ENTOPHTHALMIA

From Big Medical Encyclopedia

ENDOFTALMYT (endophthalmitis; Greek endon inside + ophthalmos of eyes + - itis) — a purulent inflammation of internal covers of an eyeglobe with formation of exudate in a vitreous.

Allocate two forms of an entophthalmia — exogenous and endogenous. The exogenous entophthalmia (a septic endoftalmiya) results from infection after the getting wounds of an eyeglobe, at perforated helcomas, and also in some cases after band operations on an eyeglobe. Endogenous E. develops owing to a drift of microorganisms in the hematogenous way to capillaries of a ciliary body and an iris from the inflammatory centers in an organism, napr, at phlegmons, abscesses, furuncles, osteomyelitis, pneumonia, meningitis, a septic endocarditis, etc.

For E., irrespective of its form, eye pains and considerable decrease in visual acuity are characteristic. At inspection of the patient with method of side lighting or by means of a slit lamp (see Inspection of the patient) note signs of an iridocyclitis (see) — the mixed injection of an eyeglobe, precipitated calcium superphosphates on a back surface of a cornea, pus in an anterior chamber (hypopyon), discoloration of an iris, formation of back synechias (commissures between pupillary edge of an iris and the front capsule of a crystalline lens). Idiosyncrasy E. the yellowish-gray reflex in the field of a pupil found at a research by method of a transmitted light and at biomicroscopy of an eye (see) is.

This reflex is caused by formation of abscess in a vitreous. In the period of involution of process the reflex gets a whitish shade owing to growth of connecting fabric on site of abscess.

In differential diagnosis consider characteristic for E. hypotonia (decrease in intraocular pressure) and signs of inflammatory process in an anterior chamber of an eyeglobe, and also the data of the anamnesis (transferred the patient the getting wound of an eye, operation on an eyeglobe, purulent septic process).

Treatment of an entophthalmia presents great difficulties due to the need of creation of high concentration of antibacterial pharmaceuticals in an eye. Early use of antibiotics of a broad spectrum of activity is shown (gentamycin, Monomycinum, a tse-porin, Oxacillinum, Morphocyclinum, Neomycinum, polymyxin, Amphotericinum, etc.), to-rye enter under a conjunctiva, suprakhorioidalno, retrobulbarno, into an anterior chamber of an eyeglobe, a vitreous, and also intravenously and intramusculary. Apply the forced instillations in a conjunctival sac of various anti-inflammatory and antibacterial pharmaceuticals according to the following scheme: within an hour each 5 — 7 min. carry out instillations; this procedure is repeated by 4 — 6 times a day within a week. Apply also streptocides, anti-inflammatory drugs (Rheopyrinum, indometacin, hexamethylenetetramine), enzymes (fibrinolysin, trypsin, papain, a lidaza, protease, a protolysine). Surgical methods of treatment include daily washings of an anterior chamber of an eyeglobe solutions of antibiotics, continuous perfusion of a vitreous, an intra arterial oftalmoperfuziya through a supraorbital artery. Recently make also a vitreoektomiya (see the Vitreous).

At early the begun complex; treatment the favorable outcome is possible. Exudate in a vitreous partially resolves that allows to keep residual sight. At an adverse current the panophthalmia (see) which is coming to an end with a blindness and death of an eye develops. Also other complications — wrinkling of a vitreous, amotio of a retina (see), an atrophy of an eyeglobe are possible that also leads to a blindness.

Prevention consists in sanitation of the centers of an inflammation, timely complex treatment of the getting wounds of an eye with removal of intraocular foreign bodys, use in time and after band operations on an eyeglobe of antibacterial pharmaceuticals of a broad spectrum of activity.

Bibliography: Arkhangelsk V. N. Morphological bases of oftalmoskopichesky diagnosis, page 135, M., 1960;

Gundorova R. A. and Peter and Paul G. A. The getting wounds and contusions of an eye, page 131, M., 1975; Zolotareva M. M. Chosen sections of clinical ophthalmology, page 59, Minsk, 1973; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 2, book 2, page 382, M., 1960, t. 3, book 2, page 395, 1962; Friedman F. E., etc. Informational content

of ultrasonic investigation at a posttraumatic entophthalmia, Vestn. oftalm., No. 5, page 49, 1982; Forster R. To., Abbott R. L. a. G e-

lender H. Management of infectious endophthalmitis, Ophthalmology, v. 87, p. 313, 1980; Lund O. E. u. To a m-p i k A. Vitrektomie bei Endophthalmitis, Klin. Mbl. Augenheilk., Bd 182, S. 30, 1983; Rowsey J. J. a. o. Endophthalmitis, Ophthalmology, v. 89, p. 1055, 1982; System of ophthalmology, ed. by S. Duke-Elder, v. 9, L., 1966.

O. B. Chentsova.

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