Moreover, this disease is often due to thermal, mechanical, chemical damage, and also as a result of disorders of innervation of the cornea. Keratitis may develop as people suffering from metabolic disorders, allergic reactions, hypersecretion of Meibomian glands. However, in some cases there is an unknown etiology.
What it is?
Keratitis - inflammation of the cornea, which manifests itself mainly its opacity, ulceration, pain and redness of the eyes. Can have traumatic or infection (influenza, tuberculosis, etc.) Origin.
Observed tearing, photophobia, blepharospasm, reducing the transparency and gloss of the cornea with its subsequent ulceration and the development of serious complications. Possible outcome keratitis - a thorn, reduced vision.
Causes of
Many causes of keratitis. They are exogenous and endogenous nature. Sometimes, to find out the cause of this disease is not possible.
Endogenous (step inside) are the reasons:
- violation of innervation;
- metabolic disease;
- disruption of the lacrimal glands;
- disease eyelids and the conjunctiva;
- avitaminosis;
- allergy;
- viruses (herpes);
- corneal erosion;
- lagophthalmos (incomplete closing of eyelids).
Exogenous (external action) are the reasons:
- infection (tuberculosis, keratitis syphilitic);
- fungal infections;
- bacteria (Staphylococcus, Pseudomonas aeruginosa);
- mechanical damage;
- chemical exposure;
- thermal effect;
- contact lenses;
Keratitis is a professional welder's disease, with the work of their eyes exposed to artificial UV radiation, which is often the cause of the disease. With timely and correctly selected treatment outcome of the disease is quite favorable, but in severe cases may develop a persistent irreversible decrease in vision, including blindness.
Classification
Allocate these types of disease:
- Bacterial keratitis. Bacterial corneal infection can arise as a result of injury or contact lens wear. Typically, bacterial keratitis causing bacteria such as the Staphylococcus aureus and Pseudomonas aeruginosa (often in those who wear contact lenses).
- Vernal keratoconjunctivitis. Cause inflammation and ulceration of the cornea - severe allergic reaction.
One of the most serious infections causing bacterial keratitis is amoebic infections (amoebic keratitis). Usually it occurs in people who wear contact lenses. Typically, the disease is the simplest Acanthamoeba. In the long term, amoebic keratitis can lead to blindness.
- Viral keratitis. Called the virus in 70% of cases of herpes simplex or herpes zoster (Herpes zoster) herpes.
- Fungal keratitis. It called parasitic fungi. The disease is accompanied by severe corneal syndrome, pain and mixed hyperemia eye. With this type of keratitis ulcerate usually both surface and deep layers of the cornea until its perforation. The inflammatory process often involves the choroid. Often fungal keratitis leads to the appearance of cataracts and a significant reduction in vision. Diagnosis of fungal keratitis is often difficult, which leads to errors in treatment.
After herpetic keratitis are often so-called "dendritic ulcer" disease may be of recurrent nature. Herpetic keratitis may be superficial or deep. The surface form is clouding point, it proceeds without the expressed clinic - this form is rare. Deep grip shape inner layers corneal ulcer accompanied by extensive formation of coarse and cataracts.
- Onhotserkozny keratitis. In the development of onhotserkoznogo keratitis leading role played by allergic reactions. Distinguish defeat the anterior and posterior parts of the eye. Exudative-proliferative process ends sclerosis membranes of the eyes.
An early sign onhotserkoznogo keratitis is conjunctival-corneal syndrome: itching, tearing, photophobia, blepharospasm. Characterized by conjunctival hyperemia and edema around the roll to form the brim (Limbach). Often, this disease leads to a significant decrease in vision or blindness.
- Photokeratitis - corneal inflammation arising from a cornea and conjunctiva burn as a result of intensive exposure to ultraviolet light (natural - with prolonged exposure to the sun or artificial - from the welding apparatus).
- Creeping corneal ulcer. It occurs most often after superficial corneal injuries in small foreign bodies. Process promotes the development dacryocystitis (purulent dacryocystitis). For usually heavy. When left untreated possible complications until perforation of the cornea.
- Ulcerative keratitis. In this form there is no swelling of the epithelial corneal ulceration. Generally, results from falling into the eyes of gram-negative bacteria (most commonly by contact lenses).
The symptoms of keratitis, photos
The disease begins to manifest itself with pain in the affected eye. Among the first symptoms of keratitis (see. photo) - watery eyes, photophobia, blurred vision. This is followed by an involuntary jerking of the eye muscles, vasodilatation of the eyeball. If the infiltration is located in the front layers of the cornea, superficial vessels develop a bright red color in the form of branched tree.
Deep vessels develop from episcleral vessels, they are darker and have the form of short straight branches - "brushes" or "metelochek". The cornea loses sensitivity, developing thereon ulcer due to localization infiltrates of different sizes and shapes. Color infiltration can be gray if it contains lymphoid cells, and yellow if infiltration reason - accumulation of white blood cells. The cornea swells and becomes cloudy. Typically keratitis accompany diseases such as inflammation of the iris, sclera and conjunctiva.
To make a correct diagnosis keratitis scraping infiltration, wherein the microscopic study determined the pathogenic microflora. Since in most cases keratitis is a co-morbidity of other bodies held various common and laboratory tests, made a careful study of the results. It recommended holding biomicroscopy of the eye using a slit lamp.
Diagnostics
The diagnosis of keratitis and its appearance is set based on clinical features and data history. The main method of research with keratitis - examination slit lamp - biomicroscopy of the eye, it can help to determine the size of the infiltrate, the depth and nature of the lesion.
To confirm the ulceration assay with fluorescein used - to instillation into the conjunctival sac of 1% solution of fluorescein ulceration area colored in green.
To determine treatment strategies are important bacteriological examination. Material taken from the edges and bottom of the ulcer, and then plated on appropriate media, determines the type of agent and its sensitivity to antibiotics.
How to treat keratitis?
Effective treatment of keratitis scheme should include local and general therapy, most often it is performed in a hospital. Perhaps outpatient treatment under medical supervision and in compliance with all the recommendations, but only if the surface inflammation. Self-medication leads to complications.
Common for all keratitis:
- oral or parenteral antibiotics, antiviral and antifungal agents, depending on the type and sensitivity,
- detoxification therapy (reosorbilakt 200.0 intravenously)
- desensitizing therapy (10% calcium gluconate is added to an IV)
- multivitamin 1 tablet 1-2 times a day.
Local treatment of keratitis:
- If not damaged epithelium, eyedrops containing hormones (Oftan-Dexamethasone, Maksideks) 2 times a day.
- Burying disinfectants (sodium sulfatsil 20% miramistin) and antimicrobial drops (Floksal, Tobrex, Oftakviks) initially every 2 hours and then 4 times per day.
- Anti-inflammatory drops (Naklof, Indokollir) every 4-6 hours.
- When viral keratitis drops containing interferon (Okoferon) 5 times a day or Oftan-go (first every hour, reducing the dose to 3 times a day).
- The good effect of subconjunctival (mydriatics - mezaton) and parabulbar (antibiotics - gentamicin, cefazolin, and hormones - Dexon) injection.
- Mydriatic (dilates the pupil in order to prevent the formation of adhesions) - tropicamide, phenylephrine, atropine. Between the different drops instillation interval should be at least 5-10 minutes.
- Zovirax ointment 5 times a day for herpetic keratitis. When herpetic keratitis even take into acyclovir 200 mg 5 times a day 7-10 days.
- Korneregel 2-3 times a day to accelerate corneal epithelialization.
- If infected tear ways, their daily washed with 0.25% solution of chloramphenicol, or 0.01% miramistinom Furacilinum 1: 5000.
To accelerate the epithelialization and resorption scars prescribed physiotherapy: elektrofonoforez, magnetic.
In the long herpetic keratitis possible application of such treatments as cryotherapy, laser coagulation go diathermocoagulation damaged areas.
Recommended diet therapy with a high content of proteins, vitamins and minerals, reduced fat and carbohydrates.
prevention
In order to prevent the manifestation of this disease, it is important to avoid eye injuries in time to treat conjunctivitis, blepharitis, dacryocystitis, and common diseases that predispose to the development of keratitis.
At work, dangerous from the point of view of an eye injury should wear special glasses to protect. If a person uses contact lenses, it should strictly adhere to all the rules of hygiene. We can not allow burns conjunctiva and cornea. If the patient is only the first signs of keratitis is important to seek medical advice immediately and strictly adhere to its provisions.
