Viral keratitis - Causes, Symptoms, Diagnosis and Treatment
Viral keratitis - Inflammation of the cornea caused by a viral infection. Viral keratitis manifests blisters, swelling and redness of the eyes, corneal syndrome, corneal ulceration and clouding, reduced vision, neuralgic pains. In order to carry out diagnostics of viral keratitis biomicroscopy, confocal microscopy and endothelial, pachymetry and K measurement, visual acuity test, determination of corneal sensitivity by culture, PCR, ELISA studies. For the treatment of viral keratitis administered antiviral, immunomodulating, antibacterial agents, analgesics, NSAIDs, anti-oxidants, vitamins, physiotherapy; if necessary, carry out or scraping of the affected epithelial keratoplasty.
Viral keratitis
simple (HSV) and herpes zoster related to filtering neyrodermotropnym viruses.
There are several types of viral keratitis herpetic nature: primary (primary infection) and postpervichny (activation of latent virus). Herpetic infection longer period may be in an inactive state, it is a reservoir of the epithelium of the conjunctiva and the trigeminal ganglion.
According to embodiments of the clinical course in ophthalmology distinguish viral keratitis point, vesicular, tree, metagerpetichesky, disk-shaped and diffuse keratouveit.
adenovirus, herpes virus infection, varicella, measles, mumps. Development of viral keratitis may contribute to lack of timely treatment of adenoviral conjunctivitis.
Predisposing factors for viral keratitis is increased permeability, or violation of the integrity of the cornea, the weakening of general and local immunity, frequent emotional stress, hypothermia.
Herpetic keratitis can be triggered by other SARS and influenza, contributing to the reduction of immune protection and activation of latent infection of the pathogen.
trigeminal neuralgia.
Primary herpetic keratitis manifests acutely; proceeds with rashes on the lips, mucous membranes, nose wings, centuries. This marked photophobia, tearing, eye redness, pain, swelling and clouding of the cornea, the development of secondary infection, lymphadenopathy. With the opening of the bubbles develop erosions and ulcers.
Poslepervichny herpes keratitis in children previously been ill with chickenpox, and adults on the weakening of immunity. The disease - subacute, duration - 2-3 weeks. Discharge from the eyes - a slight, serous-mucous membranes, the cornea poorly defined syndrome. With each subsequent exacerbation of viral keratitis duration of the disease increases, developing deeper corneal lesion and a sharp decline in vision.
Spot viral keratitis occurs without the expressed clinic is characterized by corneal opacities point. When vesicular viral keratitis in the cornea are observed small, translucent bubbles that burst rather quickly with the formation of ulcers.
When the tree viral keratitis observed minor infiltrates in the epithelium and anterior stroma layers; on the site of ulceration and fused together herpetic bubbles and characteristic gray lines in the form of tree branches, going along the superficial corneal nerves. Outline keratitis stale, but persistently, usually accompanied by the development of surface ulcers the size of 1-1.5 mm and neuralgic pains.
Metagerpetichesky keratitis is characterized by a prolonged course with severe corneal stroma, marked corneal syndrome, inflammatory infiltrates deep form and massive erosions. The cornea swells and becomes gray and dull shade; after the decay process severity on it remains a rough blurred significantly disturbing vision, possible perforation. Metagerpetichesky viral keratitis combined with anterior uveitis (iridocyclitis), retinal edema.
For disc-viral keratitis typical formation in the central zone of the cornea grayish-white hearth in the form of a disk, accompanied by severe swelling and inflammation of the cornea, conjunctiva and eyelids, increased intraocular pressure, a significant reduction in corneal sensitivity. Discoid keratitis may last from several months to a year, the outcome - deep corneal opacity and a sharp decrease in visual acuity.
Neurogenic keratitis occurs in lesions of the first branch of the trigeminal nerve and is usually accompanied by cold sores and severe neuralgic pains in the course of its ramifications, sometimes - sclerite, optic neuritis, or paralysis of the eye muscles, the development of secondary glaucoma.
visometry, laboratory and instrumental studies.
To assess the state of the cornea helps hold eye biomicroscopy, confocal microscopy and endothelial, pachymetry and keratometry, corneal sensitivity determination. For the detection of erosions and ulcers of the cornea is performed instillyatsionnaya Fluorescein test.
Detection and identification of the causative agent of viral keratitis is carried out using culture-PCR smear with the conjunctiva and cornea. Titer of virus in serum antibodies determined by ELISA. Viral keratitis is differentiated from other types of keratitis: fungal and bacterial keratitis.
diadynamic currents, iontophoresis, stimulation of the regeneration of a helium-neon laser. Corticosteroids only in very small amounts in the form of droplets in complete epithelialization of the cornea may be used in viral keratitis in regression stage of the disease.
In the absence of the results of medical treatment of viral keratitis and corneal ulceration progression surgery is indicated: when the surface forms - scraping of the affected epithelium, with deep forms - lamellar or penetrating keratoplasty, followed by rehabilitation and preventive treatment.
When frequent exacerbations viral keratitis (ophthalmic) requires vaccination antiherpetic vaccine.
Prediction and prevention of viral keratitis
Deep viral keratitis occurring with ulceration of the cornea, leading to persistent intense clouding of the cornea, dramatically reduces visual acuity.
Prevention of viral keratitis requires prevention of primary infection and recurrence of infectious diseases through vaccination, "therapy on a signal." It is necessary to guard against corneal microtrauma, stress, exposure to cold and other factors that contribute to the aggravation of "dormant" infection.