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Diagnosis of inflammation of the conjunctiva
and eye membranes ("red eye" - conjunctivitis,
keratitis, iridocyclitis, uveitis, retinitis,
endophtalmitis, panophtalmitis).
Diagnostics, treatment, prophylaxis
Lecturer:
Maksymuk O.Ju.
Of all patients with ocular pathology over
30% of patients treated to an occasion
conjunctivitis and other diseases of the
connective membranes.
Diseases of connective membranes are divided into three groups:
1) inflammations;
2) dystrophies;
3) tumors of the conjunctiva;
In its turn inflammations of the conjunctiva are divided into:
1. Conjunctivitis of exogenous origin;
1) acute and chronic conjunctivitis of infectious nature (viral,
bacterial, fungal, etc.);
2) conjunctivitis caused by physical and chemical harmfulness;
3) allergic exogenous conjunctivitis;
2. Conjunctivitis of endogenous origin:
1) conjunctivitis at common diseases;
2) autoimmune conjunctivitis
The main symptoms of acute conjunctivitis:
1) lacrimation;
2) "The feeling of sand" in the eyes;
3) redness of the eye;
The patient had difficulty opening his eyes because of the presence
of purulent discharge, which in its turn is a cardinal symptom of
bacterial conjunctivitis.
Treatment
Frequent washing with 2% boric acid, 30% albucid, 1:5000 furazilin
or potassium permanganate.
1) Valavir 2tab – 2 days 2t/d; 1tab – 1 day 2t;
2) Ocoferon 6t/d;
3) Vigren (gel)
Conjunctivitis Koch-Weeks
Causes of Koch-Weeks bacillus. The disease is extremely contact.
Affects both eyes. The disease begins suddenly.
Symptoms:
Redness of the conjunctiva;
Lacrimation;
Photophobia;
The presence of purulent discharge;
Characteristic sign of acute epidemic conjunctivitis is the involvement
in the process conjunctiva of the eyeball. Noted its redness,
presence of petechial hemorrhages.
Bacterial conjunctivitis
Pathogen – Neisser gonococcus.
Clinically distinguish gonoblennorrhea of infants, children and adults.
Gonoblennorrhea of newborn develops in 2-3 days after birth.
Symptoms:
1) swelling of the eyelids, with marked cyanotic-purple edema;
2) availability of secretions with color of meat slops;
Objectively:
Conjunctiva is sharply hyperemic, infiltrated, friable, bleeding.
After 3-4 days, the secretions from the eyes is copious, purulent.
Vascular tract
Medium membrane of the eye is called vascular or uveal tract. It
is divided into 3 parts:
1) iris;
2) ciliary body;
3) choroidal membrane (choroid)
Iris
The iris is the front, visible part of the
vascular tract. It does not direct contact
with the outer shell. Iris is located in the
front of the cavity so that between it and
the cornea stays free space - anterior
chamber of eyeball filled with liquid
contents - aqueous humor. In the
connective tissue stroma of the iris are
located branches of the anterior and
posterior ciliary arteries, that
anastomosing with each other, in the
thickness of the iris lies two muscles,
innervation is carried by branches of
sympathetic and parasympathetic
nerves.
Pupil
The average value of it is 3mm, largest - 8mm and the lowest - 1 mm.
The width of the pupil in the newborn is 2mm, it is natural reaction to
light is not significant. Presence at the child a wide pupil (3 mm or
more) and the absence of his reaction to light shows or on the
blindness, or on the pathology of muscular and nervous system.
The iris has two muscles:
1) sphincter (constriction of the pupil);
2) dilator (expansion of the pupil);
Sphincter is located in the pupillary
zone of the iris stroma, receives
innervation from the oculomotor nerve,
is the most powerful muscle.
Dilatator located as part of the inner leaf
pigment, in the outer zone, receives
innervation from sympathetic nerve.
Sensitive innervation of the iris provides
the trigeminal nerve.
Iris function:
1)participates in nutrition of
avascular structures of the eye by
ultrafiltration of blood in intraocular
fluid;
2)promotes intraocular
thermoregulation, accommodation;
3) promotes the outflow of
intraocular fluid;
4) with it help formed the anterior
chamber angle, which is a major
collector of intraocular fluid.
Ciliary body
Appear intermediate link between the iris and choroid. It is
inaccessible to immediate inspected by the naked eye. Only a small
portion, which goes to the root of the iris can be seen by the special
inspection by goniolens.
Ciliary body is a closed ring width of about 8 mm. The fore is
narrower than temporal lobe posterior border of the ciliary body goes
by the so-called, a toothed edge, and corresponds on the sclera of
the site of attachment of direct eye muscles. Front part with
appendages on the inside is called ciliary crown. The rear section
deprived appendages and is called - ciliary circle or flat part of the
ciliary body.
The ciliary body carries out production of intraocular fluid, is
involved in almost continuous act of accommodation, in the
regulation of ophthalmotonus, in thermoregulation, in the outflow
of intraocular fluid and is very subtle indicator of the pathology of
the eye or other organs and systems.
Choroid
Constitute the rear, the most extensive part of the vascular section from the
toothed edge to the optic nerve. It is tightly connected with the sclera only
around the optic nerve exit site. Thickness ranges from 0.2 to 0.4 mm, has
a complex multi-layer structure, caused by the development of the vascular
network and a large number of pigments.
Choroid contains 5 layers:
1)suprachoroidal;
2)large vessels;
3)layer of medium and small vessels
4)choriocapillary;
5)glassy plate that separates the choroid from the pigmented layer of the
retina;
The main function of the choroid - is
nutrition of the neuroepithelium of the
retina, carried out thanks to that
choriocapillary layer is open and firmly
connected to the pigment layer of the
retina. The presence in choroid of a large
number of pigments contributes to the fact
that it is absorbed by the "excess" of light
entering the bottom of the retina.
Diseases:
The structure of the vascular tract, its extensive vascular network, create
favorable conditions for the spread of various pathogens, that circulating in
the blood and allergization of tissues, so the primary diseases of the
vascular tract, most often endogenous pathology – it is rheumatism,
rheumatoid arthritis, viral infections, toxoplasmosis, tuberculosis, brucellosis,
etc . and metabolic diseases - diabetes, gout.
In recent years, defined great importance allergy in the etiology of these
diseases is influenced by many factors, particularly streptococcal infections
(tonsillitis, etc.). Provoke disease injury, cooling the body, frequent
exogenous disease of vascular tract, penetrating injuries, keratitis.
Inflammatory diseases of the vascular tract constitute about 5% of all
cases of ocular pathology. Independently or combine may flow iritis,
iridocyclitis, horioidity, chorioretinitis. Moreover inflammation can have
total character that leads to panuveitis
Uveitis
Uveitis irrespective on their localization, can be:
1) congenital or acquired;
2) exogenous and endogenous;
3) toxic allergic and metastatic;
4) granulomatous and nongranulomatous;
5) single and relapsing;
6) acute, subacute and chronic, concomitant to general
pathology and without it, with reversible development and
with complications.
By the nature of exudation: serous, fibrinous, purulent,
hemorrhagic, mixed.
Iridocyclitis (anterior uveitis)
The first sign of inflammation of the choroid - is slightly
pronounced corneal syndrome (photophobia, lacrimation,
blepharospasm, redness, decreased vision). The cardinal
symptoms of inflammation are: smearing of image, iris color
changing, pupil constriction, iris tissue swells due to the
expressed edema. Blue color of the iris becomes dirty green,
brown iris gets rusty hue. You can find the tarnish of the corneal
endothelium and the presence of precipitates. Because of the
abundant of exudation appears turbidity in moisture of anterior
chamber, is not rare in the bottom of the chamber in the form of
a strip settles pus (hypopyon), at hemorrhagic iritis found blood
in the anterior chamber (hyphema).
Posterior synechia
Posterior synechiae - is the adhesions of iris to the anterior capsule
of crystalline lens, frequent companions of iritis. They are particularly
well appreciable with drug expansion of pupil (by atropine). With
involvement in process of ciliary body, is developing such disease as
iridocyclitis, which is accompanied by a sharp pain increase in in the
eye, especially at night.
Choroiditis (posterior uveitis)
At posterior uveitis there is no corneal syndrome, as choroid have not
sensory innervation. Clinical manifestations depend on localization
the lesion focus. If the choroid affected closer to the posterior pole of
the eyeball, in particular in the area of yellow spot, the patient pays
attention to the sharp decline of central vision photopsias. These
complaints are characterized the presence in the patient of process,
which not only affects the vascular tract, but also the retina
(chorioretinitis).
During the propagation of the inflammatory of infiltration on the
retina, it becomes edematous, accompanied by a opacification of
the vitreous. In the area of ​inflammatory site, subsequently begins
to penetrate the retinal pigment epithelium that results in the
formation of pigmented lesions on it. On the fundus become visible
connective tissue scars and sclerotic vessels. Can shine through
white scleral tissue. The cause of the chorioretinitis and choroiditis
can be diseases such as tuberculosis, syphilis, toxoplasmosis, a
common infectious disease.
Endophthalmitis is an inflammatory condition of the intraocular cavities
(ie, the aqueous and/or vitreous humor) usually caused by infection.
Noninfectious (sterile) endophthalmitis may result from various causes
such as retained native lens material after an operation or from toxic
agents.
Panophthalmitis is inflammation of all coats of the eye including
intraocular structures.
The 2 types of endophthalmitis are endogenous (ie, metastatic) and
exogenous. Endogenous endophthalmitis results from the
hematogenous spread of
organisms from a distant
source of infection
(eg, endocarditis). Exogenous
endophthalmitis results from
direct inoculation of an
organism from the outside as
a complication of ocular
surgery, foreign bodies,
and/or blunt or penetrating
ocular trauma.
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