Helcoma

Description:

Helcoma (purulent keratoiridotsiklit with an ulceration, gipopionkeratit, a creeping helcoma) — an acute inflammation of a cornea of an eye with an ulceration of purulent infiltrate.

Helcoma symptoms:

Process is unilateral. At the time of the address the patient shows complaints to sharply expressed corneal syndrome, reddening and considerable deterioration in sight of an eye, intolerable pains in it amplifying at night and connects them with the eye microtrauma which happened 12 — 15 h back (a mote, blow by a tree branch, badly put on contact lens etc.). Instructions on constant dacryagogue often occur in the anamnesis from a sore eye within several months or years, refusal of the operation of a dacryocystorhinostomy offered the patient. Visual acuity is reduced to 0,2 — 0,3 and below, an eye is available to a research only after an instillation of local anesthetic — solution of Dicainum of 0,25%. Objectively — the palpebral fissure is narrowed because of hypostasis a century and a nictitating spasm. The conjunctiva is sharply edematous, note the mixed injection of vessels of an eye. In superficial and the center of a cornea the roundish infiltrate of yellow-gray or flavovirent color with indistinct borders which is painted flyuorestseiny is visible. One edge of an ulcer often подрыт and инфильтрирован pus (the progressing edge) opposite — flat. Note symptoms of the accompanying iridocyclitis: opacification of moisture of an anterior chamber and a strip of purulent exudate at its bottom (hypopyon), the erased relief and the changed color of an iris, the narrowed slow-moving pupil. An eye гипотоничен, its palpation is painful.

The diagnosis is established on the basis of data of the anamnesis (an eye microtrauma, it is frequent — instructions on a chronic dacryocystitis), complaints (a corneal syndrome), a research of sight, biomicroscopy with coloring flyuorestseiny, approximate definition of VGD, existence of purulent contents in a dacryocyst, a bacteriological research (structure of microflora, its sensitivity to antibiotics), a smear from a surface of a conjunctiva and scraping from a helcoma surface.
The helcoma differs in bystry development, increase in the area and depth of defect of fabric of a cornea; especially quickly the cornea at infection with a pyocyanic stick collapses. In most cases urgent medical measures can stop disintegration of a cornea, the surface of an ulcer is cleared, edges become brilliant, rounded off ("facer"), defect is filled with opaque fibrous fabric, cicatricial opacification — a cataract forms. At less favorable option of development of a helcoma in the center of the breaking-up purulent infiltrate there is a black extending point, then it is transformed to gryzhepodobny protrusion of a back (descemete) boundary membrane of a cornea — to a destsemetotsela, further there is a perforation of a cornea to infringement of an iris in a perforation opening. When scarring such ulcer the cataract spliced with an iris, an anterior chamber, uneven on depth, and commissures (front synechias, gonio-synechias) in its corner breaking free outflow of intraocular liquid is formed. Secondary glaucoma and an atrophy of an optic nerve with loss of all visual functions can be the result of such development of a helcoma. If the iris does not tampon an opening in a cornea, the purulent infection gets into a vitreous and covers of an eye surrounding it, vitreous abscess, an entophthalmia and a panophthalmia consistently develops, as a result process comes to the end with an atrophy of an eyeglobe or phlegmon of an eye-socket with possible thrombosis of a cavernous bosom, brain abscess, sepsis.

Helcoma reasons:

The activator in the majority (50 — 55%) of cases is the pneumococcus (Streptococcus pneumoniae), is more rare — a piogenic streptococcus, staphylococcus, a pyocyanic stick (Pseudomonas aeruginosae), Moraks's diplobacillus — Aksenfelda (Moraxella lacunata), fungi. Pneumococci are the prevailing dacryocyst contents microflora at a chronic dacryocystitis, a canaliculitis, other microorganisms live on a conjunctiva surface as opportunistic microflora (25 — 30% of cases of a helcoma) or can be on the hurting tool (10 — 15%). Development of a helcoma is usually initiated by an epithelium microtrauma (erosion) of a cornea, further there is an infection of a bald-headed surface, purulent infiltrate in superficial and the center of a cornea with the subsequent its disintegration and involvement in inflammatory process of front departments of a vascular path of an eye (an iris and a ciliary body) is formed.

Treatment of the Helcoma:

Urgent hospitalization in an ophthalmologic hospital and carrying out measures of acute management is necessary.
Acute management from the doctor of not ophthalmologist consists in imposing of a monocular bandage, intramuscular injection of an antibiotic (аугментин, ampicillin, benzylpenicillin sodium salt) and the direction of the patient with a medical ambulance in a dorsal decubitus in the ophthalmologic hospital accepting patients through "Ambulance" with the diagnosis: "suspicion on perforation of a cornea".
Acute specialized management is given in the following directions: 1) prevention of distribution of a helcoma on a surface and in cornea depth: carry out coagulation of an ulcer surface within healthy fabrics (diatermo-, thermo - a lazerkoagulyation or at least a defect tushirovaniye a wadding stick with spirit solution of diamond green 1%); 2) prevention of an union and fusion of a pupil: dig in мидриатик — solution of Atropini sulfas of 1% (it is contraindicated at emergence to a destsemetotsela and threat of perforation of a cornea!); 3) sanitation of slezootvodyashchy ways: depending on result of a palpation of area of a projection of a dacryocyst either washing of the lacrimal ways, or urgent operation of a dacryocystorhinostomy for elimination of the center of a purulent infection near a cornea. Further appoint planned treatment of a keratitis and iridocyclitis by the general rules of treatment of a keratitis (see). At the helcoma caused by infection with a pyocyanic stick it is necessary to give preference to antibiotics from group of ftorkhinolon (ципромед) or to gentamycin in combination with polymyxin M sulfate.
The forecast for sight adverse as permanent cicatricial opacification like cornea cataract is always formed. In the absence of complications (secondary glaucoma, an entophthalmia, an eyeglobe atrophy) and total disappearance of the inflammatory phenomena the optical keratoplasty can be made for recovery of transparency of a cornea and visual functions.