Ulcer cornea. - Destructive process in the cornea, accompanied by the formation of the ulcer crater. Corneal ulcer accompanied by a pronounced corneal syndrome, pain and a significant decrease in vision in the affected eye, clouding of the cornea. Diagnosis of corneal ulcers is based on data examination eye with a slit lamp, holding instillyatsionnoy sample with fluorescein, bacteriological and cytological examination of scrapings from the conjunctiva, lacrimal fluid and ELISA serum. Principles of treatment of corneal ulcers require specific (antiviral, antibacterial, antifungal, anti-parasitic), metabolic, anti-inflammatory, immunomodulatory, antihypertensive pharmacotherapy. With the threat of corneal ulcer perforation is necessary to conduct keratoplasty.
ophthalmology among severe eye lesions that are difficult to treat and often lead to significant distortions of visual function, including blindness.
The outcome of corneal ulcers in all cases is the formation of scar the cornea (cataracts). Ulcerative defect can be localized in any part of the cornea, but the most difficult runs the central zone of defeat: it is more difficult to treat, and scarring of the area always accompanied by loss of vision.
streptococci, pneumococci, Pseudomonas aeruginosa, herpes simplex virus and varicella-zoster, Mycobacterium tuberculosis, Acanthamoeba, fungi, chlamydia. Non-infectious corneal ulcers can be caused by immune genesis, dry eye syndrome, primary or secondary corneal dystrophy. For the development of corneal ulcers, a combination of a number of conditions: damage to the corneal epithelium, decreased local resistance, colonization defect infectious agents.
Exogenous factors that contribute to the development of corneal ulcers include prolonged wearing of contact lenses (including the use of contaminated fluids for their storage containers); irrational pharmacotherapy topical corticosteroids, anesthetics, antibiotics; use of contaminated instruments, and ophthalmic preparations during the treatment of ophthalmic procedures. In terms of the subsequent occurrence of corneal ulcers are extremely dangerous dryness of the cornea, the eye burns, eye contact foreign bodies, fotooftalmii, mechanical damage to the eyes, previously carried out surgery on the cornea, and others.
Favorable background for the development of corneal ulcers can be a variety of disorders of the auxiliary apparatus of the eye: conjunctivitis, trachoma, blepharitis, and dacryocystitis kanalikulit, trichiasis, eversion and inversion of the age, injury oculomotor and trigeminal cranial nerves. Corneal ulceration danger exists for any form of keratitis (allergic, bacterial, viral, meybomievom, neurogenic, filamentous, and chlamydial al.), As well as noninflammatory lesions of the cornea (bullous keratopathy).
In addition to local factors in the pathogenesis of corneal ulcers, an important role belongs to common diseases and disorders: diabetes mellitus, atopic dermatitis, autoimmune diseases (Sjogren's syndrome, rheumatoid arthritis, polyarthritis nodosa etc.), And the depletion of vitamin deficiency, immunosuppression.
vernal conjunctivitis, systemic immune diseases, dry eye syndrome, corneal dystrophy primary, recurrent corneal erosion.
iridocyclitis, panuveita, endophthalmitis, panoftalmita.
When tuberculous corneal ulcer in the body there is always the primary focus of tuberculosis infection (pulmonary tuberculosis, genital tuberculosis, renal tuberculosis). In this case, the corneal infiltrates are found to rimmed fliktenoznymi that further progress in the round ulcer. Current tubercular corneal ulcers for a long, recurrent, accompanied by the formation of gross corneal scarring.
Herpetic ulcers are formed on the site of dendritic corneal infiltrates and have irregular, branched form.
Ulceration of the cornea due to vitamin A deficiency (Keratomalacia), develops in the milk-white corneal opacity and is not accompanied by pain. Characterized by the formation of plaques in the dry xerotic conjunctiva. If hypovitaminosis B2 developing epithelial dystrophy, corneal vascularization, ulcers.
Secondary glaucoma and optic nerve atrophy.
In that case the perforation of the cornea iris not plugging, purulent infection penetrates smoothly into the vitreous body, resulting in occurrence or panoftalmita endophthalmitis. In the most unfavorable cases may develop cellulitis of the orbit, cavernous sinus thrombosis, brain abscess, meningitis, sepsis.
biomicroscopy), corneal staining solution of fluorescein (fluorescein instillyatsionnoy sample). An indication of the presence of corneal ulcers is a painting defect in bright green. In this case, the inspection to identify subtle corneal ulcers, to estimate the number, breadth and depth of the damage to the cornea.
The reaction of deep eye structures and their involvement in the inflammatory process is evaluated by transillumination, gonioscopy, IOP measurement, ophthalmoscopy, ultrasound of the eye. If necessary, carry out research and slezoproduktsii lachrymal passage function (color nasolacrimal test, trial Norn, Schirmer test).
To identify the etiologic factors causing corneal ulcer, you must cytological and bacteriological smear from the conjunctiva, the determination of immunoglobulins in the blood serum and tear fluid, microscopy scraping from the surface and edges of the corneal ulcer.
ophthalmologist. In order to prevent the deepening and expansion of corneal ulcers produced tushirovanie defect alcoholic solution of brilliant green or iodine tincture, or laser photocoagulation diathermo- ulcer surface. When corneal ulcer, dacryocystitis due to urgently needed lavage nasolacrimal duct or perform emergency dacryocystorhinostomy to eliminate the purulent center in close proximity to the cornea.
Depending on the etiology of corneal ulcer is assigned to a specific (antibacterial, antiviral, antiparasitic, antifungal) therapy. Pathogenic corneal ulcer therapy comprises administering mydriatics, metabolic, anti-inflammatory, antiallergic, immunomodulatory, antihypertensive drugs. Medications administered topically - in the form of instillations, ointment applications, subconjunctival, parabulbar injection and systemically - intravenous and intramuscular.
As the cleansing of corneal ulcers for stimulation of reparative processes and prevent the formation of rough scar appointed absorbable physiotherapy: magnetic therapy, electrophoresis, phonophoresis.
With the threat of perforation of the corneal ulcer is shown holding a cross-cutting or lamellar keratoplasty. After ulcer healing may require excimer laser removal of superficial corneal scarring.
cataract), the outlook for visual function unfavorable. In the absence of complications, after decrease inflammation may require optical keratoplasty to restore vision. When Panophthalmitis and eye socket cellulitis high risk of loss of the organ of vision. Fungal, herpetic corneal ulcers and other difficult to cure and have a relapsing course.
For the purposes of the prevention of corneal ulcers should avoid micro traumas eyes, to observe the necessary precautions when using or storing contact lenses, carry out preventive antibiotic therapy under the threat of corneal infection, and treat common eye diseases in the early stages.