Corneal ulcer

Description:

Helcoma — the crateriform defect of a cornea caused by its necrosis owing to infectious defeat (primary or secondary after traumatization, trophic disturbances, etc.). It is necessary to distinguish the concepts "erosion" and "helcoma". The helcoma means disturbance of integrity not only an epithelium of a cornea (that is characteristic of an erosion), a boumenovy membrane, but also a cornea stroma therefore the helcoma always begins to live with formation of a hem of a cornea (cataract). The ulcer can be central or regional.

Symptoms of the Corneal ulcer:

Creeping helcoma (the helcoma of a bacterial etiology, is caused by Frenkel-Vekselbaum's pneumococcus, Moraksa-Aksenfeld's diplobacillus, staphylococcus, a streptococcus, a pyocyanic stick). Severe pains of the cutting character, suppuration, dacryagogue, the expressed nictitating spasm, хемоз, the mixed injection
The yellowish-gray infiltrate of the cornea which is quickly breaking up with ulceration, having 2 edges — regressing and progressing (подрыт, it is loosened and surrounded with a rim of purulent infiltrate). The ulcer quickly increases in sizes at the expense of the progressing edge, gradually taking the most part of a cornea. From a limb to an ulcer vessels (pannus) burgeon. Often the iritis, an iridocyclitis join, development of an entophthalmia is possible.

Tubercular helcoma. Existence in an organism of the center of a tuberculosis infection. Along with ulcers of the correct rounded shape there are grayish-yellow infiltrates surrounded with branched vessels (infiltrate is in a small basket from vessels — a phlyctena), progressing with formation of ulcer defects. The current is long, with long remissions, on site ulcers rough corneal hems are formed.

The herpetic keratohelcosis is characteristic of a treelike and ulcer keratitis — on site treelike infiltrates ulcers of a treelike form are formed.

The keratohelcosis caused hypo - and avitaminosis, at insufficiency of vitamin A the keratomalacia develops — against the background of bilateral opacification of a cornea (a "milk" cornea) there are ulcers which are not followed by pain. On a conjunctiva of a sclera xerotic dry plaques are formed. Insufficiency of B2 vitamin — there are cornea vascularization, dystrophic changes of an epithelium, ulcer defects. Usually current long and rather high-quality.

Reasons of the Corneal ulcer:

Emergence of a helcoma requires 2 conditions — decrease in local resistance (including disturbance of integrity of an epithelium of a cornea) and settling of a cornea by the infectious agent.
The factors leading to appearance of defects of a cornea and/or decrease in local resistance:
- Dryness of a cornea (for example, at a lagophthalmia)
- Burns of eyes
- Mechanical damage (including when carrying contact lenses)
- Irrational use of local anesthetics, antibiotics or antiviral drugs, antidepressants, group of companies
- Diabetes mellitus
- Immunodeficiencies
- Hypo - and avitaminosis
Microorganisms:
- Gram-positive microorganisms (staphylococcus, streptococci)
- Gram-negative microorganisms (diplococcuses, sticks)
- Pyocyanic stick
- Viruses (for example, VPG)
- Tuberculosis mycobacteria
- Fungi.

Treatment of the Corneal ulcer:

Mode. Hospitalization is recommended only at a heavy current or at impossibility of out-patient treatment. The direction to the ophthalmologist is anyway obligatory.

Maintaining tactics. It is immediately necessary to begin topical antibacterial treatment, without waiting for results of crops. Purpose of antibacterial drugs inside and their introduction under a conjunctiva in the form of injections is also shown. Use of tsikloplegichesky means. Purpose of the Civil Code is contraindicated. During process attenuation — resorptional therapy for prevention of formation of a rough hem of a cornea.

Surgical treatment. At a long nezazhivaniye of an ulcer and threat of perforation of a cornea the through or layer-by-layer medical keratoplasty is shown. After healing of an ulcer often there are opacifications of a cornea. In this case carry out a keratoplasty for increase in visual acuity.

Choice drugs:

- Sulfacetamidum natricum — dusting of an ulcer the crushed powder 5-6 р / days to full epithelization, then an instillation of 30% of solution.

- Gentamycin and Tobramycinum locally — at defeat of Pseudomonas, Enterobacter, Klebsiella and aerobic gram-negative bacteria; cephalosporins (for example, cefazolin of 50 mg/ml) — at defeat by gram-negative bacteria. In an initiation of treatment the combination of derivative aminoglycosides and cephalosporins is the most effective.

- Derivatives of a ftorkhinolon, for example ciprofloxacin (0,3%) — at Pseudomonas defeat.

- Amphotericinum In parenterally — at candidiasis and an aspergillosis, also use of Clotrimazolum, Miconazolum, ketokonazol, ekonazol is possible.

- At ulcers of a virus etiology: идоксуридин locally 0,1% solution on 2 drops in a conjunctival sac each hour during the day and in each 2 h at night no more than 2 weeks — at a virus etiology of an ulcer; Poludanum of 100 mkg is dissolved in 2–5 ml of the distilled water, dug in in a conjunctival sac 6–8 р / days, in process of subsiding of an inflammation — 3–4 р / days — at a virus etiology of an ulcer. Apply only in the conditions of a hospital; interferon an alpha — 200 ME is dissolved in 2–5 ml of the distilled water, dig in in a conjunctival sac 2 drops 6–8 р / days. Alternative drug: interferon alpha 2а; the acyclovir is put in a conjunctival sac in the form of 3% of an oculentum 3 р / by days within 7–10 days.
Taurine — on 2–3 drops in an eye 4–5 р / days, solution of bee honey 3-5 р / days.
Electrophoresis with solution of a lidaza, kollalizin — 10–15 sessions.