Bacterial keratitis - Acute inflammation of the cornea eye bacterial origin. Clinically manifested by severe pain in the eye, edema, corneal syndrome, severe inflammatory injection of the eyeball, the presence of muco-purulent discharge, corneal opacity, superficial or deep ulcerations. Diagnosis of bacterial keratitis include biometrics eyes microbiological smear with corneal confocal microscopy and endothelial, pachymetry, K measurement, corneal topography, corneal sensitivity determination. The immediate treatment of bacterial keratitis is a local and systemic antibiotic therapy, supplemented by the use of keratoprotektorov, epiteliziruyutsya funds mydriatics, complications - surgery.
ophthalmology, since in most cases, is the cause of temporary disability, and further can lead to decreased visual acuity and blindness.
streptococcus, pneumococcus, Pseudomonas aeruginosa. Less keratitis pathogens are Escherichia coli, Proteus, gram-negative diplococci (gonorrhea, meningitis).
Among the exogenous risk factors for bacterial keratitis release her traumatic injuries (in Vol. H. In case of burns, foreign bodies, surgical interventions), the irrational use of drugs in the treatment of herpetic keratitis and corneal dystrophy, contact lens wear, and improper storage of them.
The development of bacterial keratitis can promote endogenous factors, which include the presence of the patient's ocular pathology (lagophthalmos, dry eye syndrome, trichiasis, corneal dystrophy, neurotrophic keratopathy, blepharitis, conjunctivitis, barley), foci of chronic infection (sinusitis, carious teeth), the state of immunodeficiency and diabetes.
purulent ulcers whitish propagating along the surface and depth in the cornea.
In the case of diphtheria corneal keratitis detected superficial and deep ulcers dirty yellow film-coated, which is visible when removing the bleeding surface.
consult an ophthalmologist, including the study of medical history and the patient's complaints, inspection of structures of the eye to detect the typical clinical presentation, diagnostic tests required destination.
Implementation of biometrics in bacterial keratitis eye can detect pathological inflammatory changes in various layers of the cornea: epithelial ulceration, infiltration, purulent stromal inflammation, tissue edema, increased anterior chamber reaction (hypopyon with or without), muco-purulent exudate, etc.
For the study of the cornea also conduct confocal microscopy and endothelial, pachymetry (measurement of corneal thickness), K measurement (determination of the parameters of the cornea), corneal topography (corneal distortion detection), the definition of corneal sensitivity.
Laboratory diagnosis of bacterial keratitis include microscopic and bacteriological smear from the conjunctiva and cornea (with infiltration, and the edges of the ulcer). Sowing smear on the respective media to determine the causative agent of bacterial keratitis and its sensitivity to antibiotics.
The differential diagnosis is carried out between different types of keratitis: bacterial, fungal and herpes.
parabulbarno (under the eyeball) administration of antibiotics, as well as receive them inside. It is also possible local use of antiseptics (sulfacetamide solution), non-steroidal anti-inflammatory drugs, glucocorticoids (dexamethasone, betamethasone).
Bacterial keratitis Treatment gonoblennoree held together with venereologist. Diphtheria keratitis treated in the infectious diseases hospital: in addition to antibiotic therapy, be sure to introduce anti-diphtheria serum intramuscularly, and instilled in the eye.
To prevent iridocyclitis and adhesions inside the eye prescribed means expanding the pupil (midriatiki). During the resorption of inflammatory infiltrates appoint keratoprotektornye epithelizing and equipment (pp quinine hydrochloride gemodializaty blood dairy calves); additionally, locally and internally - antihistamines, immunomodulators, vitamins.
With the progression of corneal ulcers perform electrocoagulation, or cryocautery diathermocoagulation ulcer edges tushirovanie ulcers iodine or brilliant green.
Even with timely and effective treatment of bacterial keratitis is usually the outcome of a thorn (clouding of the cornea in the form of white spots) that occurs as a result of the development of scar tissue and vascularization of the damaged portion of the cornea. As the surgical treatment of cataracts and restore visual function shows the excimer laser treatment for superficial corneal scars. Method phototherapeutic corneal correction (FTC) can eliminate or significantly reduce the surface haze and scarring of the cornea. If necessary, perform keratoplasty.
keratouveit and there is accumulation of pus in the lower part of the anterior chamber (hypopyon).
Because of the uneven healing of stroma possible consequence of bacterial keratitis may be irregular astigmatism that requires further wear special lenses or of the FTC.
The greatest danger in the unfavorable course of bacterial keratitis is a perforation of the cornea that can turn into a purulent endophthalmitis and Panophthalmitis (inflammation of eye tissues), lead to sympathetic ophthalmia, subatrophy (shrinkage) of the eyeball up to the complete loss of vision or even eyes.
Prevention of bacterial keratitis is to protect the tissue from the eye injury, burns, foreign bodies, toxic substances; using special goggles during construction and repair works; careful observance of rules of hygiene while wearing contact lenses. When begun bacterial keratitis is important to comply strictly with the appointment and the doctor's recommendation to prevent the development of corneal ulcer and its complications.