiotics topically. The artisan should select antibiotics considering how sensitive thereto pathogenic microflora. In some cases it is advisable intramuscular antibiotics.

Such treatment is often combined with the use of sulfonamides. In parallel, the patient should be sure to take a course of vitamin complex. Especially important in this case assignment vitamins B1, B2, B6, C, PP .

Furthermore, in certain forms of keratitis treatment of disease involves several important features. For example, if the patient holds keratitis provoked nesmykaniem eye slits, the patient is prescribed conduct installation in the eye of paraffin oil, cod liver oil. In addition, a positive effect in this case is levomitsetinovaya   or tetracycline ointment .

If a patient is diagnosed meybomievy keratitis , In this case, special attention should be paid to the correct approach to the treatment of chronic meybomita . In this case, it is advisable to conduct a special massage century installations solution of sodium sulfacyl Applying sulfatsilovoy   or tetracycline   ointments.

To reduce pain during neuroparalytic keratitis Apply installation solution quinine hydrochloride   from morphine hydrochloride . It is also practiced by local warming treatments, receiving painkillers. It is important to apply a bandage to the affected eye.

If a patient is diagnosed filamentary keratitis Mainly apply symptomatic therapy. Furthermore, complex treatment includes the use of eye drops, which is composed of vitamins, the use of a 1% emulsion sintomitsina   for insertion into the conjunctival sac. It is also envisaged receiving special vitamin complexes or intramuscular administration of vitamins.

It is important to bear in mind that taking a multivitamin, as well as the use of salt-free diet   low carbohydrate expediently at each of the forms of keratitis.

In order to stimulate the absorption of haze, using 2-3% potassium iodide solution   by electrophoresis and used lidazu   and yellow mercury ointment . It is also advisable to use biogenic stimulants subcutaneously.

In some severe cases of keratitis treatment can be carried out surgically.

If we talk about the forecast in the keratitis, it depends on what the etiology of the disease, and from where localized as infiltration proceeds. If the treatment of keratitis is conducted in a timely and correctly, a small infiltrate resorption takes place wholly or after that there are only slight turbidity. With deep and ulcerative keratitis in a patient, as a rule, remain significant haze and a decrease in vision. But even the people affected by wall-eye, you can restore vision using keratoplasty.

Prevention keratitis

In order to prevent the manifestation of this disease, it is important to prevent eye injuries, time to heal conjunctivitis . blepharitis . dacryocystitis As well as common diseases that predispose to the development of keratitis.

At work, dangerous from the standpoint of eye injuries should wear special glasses for protection. If a person uses contact lenses, it should strictly adhere to all the rules of hygiene. We can not allow the mucous membrane of the eye burns and cornea. If the patient is only the first signs of keratitis is important to seek medical advice immediately and strictly adhere to its provisions.