Keratitis

Description:

Keratitis - a cornea inflammation. It is one of the most frequent defeats of front department of an eyeglobe leading to decrease in sight.

Keratitis symptoms:

Keratitis of various etiology is characterized by a number of the general symptoms. There are affected eye pains, dacryagogue, a photophobia, visual acuity goes down. There are a nictitating spasm, the pericorneal or mixed injection of vessels of an eyeglobe, infiltrates or helcomas, vascularization and disturbance of sensitivity of a cornea. Depending on a clinical form of a disease all listed symptoms or some of them can be noted.

The main symptom of a keratitis is the disturbance of transparency of a cornea caused by its hypostasis and infiltration by cellular elements. The epithelium of a cornea loses the gloss, becomes rough, as if istykanny, exfoliates sometimes and exfoliated. Superficial defect (erosion) is formed.

Infiltrates of various size and form, single or multiple, are located in different sites, sometimes take all cornea. They can be localized in superficial or deep layers. Depending on character of cellular elements color of infiltrate various: gray - in the presence of lymphoid cells and yellow - in the presence of leukocytes (purulent infiltrate).

Usually in fabric of a cornea superficial or deep vessels appear. Superficial develop at an infiltrate arrangement in front layers of a cornea and pass to it from network of conjunctival vessels. They have bright red color and is treelike branch. Deep vessels - more dark color, usually have an appearance of the short rectilinear branches reminding "brushes" or "metelochka". They develop from deep episkleralny vessels.

Character of vascularization reflects depth of defeat of a cornea (a superficial or deep keratitis). Superficially located cornea infiltrates (which are not taking a boumenova a cover) can resolve completely, without leaving behind opacifications. Infiltrates often ulcerate, the epithelium is exfoliated, tissue of a cornea nekrotizirutsya, formed an ulcer. The last is various in size, a form and depth of an arrangement. Edges of an ulcer more often uneven, bottom pure or purulent. When healing edge and a bottom of an ulcer are cleared, its vascularization develops, regeneration of an epithelium begins and defect is filled with connecting fabric. At the adverse course of an ulcer destruction of a cornea can extend to a descemete cover; in this case it is stuck out, formed "hernia" (destsemetotsela). In case of a cornea perforation the iris of the eye or is accustomed to drinking with edges of an opening, or drops out in it. In the subsequent the cataract spliced with an iris which can lead to development of a staphyloma and to secondary glaucoma develops. Sometimes after an ulceration the cornea is flattened.

Quite often a keratitis is followed by an inflammation of a conjunctiva, a sclera, an iris of the eye, a tsiliarnogotel, and sometimes almost all covers of an eyeglobe (the keratoconjunctivitis, a keratoscleritis, keratouveit). An outcome of a keratitis usually are various intensity of a keratoleukoma owing to development of connective tissue hems. They can have an appearance of the gentle superficial opacification which is not exerting noticeable impact on visual acuity, or the rough opacification (leucoma) which is sharply lowering visual acuity.

Some forms of a keratitis have very characteristic clinical picture.

Keratitis at a nesmykaniye of a palpebral fissure. Usually in the lower part of a cornea the ulcer which owing to rejection of necrotic sites slowly goes deep and can take all layers of a cornea is formed. The struck zone of a cornea has an opaque appearance. At accession of consecutive infection there can occur purulent fusion of a cornea. The Mvybomiyevy keratitis is characterized by emergence in a limb of surface infiltrates of grayish-yellowish color, a round form, they often ulcerate. In depth of a cornea process usually does not extend.

The neuroparalytic keratitis differs in sharp decrease or lack of sensitivity of a cornea. The photophobia, dacryagogue and a nictitating spasm usually are absent. Often there are severe neuralgic pains. In uncomplicated cases process begins with opacification of blankets of a cornea and exfoliating of an epithelium in the center. The saucer-shaped ulcer is formed. Then it extends on all surface of a cornea, leaving free only a narrow zone on the periphery. In case of accession of consecutive infection there is a purulent inflammation which can end with perforation of a cornea or its final fracture. The course of a disease long owing to disturbance of a trophicity of a cornea.

At a filamentous keratitis against the background of moderate irritation of an eye there are an itch, a photophobia and there is a peculiar discharge containing thin threads which are attached by one end to a cornea. Threads represent the degenerated and twisted cells of a corneal epithelium. On site remote thread has a dot erosion. The cornea is surprised usually in the lower half - there are pointed opacifications of an epithelium, infiltrates and erosion. These changes clearly come to light at biomicroscopy with coloring flyuorestseiny. Sensitivity of a cornea remains. Due to the paracentral localization of process visual acuity remains rather high.

The disease is accompanied by other symptoms - dryness in a mouth and a nasopharynx, difficulties when swallowing, disturbance of activity of a digestive tract, chronic polyarthritis, premature dedentition. Rozatsea-keratit develops usually at pink eels of the person and it is shown in three forms. At an easy form (surface regional infiltrate) near a limb there are ulcerating infiltrates. Sometimes here calcium salts therefore opacifications have bright white color are deposited. More severe form (subepithelial infiltrate) is followed by defeat of deep layers of a cornea and its vascularization in the form of a triangle with the basis at a limb. Most hard the rozatsea-keratitis at development of an ulcer (the progressing ulcer) with distribution of process on all surface of a cornea proceeds.

The keratitis caused by a pyocyanic stick proceeds especially hard, during formation of abscess in the thickness of a cornea is followed by severe pain. Internal covers of an eye are usually involved in process. Sometimes there occurs perforation of a cornea from the outcome in an eyeglobe atrophy.

Keratitis reasons:

The etiology is very various. The disease arises owing to an infection (microbic, virus, fungal), damages (mechanical, chemical, thermal, etc.), disturbances of an innervation of a cornea, frustration of a metabolism, a lagophthalmia, hypersecretion of meibomian glands, allergies. In certain cases the etiology remains obscure.

Treatment of the Keratitis:

Treatment  is often carried out in the conditions of a hospital, especially at sharply proceeding and purulent keratitis. At clarification of an etiology, first of all carry out treatment of the disease which caused a keratitis.

For the purpose of reduction of the inflammatory phenomena and pains, and also for the prevention of an union and fusion of a pupil - early purpose of mydriatic means: instillations of 1% of solution of Atropini sulfas of 4-6 times a day, atropine in a polymeric film 1-2 times a day, for night of 1% atropinic ointment, an electrophoresis from 0,25-0,5% atropine solution. At the toxic phenomena caused by atropine it is replaced by 0.25% with hydrobromide Scopolaminum solution. Both of these means it is possible to combine 0,1% of solution of Adrenalinum hydrochloricum or 1-2% of solution of adrenaline of hydrotartrate with instillations. For the best mydriasis for a lower eyelid put the cotton plug impregnated 0,1% with Adrenalinum hydrochloricum solution for 15-20 min. 1-2 times a day or enter adrenaline solution in number of 0,2 ml subkonjyunktivalno.

At complications (increase in intraocular pressure) appoint mystical means (1% hydrochloride Pilocarpinum solution, etc.) and Diacarbum on 0,125-0,25 g 2-4 times a day.

For treatment of patients with a bacterial keratitis and ulcers of a cornea appoint antibiotics of a broad spectrum of activity. Use also 0,5% of ointment from antibiotics. Locally apply also other antibiotics: tetracycline, erythromycin, dibiomycin, ditetracycline in the form of 1% of an oculentum. It is reasonable to carry out the choice of an antibiotic depending on sensitivity to it pathogenic microflora.

At heavy helcomas Neomycinum, Monomycinum or Kanamycinum in addition enter under a conjunctiva in a dose 10 000 PIECES, in special cases to 25 000 Units of Subkonjyunktivalno enter also lincomycin on 10 000-25 000 Units, a streptomitsinkhlor a calcic complex on 25000-50000 PIECES. At insufficient efficiency of a local antibioticotherapia appoint antibiotics inside: tetracycline on 0,2 g, Oletetrinum on 0,25 g, erythromycin on 0,25 g 3-4 times a day. Quite often antibiotics enter also intramusculary.

Treatment by antibiotics combine with administration of sulfanamide drugs - 10% of solution Sulfapyridazinum sodium, 20-30% of solution of Sulfacylum-natrium in the form of installations. Inside - Sulfadimezinum on 0,5-1 g 3-4 times a day, Sulfapyridazinum in the first day of treatment of 1-2 g and in the next days on 0,5-1 g, Etazolum on 0,5-1 g 4 times a day, sulfalene the adult in the first day of 0,8-1 g, then on 0,2-0,25 g a day. Along with introduction of massive doses of antibiotics and streptocides purpose of vitamins C, Vyo1 of B2, B6, PP is necessary.

Treatment of some forms of a keratitis has the features. At the keratitis caused by a nesmykaniye of a palpebral fissure it is recommended to install several times a day in an eye fish oil, almond, paraffin oil or to put levomitsetinovy, Unguentum Tetracyclini. At an unremovable lagophthalmia and already appeared keratitis - a temporary or constant tarzorafiya.

In cases of a meibomian keratitis essential value has systematic treatment of a chronic meibomitis. Carry out massage a century with expression of a secret of meibomian glands with the subsequent processing of edges of a century diamond green. Appoint instillations of solution of a sulfacetamide of sodium and a mortgaging sulfatsilovy or Unguentum Tetracyclini.

Pains at a neuroparalytic keratitis decrease from instillation of 1% of solution of quinine of a hydrochloride with morphine a hydrochloride, intake of analginum with pyramidon on 0,25 g, local thermal procedures. Imposing of a bandage or hour glass on the affected eye, especially for the night is necessary. Sometimes it is necessary to resort to sewing together a century for long term.

At a filamentous keratitis symptomatic treatment. Instillations of a liquid paraffin or fish oil, the eye drops containing vitamins (0,01% citral solution, Riboflavinum with glucose), 20% of solution of a sulfacetamide of sodium, irrigations of eyes of 1-2,5% chloride sodium solution 2-3 times a day; introduction to a conjunctival sac of 1% of an emulsion of synthomycin. A, B1 V2, V6, V12, S, RR vitamins inside or intramusculary.

Topical treatment of a rozatsea-keratitis should be combined with the general. Appoint corticosteroids: 0,5-1% an emulsion of a cortisone, 2,5% an emulsion of a hydrocortisone, 0,5% prednizolonovy ointment, 0,1% dexamethasone solution on 0,2-0,3 ml subkonjyunktivalno daily. Apply vitamins B a type of instillation of eye drops (0,01% Riboflavinum citral solution) and a mortgaging of 0,5% of tiaminovy ointment, and also insulin ointment. Inside isopromethazine (Pipolphenum) on 0,025 g 2-3 times a day; methyltestosterone on 0,005 g 2-3 times a day are sublingual; Testosteroni propionas of 1% Solutio oleosa on 1 ml intramusculary in 2 days, 10 injections on a course; B1 vitamin on 1 ml intramusculary, 30 injections on a course. Also periorbital or perivazalny novocainic blockade on the course of a temporal artery is recommended; in persistent cases a roentgenotherapy. The glycoprival electrolyte-deficient diet using polyvitamins is appointed.

Treatment of patients with the keratitis caused by a pyocyanic stick carry out by instillation 2,5% of solution of polymyxin M of sulfate (25 000 Units/ml) of 4-5 times a day and introduction of Neomycinum under a conjunctiva in a dose of 10 000 PIECES once a day.

Upon termination of inflammatory process the rassasyvaniye of the opacifications which remained in a cornea requires prolonged treatment. Ethyl morphine the hydrochloride is applied and in the form of subconjunctival injections - since 2% of solution enter 0,2-0,3-0,4-0,5-0,6 ml, gradually passing to higher concentration (3-4-5-6%); 1% apply solution of a ztilmorfin of a hydrochloride also in the form of an electrophoresis.

Apply 2-3% to a rassasyvaniye of opacifications potassium iodide solution in the form of an electrophoresis, to a lidaz. Appoint also 1% yellow mercury ointment. From the general excitants apply biogenic stimulators (aloe extract liquid, FIBS, пелоидодистиллат, a vitreous, etc.) in the form of subcutaneous injections on 1 ml, 20-30 injections on a course. Conduct autohemotherapy courses (on 3-5-7 - 10 ml).

At the corresponding indications resort to surgical treatment (optical corectomy, a keratoplasty, antiglaukomatozny operation).

The forecast at a keratitis depends on an etiology of a disease, localization, character and a current of infiltrate. At timely and correct treatment small surface infiltrates, as a rule, resolve completely or leave easy oblachkovidny opacifications. A deep and ulcer keratitis in most cases comes to an end with formation of more or less intensive opacifications of a cornea and decrease in visual acuity, especially considerable in case of the central arrangement of the center. However even at leykoma it must be kept in mind a possibility of return of sight after a successful keratoplasty.