Blepharitis
The focus of inflammation in this disease is localized along the edge of the eyelids. The causes of blepharitis are usually prolonged exposure to caustic substances, smoke, volatile liquids, the presence of a chronic infection in the body, or infection due to injury to the eyelids.
It is customary to distinguish 3 forms of the disease: simple, ulcerative and scaly.
Simple blepharitis is accompanied by redness of the edges of the eyelids with slight swelling, without spreading the process to the surrounding tissues. The process is accompanied by a sensation of a foreign body in the eye, which causes the patient to blink frequently. Sometimes foamy discharge is observed in the inner corners of the eye.
Scaly blepharitis is accompanied by severe redness of the eyelid margins and noticeable swelling. Its characteristic feature is grayish or pale yellow scales at the edges of the eyelids. Their mechanical removal leads to mild bleeding. The patient feels itching in the eyelids, sometimes there is a feeling of a foreign body, pain when blinking. Advanced cases occur with pain and photophobia. Visual acuity often decreases.
Ulcerative blepharitis is the most severe form of the disease. Its characteristic sign is dried pus at the roots of the eyelashes, which causes them to stick together. After the crusts are eliminated, slowly healing ulcers form. Eyelashes fall out and often then grow incorrectly. Often accompanied by conjunctivitis caused by the spread of an infectious agent.
Purulent eye infection
As a rule, its causative agent is streptococci or staphylococci, which penetrate inside when the eye is injured by a sharp object.
The course of the disease goes through 3 stages - iridocyclitis, endophthalmitis, panophthalmitis.
Iridocyclitis occurs a couple of days after an eye injury and is accompanied by severe pain of the eyeball upon palpation. The iris takes on a grayish or yellowish tint due to accumulated pus, and the pupil seems immersed in a kind of haze.
Endophthalmitis is a more severe form of purulent inflammation. The infection spreads to the retina, and pain is felt even with the eye closed. Visual acuity quickly drops to light perception. During the examination, characteristic signs are revealed - dilation of the conjunctival vessels, a greenish or yellowish tint of the fundus.
Panophthalmitis is a rare complication of endophthalmitis with timely treatment. Purulent inflammation spreads to all tissues of the eye. Unbearable pain occurs, the eyelids swell, the mucous membrane turns red and swells. Pus oozes through the cornea, the color of the white becomes greenish. The skin around the eye becomes red and swollen. An eye abscess may occur. Severe cases of the disease require surgery. Even with successful antibiotic therapy, visual acuity is noticeably reduced.
Treatment
Therapeutic measures are fraught with great difficulties, since the bacterium is very resistant to anti-tuberculosis drugs.
Non-tuberculous mycobacteriosis will include the following treatment:
- local immunity is increased with the help of special immunostimulants;
- "Kanamycin", "Amikacin", "Ethionamide" are prescribed;
- nonspecific antibiotics are prescribed.
Indicators of successful therapy will be:
- improving the general well-being of the patient;
- disappearance of signs of intoxication;
- stabilization of pathological changes in the lungs.
If the disease has reached a chronic stage, surgical intervention may be prescribed to eliminate the negative consequences caused by mycobacteria.
Dacryocystitis
Inflammation of the lacrimal sac of an infectious nature. Predisposing factors to the disease are the characteristics of the lacrimal canal and fluid stagnation in the lacrimal gland.
The disease is manifested by liquid purulent discharge and lacrimation. A tumor develops in the inner corner of the eye - a swollen lacrimal gland. When pressed, pus flows out of it. Sometimes hydrocele of the lacrimal gland may develop.
Dacryocystitis can be easily cured with timely treatment. Complications often include keratitis and conjunctivitis with a slight decrease in vision.
Discharge from the eyes
Sometimes young children develop a sticky discharge from their eyes. After sleep, crusts appear on the eyes or the eyelids stick together. Although the symptoms are quite unpleasant, in most cases it is a harmless, self-limiting condition. But in case of redness and increased discharge, treatment may be required.
There are three main reasons for this phenomenon:
- Conjunctivitis,
- Blockage of tear ducts
- Blenorrhea of newborns.
Except for infections acquired at birth, sticky discharge usually resolves without treatment.
It is important not to delay therapy for a long time, since this disease is most effective at a young age.
Keratitis
This is an inflammatory process localized in the tissues of the cornea. There are exogenous and endogenous forms of the disease and its specific varieties (creeping ulcer of the cornea).
Exogenous keratitis develops after a chemical burn and infection with viruses, microbes and fungi. The endogenous form occurs against the background of a creeping corneal ulcer or infectious diseases of a fungal, bacterial and viral nature (syphilis, herpes, influenza). Sometimes the cause may be some metabolic abnormalities or hereditary predisposition.
The disease begins with tissue infiltration, continues with ulceration, and ends with regeneration.
The infiltrate is a fuzzy yellowish spot. The area of damage varies from microscopic to global, over the entire area of the cornea. Its formation leads to decreased visual acuity, the development of photophobia, lacrimation and spasms of the eyelid muscles (corneal syndrome).
After some time, an ulcer forms. If left untreated, it spreads to the cornea and internal structures of the eye. Its healing is possible only with antibacterial therapy.
If the area of the ulcer is small, visual acuity does not decrease. With extensive damage, blindness can occur.
ENDOPHTHALMITIS
A group of intraocular infections involving the vitreous body of the eye. The main forms are exogenous
and
endogenous
(
metastatic
)
bacterial
and
fungal endophthalmitis
.
Most cases of bacterial endophthalmitis
occurs after surgery for cataracts and in the case of various traumatic lesions.
EXOGENOUS BACTERIAL ENDOPHTHALMITIS
Main pathogens
(after cataract removal): S.epidermidis, S.aureus, Streptococcus
spp.,
Pseudomonas
spp.,
H.influenzae
, representatives of the
Enterobacteriaceae
.
ENDOGENOUS BACTERIAL ENDOPHTHALMITIS
Most often, the infection spreads hematogenously. Two main risk factors are of particular importance: the presence of an immunodeficiency state and intravenous drug use.
Main pathogens
B.cereus, Streptococcus
spp.,
S.aureus, N.meningitidis, S.pneumoniae
.
Choice of antimicrobials
Empirical therapy for bacterial endophthalmitis (performed immediately after diagnostic aspiration of the vitreous and aqueous body):
Drugs of choice:
amikacin 0.4 mg or ceftazidime 2.25 mg in 0.1 ml + vancomycin 1.0 mg in 0.1 ml (intravitreal administration); vancomycin 25 mg in 0.5 ml and ceftazidime 100 mg in 0.5 ml (periocular administration); after 12 hours - dexamethasone phosphate 4 mg in 1 ml or prednisolone succinate 25 mg in 1 ml (periocular administration); prednisolone (systemic therapy) 60 mg.
Duration of therapy:
periocular injections daily for 4-7 days (each drug in a separate syringe); glucocorticoids (systemic therapy): 10-14 days.
FUNGAL ENDOPHTHALMITIS
Main pathogens
Candida
spp.,
Aspergillus
spp.
Choice of antimicrobials
Drugs of choice:
amphotericin B 5-10 mg in 0.1 ml (intravitreal administration).
Alternative drugs:
fluconazole 0.1-0.2 g/day (orally).
Duration of therapy:
2 months
If necessary, vitrectomy can be performed.
Table 1. Antiviral drugs for the treatment of eye diseases
| Stromal herpetic keratitis and keratouveitis | Table 0.5 g - 2 times a day, 5-10 days, in addition to local therapy in 3% of eyes. acyclovir ointment | |
| Idoxuridine | Superficial herpetic keratitis | Eye. cap. 0.1%, instilled 8 times a day until complete epithelialization, discontinued if there is no effect in the first 3-5 days |
| Human leukocyte interferon with activity 500 units per bottle. | Adenoviral conjunctivitis Epidemic hemorrhagic conjunctivitis Superficial herpetic keratitis | Contents of the flask. diluted in 2 ml of water for injection, instilled 6-8 times a day, gradually reducing to 3-4 times |
| Human leukocyte interferon with activity of 8 thousand units per bottle. | Adenoviral conjunctivitis Epidemic hemorrhagic conjunctivitis Superficial and stromal herpetic keratitis, corneal ulcer | Same |
| Polyadenylic and polyuridylic acid complex 200 mcg (100 units/vial) | Adenoviral conjunctivitis Superficial herpetic keratitis | Same |
Table 2. Drugs for local antimicrobial therapy of eye diseases
| A drug | Dosage form | Administration frequency per day, times |
| Benzylpenicillin | Eye. cap. 100 thousand units/ml, freshly prepared | 3-6 |
| Erythromycin | Eye. ointment 0.5%, in tubes of 10 g | 3-4 |
| Tetracycline | Eye. ointment 1%, in tubes of 3 g, 7 g, 10 g | 3-4 |
| Chloramphenicol | Eye. cap. 0.25%, per bottle. 10 ml Eye. linim. 1%, in tubes of 25 g and 30 g | 3-5 |
| Gentamicin | Eye. cap. 0.3%, per bottle. 10 ml each | 3-6 |
| Tobramycin | Eye. cap. 0.3%, per bottle. 5 ml Eye. ointment 0.3%, in tubes of 3.5 g | 3-5 |
| Ciprofloxacin | Eye. cap. 0.3%, per bottle. 5 ml each | 2-5 |
| Ofloxacin | Eye. cap. 0.3%, per bottle. 5 ml Eye. ointment 0.3%, in tubes of 3 g | 3-6 3-5 |
| Lomefloxacin | Eye. cap. 0.3%, per bottle. 5 ml each | 3-6 |
| Polymyxin B | Eye. cap. 0.1-0.25%, freshly prepared | 3-6 |
| Fusidic acid | Eye. drops, gel 1%, in tubes of 5 g | 2 |
| Vancomycin | Eye. cap. 1-2%, freshly prepared | 4-6 |
| Combination drugs | ||
| Gentamicin/dexamethasone | Eye. cap. gentamicin 0.3%, dexamethasone 0.1% in 1 ml, in a bottle. 5 ml Eye. ointment, 5 mg/1 mg in 1 g, in tubes of 2.5 g | 2-3 2 |
| Tobramycin/dexamethasone | Eye. ointment 3 mg/1 mg in 1 ml, in tubes of 3.5 g Eyes. drops, tobramycin 0.3%, dexamethasone 0.1% in 1 ml in a bottle. 5 ml each | 2 |
| Neomycin/polymyxin B/dexamethasone | Eye. cap. 3.5 mg/6 thousand units/1 mg in 1 ml, in a bottle. 5 ml Eye. ointment 3.5 mg/6 thousand units/1 mg in 1 g, in tubes of 3.5 g | 2 |
| Other means | ||
| Boric acid | Eye. cap. 2%, per bottle. 5 ml each | 2-3 |
| Picloxidine | Eye. cap. 0.05%, per bottle. 5 ml each | 2-3 |
| Silver nitrate | Eye. cap. 1%, freshly prepared | Instillation 1 time for the prevention of blenorrhea in newborns |
| Sulfacyl sodium | Eye. cap. 20%, per bottle. 10 ml each, 1 ml in a dropper tube | 3-5 |
For severe corneal ulcers, a forced technique is used: in the first 2 hours every 15 minutes, then until the end of the first day - every hour, on the second day - every 2 hours, on the third - every 3 hours
Table 3. Doses of antimicrobial drugs for subconjunctival and parabulbar injections
| A drug | Dose |
| Benzylpenicillin | 0.5-1 million units |
| Ampicillin | 50-100 mg |
| Oxacillin | 100 mg |
| Cefazolin | 100 mg |
| Ceftazidime | 100 mg |
| Gentamicin | 20-40 mg |
| Tobramycin | 20 mg |
| Amikacin | 20 mg |
| Vancomycin | 25 mg |
Table 4. Doses of antimicrobial drugs for systemic administration for bacterial eye infections
| A drug | Oral dose | Parenteral dose |
| Benzylpenicillin | 1 million units every 6 hours | |
| Ampicillin | 0.5 g every 6 hours | 0.25-0.5 g every 6-8 hours |
| Oxacillin | 0.25-0.5 g every 4-6 hours | |
| Ceftazidime | 1.0-2.0 g every 8-12 hours | |
| Cefepime | 1.0 g every 8-12 hours | |
| Erythromycin | 0.5 g every 6 hours | |
| Azithromycin | 0.5 g on day 1, 0.25 g on days 2-5 For chlamydia - 1.0 g once | |
| Tetracycline | 0.5 g every 6 hours | |
| Doxycycline | 0.1 g every 12 hours | |
| Gentamicin | 1 mg/kg every 8 hours | |
| Tobramycin | 1.5-2 mg/kg every 8 hours | |
| Amikacin | 10 mg/kg every 12 hours | |
| Ciprofloxacin | 0.5 g every 12 hours | 0.4-0.6 g every 12 hours |
| Ofloxacin | 0.2-0.4 g every 12 hours | |
| Levofloxacin | 0.25 g every 12 hours or 0.5 g once a day | 0.5 g 1 time per day |
| Lomefloxacin | 0.4 g every 12-24 hours |
Keratoconjunctivitis
A disease caused by an adenovirus that affects the conjunctiva and cornea.
Transmitted by contact.
From the moment of infection to the onset of the disease, 7-8 days pass. It begins with headache, chills, weakness and apathy. Then there is pain in the eyes and redness of the sclera, a feeling of a foreign body inside and profuse lacrimation with mucus discharge from the lacrimal canal.
The conjunctiva turns red, small bubbles with liquid inside appear on it - a characteristic manifestation of an adenoviral infection.
With timely treatment, after 5-7 days, signs of infection disappear, with the exception of photophobia. Cloudy lesions form in the cornea. Complete healing occurs after two months.
Symptoms
The onset of the disease in children is quite harmless: it seems that just a small speck has gotten into the eye. Soon after infection, signs of inflammation characteristic of conjunctivitis appear.
The signs are always the same, so they are easy to identify:
- redness (hyperemia) of the eyeballs;
- swelling of the upper and lower eyelids;
- narrowing of the palpebral fissure;
- lacrimation and photophobia;
- drying of yellow crusts on the eyelids;
- sticking of eyelashes (especially in the morning after waking up);
- mucous and purulent discharge from the eyes;
- deterioration of sleep and appetite;
- general lethargy and moodiness.
Older children have complaints about deterioration in visual acuity, discomfort, itching, burning and the sensation of foreign bodies in the eyes. Infants, other than crying, cannot tell in any way what is bothering them, so any separation from their eyes is a reason to suspect conjunctivitis.
Symptoms of conjunctivitis are expressed differently (some are mild, others are more intense), but when the disease appears, they will definitely show up. Treatment of the disease must be started immediately, otherwise innocent symptoms may be followed by very serious consequences (partial or complete blindness, eyelid deformation, brain abscess, perforation, corneal ulcer).
Viral conjunctivitis
The cause of the disease is the introduction of a viral agent. There are several forms of the disease, with a specific nature of the pathological process.
Herpetic conjunctivitis is typical for young children. The inflammatory process spreads beyond the mucous membrane into the surrounding tissues. It can be catarrhal, follicular and vesicular-ulcerative.
The most severe form of the disease is vesicular ulcerative. It is manifested by the appearance of small transparent bubbles with liquid on the mucous membrane of the eye. They are characterized by spontaneous opening with the formation of painful ulcers, which causes lacrimation and photophobia in patients.
After 5-7 days, the symptoms of the disease disappear spontaneously without additional therapy. Visual acuity does not change, no traces remain on the cornea.
Herpes
The disease manifests itself in different ways, the most dangerous being herpetic damage to the organs of vision. The pathological process can affect the cornea and lead to blindness.
The virus can enter the human body sexually, through the respiratory organs or the mucous membrane of the oral cavity. Infection can also occur through shared use of a towel or utensils.
The body has protection in the form of immunity, and therefore it can resist adequately for a long time. When the immune system is weakened for any reason, ophthalmoherpes occurs. Its appearance can be caused by simple hypothermia, injury, stressful situations, and pregnancy.
When herpes appears before your eyes, it can easily be confused with a bacterial infection or allergy, which is why it is forbidden to diagnose it yourself. Ophthalmoherpes manifests itself as follows:
- pain syndrome;
- redness of the eyelid and mucous membrane of the eye;
- deterioration of vision, including twilight vision;
- photosensitivity;
- severe lacrimation.
The condition can be aggravated by nausea, pain, high fever, and enlarged regional lymph nodes. To make a diagnosis, a cell scraping is taken from the patient from the affected mucous membrane and skin area. Thanks to enzyme immunoassay, antibodies to infection can be determined.
Ophthalmoherpes can be treated with the following medications:
- immunotherapy drugs: “Amiksin”, “Poludan”, “Reaferon”, “Interlok”;
- antiviral: “Valacyclovir”, “Oftan-IDU”, “Acyclovir”;
- mydriatics that relieve spasms: “Irifrin”, “Atropine”;
- vitamins;
- antibiotics;
- antiseptics;
- vaccine against herpes, which is administered only during the period when there is no exacerbation: “Gerpovax”, “Vitagerpavak”.
Gonococcal conjunctivitis
Another name for the disease is gonoblennorrhea. This is an intense process of inflammation of the mucous membrane of the eye during the penetration of a gonococcal infection. The disease is transmitted exclusively through contact (sexual intercourse, from mother to fetus during childbirth, etc.).
The first symptoms of gonoblennorrhea in newborns appear 3-4 days after birth. The eyelids swell and become purplish-red or bluish in color. Bloody discharge appears from the lacrimal canal. Certain areas of the eye become ulcerated and cloudy. In advanced cases, panophthalmitis develops with loss of vision and atrophy of the eyeball. After therapy, rough scars may remain on the affected areas of the cornea.
Gonococcal conjunctivitis in adults is accompanied by general malaise, fever, and general pain.
Scleritis This is an acute inflammatory process in the sclera of the eye. More often it develops against the background of viral, bacterial or fungal general pathologies, as an ascending infection.
Episcleritis is a superficial scleritis affecting the upper layer of the sclera. The eye becomes red, its movements become painful. There is no lacrimation, which is considered a characteristic sign of the disease, photophobia rarely develops, and visual acuity does not change. An infected area of purple or red color appears on the sclera, slightly rising above the surface.
Deep scleritis spreads into the eye shells and in advanced cases spreads to the surrounding tissues, affecting the ciliary body and iris. Sometimes multiple foci of infection are possible, which often causes severe purulent complications.
Purulent episcleritis is caused by staphylococcus. The disease progresses rapidly, affecting both eyes. In the absence of therapy, it can continue for years, subside and recur. In areas of infection, the sclera becomes thinner and vision decreases noticeably. When the inflammatory process moves to the iris, glaucoma may develop.
How to recognize: first signs and symptoms
After the incubation period, the second stage of the disease begins. At this time, the disease is already obvious and has all the characteristic symptoms. Conjunctivitis usually manifests itself with the following symptoms:
- Tearing. The most striking and classic sign. Occurs in 98% of sick children. Tearing bothers the baby throughout the day. It decreases somewhat at night and after instilling drops. In the first three days, lacrimation can be unbearable. As a rule, the discharge from the eye is light. In some cases, it may be bloody or yellow in color.
- Redness of the eye. The vessels located on the surface of the eyeball become very red and become very noticeable upon examination. In children with severe disease, redness can be very pronounced. The eyes look tired. In severe cases, the entire white space of the eye around the iris turns red.
- Photophobia. Due to inflammation on the mucous membrane, this rather unpleasant symptom appears. The baby cannot open his eyes during the daytime. Bright rays of light cause pain in the child and increase tearing. In the dark or when the room is curtained, babies feel much better.
- Discharge of pus. This attribute is optional. It most often occurs in children with bacterial conjunctivitis. Typically, both eyes are affected at the same time. Discharge of pus occurs throughout the day. In this case, mandatory prescription of antibacterial eye drops is required. For severe cases of the disease, doctors may prescribe antibiotics in tablets or even injections.
- Increased body temperature. With a mild course of the disease, it increases to 37-37.5 degrees. In more severe cases or when the first complications appear, the temperature rises to 38-39 degrees. The baby's health deteriorates and weakness increases. Children become more capricious and try not to open their eyes. Night and daytime sleep bring temporary relief.
- Sensation of a foreign object or “sand” in the eyes. This is also an important diagnostic sign of conjunctivitis. Occurs in more than 80% of patients.
- Manifestations of an allergic reaction. Occurs in case of allergies. Babies have a fever and may have a runny nose or congestion when breathing. Children with atopic dermatitis develop itchy red marks on the skin. The child's well-being is greatly deteriorating. The baby becomes lethargic and eats poorly.
Choroiditis (posterior uveitis)
This is an inflammatory process behind the choroid. The reason for its occurrence is the introduction of microbes into the capillaries.
The disease is characterized by an initial absence of symptoms. As a rule, choroiditis is discovered incidentally during an ophthalmological examination.
If the focus of inflammation is localized in the center of the choroid, characteristic signs are sometimes observed: distortion of the contours of objects, flickering and light flashes before the eyes.
In the absence of timely antibacterial therapy, retinal edema develops with microscopic hemorrhages.
Strabismus at an early age
This pathology is characterized by asymmetrical eye movements that are difficult to correct and the inability in some cases to focus the gaze on an object. It manifests itself mainly in preschool age and causes a risk of complications in the form of amblyopia (decreased visual acuity that cannot be corrected with optical devices).
Causes of strabismus:
- Hereditary factors.
- Physical and mental trauma.
- Infectious diseases suffered by the mother during pregnancy.
- As a concomitant symptom of farsightedness and myopia.
The pathology is treatable, but this process can be lengthy (up to several years). Surgery may be required to fully restore binocular vision. In some cases, specialists make do with hardware techniques, including light stimulation.
Barley
The disease is an inflammatory process in the sebaceous gland and ciliary bulbs, caused by staphylococcal and streptococcal infections against a background of weakened general immunity.
It is characterized by redness of the eyelid area, which then turns into infiltration and swelling. Gradually, redness spreads to nearby tissues, swelling of the conjunctiva increases. After 2-3 days, a cavity with pus forms inside the infiltration. On the 3-4th day from the beginning of the process, the purulent sac breaks through with the release of pus beyond the eyelid, pain and swelling subside. In severe cases, the process can spread to surrounding tissues.
By contacting the Moscow Eye Clinic, each patient can be sure that some of the best Russian specialists will be responsible for the results of treatment. The high reputation of the clinic and thousands of grateful patients will certainly add to your confidence in the right choice. The most modern equipment for the diagnosis and treatment of eye diseases and an individual approach to the problems of each patient are a guarantee of high treatment results at the Moscow Eye Clinic. We provide diagnostics and treatment for children over 4 years of age and adults.
Causes of eye diseases
The main causes of eye diseases are:
1. Various infectious agents (Staphylococcus aureus, gonococcus, pneumococcus, Haemophilus influenzae and Pseudomonas aeruginosa). In addition, inflammatory diseases of the organs of vision can be caused by parasites, fungi, viruses (herpes, molluscum contagiosum, adenovirus, chlamydia, cytomegalovirus, aspergillosis, toxoplasma and a number of others). If left untreated, these diseases can cause a number of complications.
2. Defects and anomalies of development (cause hereditary diseases of the organ of vision).
3. Age-related degenerative-dystrophic changes (glaucoma, cataracts).
4. Tumor and autoimmune processes.
5. Pathologies of other organs that affect the condition of the visual organs (hypertension, dental diseases, meningitis, encephalitis, diabetes mellitus, anemia, leukemia, and so on).
