Keratitis of the eye - inflammation of the cornea

The main part of the outer surface of the eye (iris and pupil) is reliably covered by the cornea - a peculiar Biological lens, which has not only a protective role, but is also one of the refractive media eyes. The shell consists of several layers, some of which can be self-repairing.Sometimes pathological processes and traumas cause the corneal layer of damage, and then inflammation starts in it - the corneal cells try to restore its functionality. In this article, we will look at the symptoms and treatment of keratitis.

Definition of disease

Distinguish the following layers of the cornea:

• Epithelium- the uppermost, its main role - protective function. Epithelium also delivers to the tissues of the cornea nutrients and oxygen, coming to him from the tear film. The epithelium has high restorative capacities;
instagram viewer
• Bowman's membrane- a thin layer of cells separating the stroma from the epithelium and not subject to restoration. Its meaning is not fully understood;
• Stroma- the most voluminous layer, consisting of collagen fibers and cells responsible for restoration;
• Descemet's membrane- its function is to separate the stroma and endothelium. Has high elasticity and resistance to damage;
• Endothelium- responsible for keeping the cornea transparent, involved in nutrition. It is a kind of "pump" that removes excess moisture from the cornea. Very poorly restored.

The place where the cornea passes to the sclera (opaque section of the corneal membrane) is called the limb.

The severity of inflammation depends on the location of its localization and the depth of penetration of lesions.

Types and Classifications

Depending on various characteristics, keratites are distinguished:

• Superficial and deep.Superficial inflammation affects not more than 1/3 of the thickness of the corneal layer (epithelium, the upper part of the stromal layer). With deep keratitis, the entire stroma is drawn into the inflammatory process;
• Central, paracentral and peripheral (marginal). In the first case, the infiltrate is located in the pupil zone, in the second - in the projection of the iris, in the third - in the limb zone. The more central the location of the infiltrate, the greater the visual impairment in the outcome of the disease;
• Exogenous (external) and endogenous (internal).Exogenous include inflammation of the bacterial, fungal, viral, traumatic, and keratitis, which developed as a result of meibomites, conjunctivitis, and lesions of the eyelids. Endogenous keratitis includes inflammation that occurs on the background of tuberculosis, brucellosis, malaria, syphilis, as well as neurogenic, allergic, hypo- and avitaminous diseases.

There are also several types of inflammation of the cornea of ​​unknown etiology: rosacea-keratitis, corroborating corneal ulcer, filamentous keratitis.

Causes

In the vast majority of cases, the causative agent of keratitis is the virus.In 70% of cases it is the herpes virus and herpes zoster (Zoster virus). Other possible initiators of corneal inflammation include:

• Adenovirus, chickenpox, measles.Most often they are activators of keratitis in childhood;
• Nonspecific bacterial flora: streptococcus, staphylococcus, diplococcus, pneumococcus, intestinal or Pseudomonas aeruginosa, Klebsiella, Proteus;
• Specific pathogens:salmonellosis, brucellosis, gonorrhea, tuberculosis, malaria, syphilis, diphtheria, chlamydia, etc. ;
• Fungi:Aspergilla, Candida, Fusarium.

Amoebic keratitis is one of the most severe in treatment, the causative agent is the bacterium Acanthamoeba. Most often this type of disease develops in people using contact lenses and in the future has the most disappointing predictions (right up to blindness).

In addition to infectious causes, the development of keratitis can be triggered by the following factors:

• Allergic reaction:when using medicines, with helminthic invasion, pollinosis, increased susceptibility to pollen of plants or food products. In this case, the development of inflammation contributes to the presence of rheumatoid arthritis, Sjogren's syndrome, nodular periarthritis, etc. Intensive ultraviolet radiation can provoke the development of photokeratitis;
• Injuries:thermal, chemical, mechanical, radiation. This includes postoperative complications;
• Eye Diseases: conjunctivitis, blepharitis (inflammation of the eyelids), dacryocystitis (inflammation of the lacrimal sac), canaliculitis (inflammation of the lacrimal canals), meibomite (inflammation of the sebaceous glands of the century);
• Improper use of contact lenses: violations of hygiene rules during storage and putting on, as well as non-compliance with the terms of wearing;
• Endogenous factors:metabolic disorders (gout in history, diabetes mellitus), lack of vitamins, exhaustion, impaired immunity (local and general).

The variety of possible causes makes adequate diagnosis problematic, but it is extremely necessary to choose the right therapeutic tactics and timely response to inflammation.

Symptoms

Characteristic for all types of keratitis signs are:

• Shroud before the eyes;
• Burning and carving;
• Photophobia and lacrimation;
• Redness of the eyes and corneal edema;
• The opacity of the cornea.

To the feeling of discomfort is added difficulty in opening the eyelids (blepharospasm) and headaches localized on the side of the affected eye.

Possible complications

The main complication in the development of inflammation in the cornea - the formation of scars, which eventually do not resolve.Thus, the main property of the cornea - its transparency, is violated, and this circumstance, of course, disrupts the quality of visual perception.

However, in case of penetration of the inflammatory process into the deeper layers, it is possible to develop severe complications:

• Iridocyclitis.The spread of inflammation to the iris and ciliary body in 20% of cases leads to the most serious consequences, up to the loss of the eye. The main provoking factor is rheumatism;
• Scrolls.Inflammation of the sclera (fibrous membrane of the eye) is most often bacterial in nature and serves as a symptom of some systemic diseases (lupus erythematosus, rheumatoid arthritis, Bekhterev's disease);
• Endophthalmitis and panophthalmitis. The most dangerous condition is when the infection penetrates the eyeball and captures its membranes and all tissues. In this case, the probability of loss of the eye is high;
• Secondary glaucoma. As a result of pathological changes, the drainage function in the eyeball is disrupted, and as a result of the increase in IOP, glaucoma develops, a process that does not respond to treatment and invariably leads to blindness.

Iridocyclitis - a complication of keratitis

The effects of keratitis always affect the quality of visual perception, and in neglected forms can cause loss of the eye. Therefore, in case of suspicious symptoms, a thorough diagnosis should be carried out.

Diagnostics

When carrying out the diagnosis to conventional methods (visometry, ophthalmoscopy, biomicroscopy), the doctor can add microbiological studies: scraping from the cornea and PCR (polymerase chain reaction). It is also possible to carry out a fluorescein test.

Checking visual acuity (visometry)

Compulsory differential diagnosis with the following diseases: iridocyclitis, conjunctivitis, corneal dystrophy, acute attack of glaucoma.

Treatment

At the initial stages, a complex medication is administered with the use of local or, if necessary, systemic drugs.In the most severe cases, surgical intervention is possible.As a supplement to the main treatment for the appointment of a physician, physiotherapy and folk treatment can be used.

Medication Therapy

The choice of medications depends on the diagnostic results:

• Antiseptics:Miramistin, 20% Sulfacil sodium;
• Antibiotics:Floksal, Oftakviks, Tobrex. At the beginning of the disease, application is recommended every 2 hours with a gradual decrease in the regularity of instillation;
• Corticosteroids:Maxidex, Oftan-dexamethasone. The use of drugs is indicated if there is no damage to the epithelium;
• Antiviral:Oftan-go, Okoferon. The regularity of their instillation also decreases with the extinction of symptoms;
• Anti-inflammatory:Indocollar, Naklof. Possess additional analgesic effect;
• Midriatica:Mezaton, Atropine, Tropicamide. They are a preventive agent to prevent the formation of adhesions.

Drops Indocolier

Each drug has a number of contraindications and side effects, so the application must be strictly justified and pass only according to the doctor's prescription.

As additional medicamental measures can be used:

• Subconjunctival (with mydriatica) and parabulbar (hormones or antibiotics) injections;
• The use of Korneregel, which accelerates the recovery of the epithelium;
• With herpetic keratitis - ointment Zovirax (up to 5 r. per day) and acyclovir orally up to 10 days;
• When infection of lacrimal passages - washing with miramistin, levomitsetinom, furatsilinom.

Acyclovir

Physiotherapeutic treatment (magnetotherapy, electrophonophoresis) contribute to the resorption of scars and increase the speed of epithelialization of the cornea.Observance of a certain diet is also an effective measure for recovery: increased content of proteins, microelements and vitamins, restriction of carbohydrates and fats.

Surgically

In case of extensive ulceration of the cornea, as well as in the absence of visible effect from conservative treatment, it is possible to apply surgical methods of treatment:

• Laserocoagulation;
• Microthermocoagulation;
• Cryoapplication of the defect.

Laser Coagulation Procedure

With a sharp decrease in vision due to cicatricial scarring of the cornea, the doctor can recommend carrying out:

• Excimer-laser procedure;
• Keratoplasty.

Carrying out keratoplasty with a laser.

In the case of developing secondary glaucoma, surgical or laser treatment of this dangerous disease may be necessary.

With the most unfavorable development of keratitis, enucleation of the eyeball is performed - the removal of the eye from the orbit cavity by surgical means.

Folk remedies

The use of folk remedies in keratitis is only an additional measure to the main treatment:

• Bury sea buckthorn oil every hour for 1-2 drops throughout the week, for the next 7 days - every 3 hours;
• Lubricate the liquid composition (honey and water 1: 1) the surface of the cornea three times a day until complete recovery;
• Make compresses of white clay on the eyes. The thickness of the flat cakes is -2 cm, according to the size of the orbit. The duration of the procedure is, hours;
• The effusion of freshly baked bread should be dripped into the eye 1 drop each morning, afternoon and evening;
• Bury the infusion of lice for 14 days: 1 tbsp. l. medicinal raw materials for a glass of boiling water. The procedures should be performed 3 to 4 times a day.

When using folk remedies, do not forget to enlist the approval of an ophthalmologist - each herbal component can have an unforeseen effect in your particular case and aggravate the situation.

Prevention

Prevention of the disease with keratitis is easy to implement when eliminating the causes of its occurrence.This requires:

• Avoid injuries of any origin and protect the eyes from external irritants;
• In a timely manner, treat any infectious lesions of the eyes, and also eliminate common infectious and systemic diseases;
• Regularly undergo preventive examinations with an ophthalmologist and pay special attention to the level of general immunity.

Video

conclusions

Do not forget that keratitis is an inflammation that can lead to more severe consequences (chorioretinitis, uveitis) and any inflammation can be neutralized by the body itself.Sometimes they should be supported, and in this case, the invaluable help of a doctor can play a decisive role.

So watch your health and make timely diagnosis - then keratitis if it hits you, then in the lightest form.