Keratitis of the eye - photos, signs and modern ways of treatment

Keratitis is one of the most common ophthalmic diseases affecting the front of the eye.

Pathology is characterized by the development of the inflammatory process in the cornea of the optic. The cornea performs a refractive function, and its homogeneity, transparency and sphericity determine the visual perception of the eye.

With the development of the inflammatory process, corneal opacity and the formation of sores occur. Quite often, such changes are irreversible, which can lead to a decrease in visual acuity, even to its complete loss.

Classification of

Keratites can develop under the influence of external and internal factors. Pathology can occur in mild, moderate or severe forms.

Classification of the disease depends on the degree of damage to the cornea. According to this, keratitis happens:

is superficial;
deep.

For superficial keratitis is characterized by damage to the upper layer of the cornea. In this situation there are no irreversible processes that can lead to loss of vision.

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The following classification of keratitis depends on the causes of its development. According to this criterion the disease is divided into:

bacterial form, in which the infection penetrates into the anterior parts of the visual organ due to injuries or contact lens wear;
viral form( often keratitis causes abnormal activity of herpesviruses);
is a fungal form, which is one of the most dangerous because it can cause the appearance of a thorn. This type of keratitis leads to the fact that all layers of the cornea, up to the blood vessels that feed the eye, are affected.

In addition, there is another gradation of keratitis:

The so-called "creeping corneal ulcer", which can be triggered by the ingress of small foreign objects that injure the upper layer of the cornea.
Onchocerciasis keratitis, which develops due to the presence of allergic reactions. Such a pathological process can affect both the anterior and posterior region of the eye. Severe manifestations of allergies can lead to the development of so-called.spring keratoconjunctivitis.
Photokeratitis is a form of the disease caused by a burn of the cornea and conjunctiva caused by exposure to ultraviolet radiation.
Non-ulcerative keratitis is a pathological process caused by the attack of gram-negative microorganisms penetrating into the eye tissues.
Superficial marginal keratitis - develops as a complication of inflammation of the eyelid and mucous membranes of the eye, as well as with untreated meibomite.
Neurogenic keratitis.
Acanthamoeic keratitis, arising from the irrational use of contact lenses.

With deep keratitis, the inflammatory process affects the inner layers of the cornea, which in the future can lead to the appearance of scars, as well as to reduced visual acuity.

Causes of

In most cases, the development of keratitis is facilitated by the penetration of viruses into the tissues of the eye. In 70% of cases, the cause of the pathology is herpesvirus type 3 - Varicella-Zoster, which is the causative agent of chickenpox and herpes zoster.

To external causes of keratitis include:

mechanical damage to the integrity of the cornea of the eye;
hit on the eye mucous of chemicals;
burns;
bacterial infections;
fungal infections;
wearing contact lenses;
working conditions with a high degree of danger.

To internal factors predisposing to the development of keratitis, include corneal pathologies caused by:

a strong infectious corneal lesion from the inside;
acute reaction of the body to neuroparalytic effects;
deficiency of vitamins.

Modern ophthalmology has therapeutic methods that help to successfully fight keratitis. However, in severe cases they do not always help prevent visual acuity reduction, or its complete loss.

Symptoms of keratitis and photos

A common symptom of all forms of keratitis is the development of the so-called corneal syndrome. It is characterized by the appearance of:

sharp pains in the eye;
photophobia;
increased lacrimation;
reflex blepharospasm characterized by involuntary closing of the eyelid of the diseased eye;
reduced visual acuity;
sensation of "sand" or foreign object in the eye;
pericorneal injection of the eyeball.

In keratitis, an infiltrate is formed, which subsequently begins to press on the nerve endings of the cornea. This is the reason for the development of corneal syndrome.

In addition, with keratitis, the cornea loses its transparency and shine. It becomes cloudy, its sphericity and photosensitivity changes. For neurogenic keratitis, on the contrary, a decrease in the sensitivity of the cornea, and a decrease in the intensity of manifestation of corneal syndrome.

The accumulation of lymphoid cells gives a grayish infiltrate. If the number of leukocytes dominates, it becomes yellow, which indicates the presence of pus. With superficial keratitis, the infiltrate can dissolve itself, but with a deeper lesion at the site of the infiltrate, corneal opacities of varying severity develop. Depending on it, the visual function of the patient suffers.

The formation of ulceration of the cornea is considered the most unfavorable variant of keratitis progression. Next, peeling and sloughing of the epithelium begins, which leads to the formation of erosions on the surface of the cornea. Progression of the pathological process and the death of tissues causes the appearance of ulcers.

Keratitis, accompanied by corneal ulcers, often results in the formation of a thorn. In severe disease, deep ulcerous defects reach the anterior chamber of the eye, leading to the development of hernia Descemet's membrane. In some cases, ulcers perforate, develop endophthalmitis, secondary glaucoma and other complications.

Keratitis often occurs in combination with other eye diseases, for example, conjunctivitis( keratoconjunctivitis), scleritis( keratoscleritis), uveitis( keratouveitis).With the involvement of all eye membranes in the pathological process, the death of his tissues and the loss of visual function occur.

Diagnosis

Diagnosis is a relatively easy process, based on the study of patient complaints for the presence of previously considered symptoms. To detect the effect of exogenous factors, scraping of tissues from the surface of the infiltrate is carried out. Usually during the study, the presence of pathogens is determined.

With endogenous keratitis, a number of studies are being conducted to determine the etiology of an ophthalmic disease. In this case, the oculist necessarily studies the patient's anamnesis in detail, as often keratitis occurs against the background of another pathology. A mandatory exercise is biomicroscopy using a special slit lamp.

It is very important to differentiate keratitis from various degenerative processes in the cornea. With the primary degeneration of the cornea, both visual organs suffer. In addition, the disease is characterized by a chronic course and very slow progression.

How to treat keratitis?

After a thorough diagnosis, the doctor develops a treatment regimen. If the inflammatory process proceeds without complications and concomitant diseases, the patient undergoes outpatient therapy. With a deep eye injury, the presence of pathological discharge, or a high risk of complications, the patient is placed in a hospital.

The treatment regimen for keratitis often involves the use of:

Local anesthetics( in the form of eye drops) to relieve pain;
Restorative and moisturizing eye gels( if the cause of keratitis was the prolonged wearing or misuse of contact lenses);
Moisturizing drops( if there were abnormalities in the operation of the eye glands);
Antihistamines( drops, tablets or injections) with the allergic form of keratitis;
Antimicrobials - for the bacterial origin of keratitis( antibacterial ointments may be used, but in severe cases resort to parabulbar or subconjunctival injections.) If therapy does not produce the expected results, the antibiotic may be administered in the form of tablets, or administered intramuscularly or intravenously.);
Antiviral drugs if keratitis is the result of a viral infection;
Intramuscular injections and instillation of the eye with antibiotic drugs for syphilitic lesions of the cornea( in this case, the therapy is performed by an ophthalmologist and a venereologist).

If keratitis was caused by ingestion of a foreign object, it is first withdrawn, and only then, after evaluating the degree of corneal damage, treatment is started. Sometimes even surgical intervention may be required.

Treatment of tuberculous keratitis is carried out jointly with a phthisiatrist. The course of therapy is rather complicated and lengthy.

In some situations, in addition to pharmacotherapy, laser coagulation, cryotherapy, diathermocoagulation are used. With the help of these methods, only the affected areas of the eye are treated. Along with these methods, vitamin and diet therapy are carried out.

An integrated approach to treatment gives maximum results, and helps to avoid complications of pathology. If, however, there is no positive dynamics with such therapy, or the patient begins to rapidly lose sight, a corneal transplantation can be performed.

The duration of the course of therapy and recovery period depends on the professionalism of the doctor and the quality of the medical services provided.

Carrying out the operation

A severe course of keratitis requires a mandatory operation, especially when forming a purulent ulcer of the stratum corneum. With different types of keratitis, laser coagulation methods can be used, and for fungal etiology of the disease, laser coagulation or microsurgical intervention.

Endothelial dystrophy of the cornea is treated exclusively surgically. In this case, we are talking about the horny layer of the eye, although after such an operation the risk of complications is quite high.

The operation can also be performed to prevent the spread of keratitis. So, for the beginning, the epithelial membrane of the eye is scraped off, followed by electrocoagulation, neurotomy, layered keratoplasty. An ophthalmologist may resort to laser coagulation.

If inflammation of the cornea creates an infiltrate, then after it can remain clouded areas. When a thorn is formed on the eye, an operation is performed to transplant the stratum corneum.

Complications and prognosis

The outcome of treatment and the consequences of such a disease as keratitis, mostly depend on the etiology of the pathological process, the degree of damage to the visual organ, the location of the infiltrate and the presence of concomitant diseases. If the therapy is started in a timely manner and brought to an end, the outcome is very favorable - up to the complete and complete dissolution of the infiltrate. In some cases, there may be a slight cloudiness on the surface of the cornea, similar to a cloud.

When the pathological process of the deep layers of the eye is damaged, or when the paracentral or central localization of the infiltrate occurs, there is a significant opacity of the cornea.

The result of keratitis can be the formation of a thorn, the development of secondary glaucoma, atrophy of the optic nerve or eyeball. As a consequence, there is a complete loss of vision. Dangerous for life are septic complications, such as thrombosis of the cavernous sinus, phlegmon of the orbit, or even septicemia.

Prevention

Special attention should be paid to the prevention of keratitis. To avoid disease, it is necessary, if possible, to avoid any damage to the mucous membrane of the eyes. Especially relevant this warning is for people working at traumatic enterprises.

It is also important not to start any ophthalmologic disease, and on time and completely cure it. In addition, the following rules play an important role in the prevention of keratitis:

does not neglect hygiene;
correctly store and use contact lenses, if any;
carefully protect the eyes from the effects of external irritants, and avoid getting on their mucous membranes of foreign objects;
to avoid( if possible) diseases that can lead to the development of keratitis( see above);
include in the diet as many proteins, vitamins, minerals as possible. If necessary, you can resort to taking multivitamin complexes.

Great importance is the prevention of keratitis in those people who have previously experienced this disease.