Mycoses of eyes
Contents:
Description:
About thirty-forty years ago observations of oculomycoses were rather rare. In ophthalmologic literature there were single descriptions when the fungal etiology of a disease or was established by cultural methods or was even just assumed. Though still such observations meet much less often in comparison with bacterial processes, the frequency of mycoses of eyes constantly grows. Are involved in pathological process as eye appendages: eyelids, conjunctiva, the lacrimal bodies, eye-socket, and directly all parts of an eyeglobe: cornea, sclera, eye choroid, retina, vitreous and optic nerve. Though in some cases increase in frequency of detection of these diseases is connected with improvement of the diagnostic equipment, nevertheless mainly use of antibiotics of a broad spectrum of activity, corticosteroids and a long katerization, and also immunodeficient frustration, iatrogenic diseases or infectious processes is the reason of growth of number of cases of oculomycoses.
Symptoms of Mycoses of eyes:
Mycotic defeats of anatomical structures of eyes happens:
Mycoses century (fungal blepharitis)
Mycoses of the lacrimal bodies
Conjunctiva mycoses
Cornea mycoses (fungal keratitis, keratomycoses)
Fungal damages of soft contact lenses
Fungal pollution of environments of storage of corneal transplants
Mycoses of scleras
Eye choroid mycoses (fungal uveites)
Fungal entophthalmias
Reasons of Mycoses of eyes:
Etiological agents of mycoses of eyes are:
Hyaline gifomitseta (mitselialny mushrooms): group of mushrooms with a septirovanny mycelium and with a melanin otsustviye in a cell wall both in fabric, and in culture.
Feoidny mitselialny mushrooms: a septirovanny mycelium with the expressed melanin inclusion (pigmentation) in a cell wall in culture and usually in fabric.
Yeast.
Zygomycetes: mold mushrooms with a besperegorodochny mycelium, a sporangium and zygospores.
Treatment of Mycoses of eyes:
Treatment of mycosis of a cornea. At treatment by antibiotics and corticosteroids there occurs some improvement which is replaced by sharp deterioration in process, sometimes proceeds as the late torpid iridocyclitis which is observed after extraction of a cataract. Retina abscess cases at a candidiasis are very rare, a metastatic choroiditis at an actinomycosis, a peripheral retinitis at a sporotrichosis, an atrophic chorioretinitis and macular changes at histoplasmosis.
Treatment of mycosis of an orbit. Specific fungicidal and fungistatic medicines which choice is defined by an infestant are important. Nystatin is especially effective at kaididoza, to a lesser extent at a sporotrichosis, a zymonematosis, histoplasmosis. Drug is appointed in the form of drops (10 000 — 50 000 PIECES in 1 ml, 4 — 8 times a day), by ointments (50 000 PIECES in 1 g) or enter under a conjunctiva 10 000 — 25 000 PIECES, in hard cases inside on 500 000 PIECES 2 — 3 times a day. Levorinum is appointed mainly at candidiases in the form of drops (10 000 — 25 000 PIECES in 1 ml of solvent, 4 — 8 times a day) or ointments (25 000 PIECES in 1 g 3 — 4 times a day). Amphotericinum In is effective concerning many pathogenic fungi including causing deep mycoses. It is entered intravenously, a drop method at the rate of 0,25 mg/kg. Dissolve Amphotericinum just before use in 5% glucose solution, at the same time the content of drug in 10 ml should not exceed 1 mg.
Under a conjunctiva Amphotericinum enter in a dose 0,1 — 0,15 mg, into an anterior chamber — 0,03 — 0,05 mg. Locally it is applied in the form of drops (2,5 — 5 mg/ml prepared for 5% solution of glucose, 4 — 6 times a day) and 0,5% of ointment (3 — 4 times a day). Widely use iodine drugs (potassium йодидЗ %, on a tablespoon 3 times a day; 5% iodic tincture for a tushirovaniye of ulcers). At an actinomycosis appoint benzylpenicillin sodium salt (100 000 — 300 000 PIECES intramusculary in each 6 h) in a combination to streptomycin or streptocides. At mycoses the century and orbits apply depending on the activator nystatin, levorinum inside, Amphotericinum intravenously, benzylpenicillin sodium salt intramusculary in combination with iodine drugs inside. At mycoses of the lacrimal tubules they are split and delete contents with an acute spoon. Then grease tubules with solution of iodine and appoint instillations of antifungal means. At mycoses of a conjunctiva and easy superficial keratomycoses of rather topical administration of antifungal means (nystatin, levorinum, Amphotericinum).
At ulcer keratomycoses scrape out infiltrate with a defect tushirovaniye iodine tincture. At a deep helcoma diathermocoagulation or cryotherapy with the subsequent prolonged topical administration of antifungal means (nystatin, levorinum, Amphotericinum) in drops or ointment are shown. In hard cases their introduction under a conjunctiva And use inside is shown, besides, Amphotericinum is entered intravenously. For a mydriasis let in an eye 1% atropine sulfate solution (3 — 4 times a day) or put an eye film with atropine (once a day). At inefficiency of medicamentous therapy the keratoplasty is recommended.
At intraocular mycosis the general treatment by antifungal drugs combine with introduction them under a conjunctiva (nystatin of 25 000 PIECES, Amphotericinum of 0,1 mg). In hard cases of an intraocular infection introduction to an anterior chamber of nystatin (100 — 200 PIECES) or Amphotericinum (0,03 mg) is admissible.
The forecast at intraocular mycosis heavy, process usually comes to an end with death of an eye. In case of mycosis of an orbit meningitis from the death is possible. At cornea mycosis the outcome depends on a contagium, weight of process and timeliness of specific treatment. The forecast at mycosis of a conjunctiva and slezootvodyashchy ways, despite current duration, favorable.
