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April 27, 2012
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Keratitis call inflammatory process of a cornea. This disease affects front department of an eyeglobe most often and as a result provokes deterioration in sight at the person.
If at the person the keratitis is shown, symptoms of this disease arise as a result of infections. It can be an infection of a virus, microbic, fungal origin. Besides, this illness often is a consequence of thermal, mechanical, chemical damages and also as result of disturbance of an innervation of a cornea. The keratitis can develop also at the people having disbolism, allergic shows, hypersecretion of meibomian glands. However the obscure etiology in some cases takes place.
Current of a keratitis
In development of a keratitis symptoms of an illness are shown initially by hypostasis and infiltrates. Under infiltrates in certain cases there is amotio of an epithelium, owing to its exfoliating often there are erosion, gloss of a cornea disappears, the roughness is shown. To development of infiltrate or after its emergence there is a growing of deep and superficial vessels from a conjunctiva and a sclera. As a rule, small infiltrates which are shown on a surface pass into nothingness, and opacifications of various degree become an effect of deep infiltrates.
If the disease is complicated by a purulent infection, then at development of infiltrate there is a necrosis of fabric of a cornea and ulcerations are shown. After healing of an ulcer cicatricial fabric is formed, and the leucoma is shown afterwards.
It is accepted to distinguish two types of a keratitis: exogenous and endogenous type. The exogenous keratitis is shown as an effect of the injuries arising after mechanical, and also other damages. Also this type of a keratitis is a consequence of the infectious diseases having a bacterial origin. An exogenous keratitis has a virus etiology, arises at fungal diseases of a cornea, pathologies a century, conjunctivas, meibomian glands.
Endogenous forms of a keratitis are an infectious, neurogenic keratitis, and also a keratitis which arise at avitaminosis and a hypovitaminosis, and that keratitis which etiology is not found out.
Despite various etiology of a keratitis, symptoms they observe mainly general. The people who got sick with this illness complain of eye pain which is affected with a keratitis. They observe constant dacryagogue, visual acuity worsens, the photophobia takes place. Besides, at patients the pericorneal or mixed injection of vessels of an eyeglobe, a nictitating spasm is shown. On a cornea there are ulcers or infiltrates, the cornea at the same time can lose sensitivity. As a rule, if at the person the keratitis, the symptoms described above develops take place in a complex or only some of them are shown. In this case it depends on what clinical form of an illness is shown at the patient.
Disturbance of transparency of a cornea is considered the most considerable symptom of a keratitis. This phenomenon – a direct consequence of emergence of an infiltration and hypostasis of cellular elements. There are noticeable changes and in a condition of an epithelium of a cornea: its gloss disappears, at the same time there is a roughness. In certain cases there is amotio and exfoliating of an epithelium. As a result on a surface the erosion is shown.
The arrangement of infiltrates at a keratitis can be various: they have the different form and the sizes, and can develop in different places. Often infiltrates can take a cornea in general, at the same time they develop both as single and as multiple infiltrates. Their localization is possible both on a surface, and in deep layers of a cornea. Infiltrates can have different shades that directly depends on character of cellular elements. So, in the presence of lymphoid cells at the patient infiltrate of gray color is shown; at the same time, if purulent infiltrate and available a large number of leukocytes develops, then its shade will be yellow.
As a rule, emergence of superficial or deep vessels happens in cornea fabrics. Development of superficial vessels is shown if infiltrate is located in front layers of a cornea. Transition of these vessels comes from a network of conjunctival vessels. Arborization and bright red color is characteristic of such vessels. The shade of deep vessels will be more dark. Such vessels look as short rectilinear branches. They pass from deep episkleralny vessels.
Depending on character of vascularization depth of defeat of a cornea is measured. In this case we can speak about a superficial or deep keratitis.
If infiltrates are located superficially, then their full rassasyvaniye is possible afterwards, and as a result opacification will not be shown.
Very often at infiltrates there are ulcers which widely vary both by the size, and according to depth of their arrangement. The ulcer can have both a pure, and purulent bottom, at the same time its edges are mainly unequal. If edges of an ulcer begin to live, then and its bottom gradually begins to be cleared. The ulcer heals, the epithelium is regenerated, and the place where the ulcer developed, connecting fabric fills.
However if development of an ulcer proceeds adversely, then the cornea sometimes collapses to a descemete cover. As a result of such process, the patient has a cataract which is spliced with an iris. In this case as complication emergence in the patient of secondary glaucoma is possible. In some cases the flattening of a cornea becomes an effect of an ulcer.
Except the described symptoms, at a keratitis inflammatory processes of a sclera, conjunctiva, iris of the eye, tsiliarnogotel are often observed. In some cases the inflammation practically of all covers of an eyeglobe can take place. Then diagnose a keratoconjunctivitis for the patient, keratouveit, a keratoscleritis.
In the main ambassador of a keratitis at the person the keratoleukomas different in intensity are shown. It occurs in view of formation of connective tissue hems. Similar opacifications can affect visual acuity of the patient differently. Sometimes there is small superficial opacification at which visual acuity remains invariable. But not less seldom there is rough opacification called by a leucoma which sharply reduces visual acuity of the person.
Allocate a number of forms of a keratitis with a certain clinical picture. At development of a keratitis at a nesmykaniye of a palpebral fissure the ulcer at the patient develops in the lower part of a cornea. Gradually it goes deep into as necrotic sites are torn away. As a result it can pass in all layers of a cornea. If at the same time there is a development of consecutive infection, then the keratitis of this form can be complicated by purulent fusion of a cornea.
At a neuroparalytic keratitis at the patient always sensitivity of a cornea sharply goes down or it completely is absent. At this form of a keratitis neither a photophobia, nor dacryagogue it is not observed. At the same time perhaps emergence of intensive pain of neurologic character. If there are no other complications, then pathological process is initially shown by opacification of blankets of a cornea. In the center the epithelium begins to oblushchivatsya, and as a result there is an ulcer of saucer-shaped type. Gradually there is its distribution on a cornea surface. Manifestation of consecutive infection which is fraught with a purulent inflammation is especially dangerous. Development of perforation of a cornea or its final fracture is in that case probable. This form of an illness proceeds a long span.
If at the patient the filamentous keratitis which is shown against moderate irritation of an eye takes place, then the photophobia and a constant itch will be the main symptoms in this case. There is a little later a peculiar discharge which contains the thin threads attached to a cornea from one end. Such threads are the twisted and degenerated cornea epithelium cells. If to remove a thread, then on this place there will be an erosion in the form of a point. At this form of a keratitis there is a defeat of a cornea in its lower part. The cornea at the same time keeps sensitivity, sharpness sight does not decrease.
Besides, at a keratitis also other characteristic signs are shown. Patients feel constant feeling of dryness in a nasopharynx and in a mouth, it is difficult for it to swallow. As a result perhaps complex disturbance of digestion. Besides, at a keratitis at the patient chronic polyarthritis can develop, begin is premature to drop out teeth. teeth.
If emergence of a keratitis is provoked by a pyocyanic stick, then its current will be especially heavy. When in a cornea there is abscess, the person suffers from severe pain. In this case there is an involvement in process of internal covers of an eye. This form of a keratitis can be complicated as a result by an eyeglobe atrophy.
Diagnosis of a keratitis
To establish the diagnosis "keratitis" simply in the presence at the patient of the clinical symptoms described above. Capture of scraping from infiltrate is made for definition of influence of exogenous factors. In its analysis existence of pathogenic microflora is defined. Besides, in the anamnesis of the patient the eye injury is often specified.
At suspicion on an endogenous keratitis a number of laboratory analyses and researches of the general character for the purpose of definition of an etiological factor is made. The specialist without fail carefully studies the anamnesis, the endogenous keratitis is a symptom of a certain disease of the general character.
Also in the course of diagnosis carry out biomicroscopy with use of a slit lamp.
It is important to carry out the differential diagnosis with a number of the degenerative phenomena in a cornea. If at the patient primary degeneration of a cornea takes place, then, as a rule, process is bilateral, has a chronic current, and rather slow progressing.
Treatment of a keratitis
If the keratitis is diagnosed for the patient, treatment of this illness is mainly made in a hospital. It is especially important to hospitalize immediately the patient in a case a keratitis purulent and proceeding sharply. If the etiology of an illness is known, then treatment of a keratitis assumes therapy of the illness which provoked a keratitis.
To reduce an inflammation and pain of the patient, to him reception of mydriatic drugs which also help to prevent fusion and an union of a pupil is appointed.
If the ulcer of a cornea and a bacterial keratitis is diagnosed for the patient, treatment of an illness assumes use of the antibiotics having a wide range of influence. Perhaps also use of oculentums from antibiotics locally. The specialist has to choose antibiotics taking into account that, the pathogenic microflora is how sensitive to them. In certain cases reasonablly intramuscular introduction of antibiotics.
Such treatment is often combined using sulfanamide drugs. Parallel to the patient surely it is necessary to complete a course of reception of a vitamin complex. Especially important in this case purpose of B1 B2 vitamins, B6, C, PP.
Besides, at certain forms of a keratitis treatment of a disease assumes some important features. So, if at the patient the keratitis provoked by a nesmykaniye of a palpebral fissure takes place, then to the patient appoint carrying out installation in an eye of paraffin oil, fish oil. Besides, the positive effect in this case renders levomitsetinovy or Unguentum Tetracyclini.
If the meibomian keratitis is diagnosed for the patient, then in this case special attention should be paid on the correct approach to treatment of a chronic meibomitis. In this case carrying out special massage a century, sodium sulfacetamide solution installations, use sulfatsilovy or Unguentum Tetracyclini is reasonable.
To reduce pain at a neuroparalytic keratitis, hydrochloride quinine solution installations with morphine a hydrochloride are applied. Also the local warming procedures, reception of anesthetics practice. It is important to apply a bandage the affected eye.
If the filamentous keratitis is diagnosed for the patient, will mainly be applied symptomatic therapy. Besides, complex treatment includes use of eye drops as a part of which there are vitamins, use of 1% of an emulsion of synthomycin for introduction to a conjunctival sac. Also reception of special vitamin complexes or administration of vitamins intramusculary is provided.
It is important to consider that reception of polyvitamins, and also use of an electrolyte-deficient diet with the low content of carbohydrates it is reasonable at each of keratitis forms.
To stimulate a rassasyvaniye of opacifications, 2-3% potassium iodide solution by an electrophoresis are used, and also apply a lidaza and yellow mercury ointment. Use of biogenic stimulators subcutaneously is also reasonable.
In some hard cases of a keratitis treatment can be carried out by a surgical method.
If to speak about the forecast at a keratitis, then it directly depends on what etiology of an illness, and also from where it is localized as infiltrate proceeds. If treatment of a keratitis is carried out timely and correctly, then the rassasyvaniye of small infiltrate passes completely or after that there are only insignificant opacifications. At a deep and ulcer keratitis the patient, as a rule, has considerable opacifications, and there is a decrease in sight. But even the people who are ill a leucoma can return sight by means of a keratoplasty.
Prevention of a keratitis
To prevent display of this illness, it is important not to allow eye injuries, in time to treat conjunctivitis, a blepharitis, a dacryocystitis, and also the general diseases which contribute to development of a keratitis.
At work, an eye, dangerous from the point of view of traumatizing, it is necessary to put on special glasses for protection. If the person uses contact lenses, he has to follow all rules of hygiene accurately. It is impossible to allow burns of a mucous membrane of eyes and a cornea. If the patient only has first signs of a keratitis, it is important to see a doctor at once and to strictly adhere to his instructions.
Section: Diseases of eyes