KERATITIS

From Big Medical Encyclopedia

KERATITIS (keratitis; Greek keras, keratos a horn, horn substance + - itis) — the inflammation of a cornea of various etiology which is followed by its opacification and decrease in sight.

The etiology

the Aetiology is very various. The infection has the greatest value, and activators can get into a cornea in both the exogenous, and endogenous way. Exogenous To. are caused by various microorganisms — pneumococci, Koch's stick — Uiksa, viruses and fungi. To development To. diseases a century, conjunctivas, glands of a cartilage a century (a meybomiyeva of gland) and the lacrimal ways promote hron. To. arise also at action mechanical, chemical and physical. environmental factors.

Endogenous To. can develop at hron. inf. diseases of an organism — tuberculosis, syphilis, a brucellosis, a herpetic disease, a leprosy etc., and also owing to disbolism, hypo - both avitaminosis and a medicinal allergy.

Classification

the Most accepted is etiol, K. Vydelyayut K. classification exogenous and endogenous. Treat an exogenous keratitis: 1) traumatic To., caused by action of mechanical, chemical, thermal factors or action of a radiant energy; 2) bacterial To. (helcoma, creeping helcoma, etc.); 3) To. in connection with diseases of a conjunctiva, a century and glands of a cartilage a century (superficial regional To.); 4) To. virus etiology (adenoviral Sander's disease, tracheomatous pannus); 5) fungal To. (actinomycosis, aspergillosis).

Endogenous keratitis is subdivided on: 1) infectious To. (tubercular, tubercular and allergic, brucellous, malarial, syphilitic, leprose); 2) virus To. (herpetic, a Sander's disease, To. at measles, smallpox); 3) neurogenic To. (neuropore lytic, recurrent erosion of a cornea); 4) hypo - and avitamonous To.; 5) allergic To.; 6) To. the obscure etiology (a rozatsea-keratitis, filamentous To., the corroding helcoma). On depth of defeat of a cornea distinguish To. superficial and deep.

In article the most widespread are preferential described To.

The pathological anatomy and a pathogeny

the Main sign of an inflammation of a cornea is emergence of opacification in it owing to hypostasis and infiltration cellular elements. Infiltrate can consist from lymphoid, plasmocytes or polynuclear leukocytes getting from regional looped network of vessels. Infiltration of a cornea is followed by various changes of its layers: epithelium, stroma and endothelium. At heavy To. there is a necrosis of a cornea that leads to a softening of a stroma, formation of abscess and development of an ulcer; purulent infiltration with disintegration of all cornea is sometimes observed. At not purulent To. corneal cells are exposed to proliferation and dystrophy with the subsequent disintegration.

Along with infiltration there is a growing into a cornea of neogenic vessels from regional looped network (vascularization); vessels pass superficially under an epithelium or in deep layers of a cornea between its plates and tyazham of connecting fabric are followed.

In a pathogeny To. a certain value has the general condition of an organism, the condition of the general and local immunity which is carried out by the humoral antibodys, cell-bound immune complexes and sensibilized lymphocytes defining weight and character of a course of inflammatory process in a cornea.

A clinical picture

Characteristic a wedge, signs To. are: 1) symptoms of irritation of a cornea — dacryagogue, a photophobia, a nictitating spasm, and is frequent also pain; 2) existence of the pericorneal or mixed injection; 3) the opacification of a cornea which is followed by disturbance of transparency, smooth surface, gloss, sphericity (smoothness) and sensitivity of a cornea. Inflammatory infiltrates can have various form, size and depth of an arrangement. They can be dot, roundish, have an appearance of branches, strokes or to diffuzno take all cornea. Color of infiltrate depends hl. obr. from cellular structure: at small accumulation of cells of a lymphoid row infiltrate has grayish color, at purulent infiltration — yellowish, and at considerable vascularization gets a rusty shade.

Borders of infiltrate indistinct at the expense of the expressed hypostasis of surrounding sites of a cornea. Respectively over infiltrate gloss, smooth surface of a cornea disappear, it becomes rough, the epithelium is exfoliated. In most cases at To. there is vascularization of a cornea neogenic vessels. At superficial To. vessels get into it from vessels of a conjunctiva of an eyeglobe: they are bright red, it is treelike branch and anastomosed with each other, passed from a conjunctiva to a cornea through a limb, going to the center of infiltrate (superficial neovascularization). At deep To. vessels burgeon in thickness of a cornea in the form of brushes, brushes and have the rectilinear course (deep neovascularization). Covered with rather thick muddy film of infiltrate, they are soft muddy-red color, are visible indistinctly and only within a cornea. At defeat of all thickness of a cornea vascularization is observed by both superficial, and deep vessels.

Along with infiltration and growing of vessels around a cornea the pericorneal injection appears. She is various intensity — from an easy pink nimbus to the dark-violet wide belt covering a cornea. At To. happens also superficial — conjunctival — an injection, but usually insignificant.

An outcome To. depends on an etiology, virulence of a microorganism, extent of involvement of a cornea and body resistance. The small surface infiltrates which are not destroying a front boundary plate (a boumenov a cover) or located on the periphery near pericorneal vascular network, can completely resolve. The infiltrates located under a boumenovy cover in surface layers of a stroma partially resolve, and other their part will be organized without disintegration of f leaving a gentle hem in the form of oblachkovidny opacification (nubecula) or a spot (macula). Diffusion infiltration of a stroma of a cornea in average and deep layers is usually not inclined to disintegration; it partially resolves and leaves more or less expressed cicatricial opacification.

Purulent infiltrates proceed usually with a considerable necrosis of fabric and, as a rule, break up and ulcerate.

Complications arise owing to transition of inflammatory process to other covers of an eye — on an iris, a ciliary body and a sclera with development of a keratoiritis, keratoiridotsiklit and keratoscleritis. In these cases along with signs To. the phenomena of an iritis develop, iridocyclitis (see), sclerite (cm). Owing to toxic action of microorganisms and products of their exchange neuritis can develop optic nerve (see). In rare instances the perforation of a purulent helcoma can lead to purulent to an entophthalmia (see), to secondary glaucoma, a subatrophy of an eyeglobe and a sympathetic inflammation of other eye (see. Sympathetic ophthalmia ).

The diagnosis

In typical cases the diagnosis To. does not represent difficulties and the wedge, symptoms is put on the basis of characteristic. Are characteristic of the inflammation of a cornea caused by exogenous factors superficial To. and keratoconjunctivites with disintegration of a cornea, in particular purulent ulcers. For endogenous To. deep parenchymatous defeat of a cornea without disintegration of its fabric is characteristic.

Differentsialno - a diagnostic character separate To. the condition of sensitivity of a cornea is. Decrease, and sometimes and total loss of sensitivity is more often noted at neurogenic and herpetic To. At the same time sensitivity and on other eye is quite often lost that indicates the general disturbance of a nervous trophicity.

The differential diagnosis is carried out with dystrophic processes in a cornea. Primary dystrophies of a cornea usually bilateral, differ hron, a current, slowly progress, the photophobia is only occasionally noted, vascularization of a cornea is absent, its sensitivity is lowered.

For establishment of an etiology To. the complex a lab is applied. the methods including cytology of a conjunctiva, a method of fluorescent antibodies (see. Immunofluorescence ), serol. methods — RSK, a neutralization test, nefelometriya with virus, microbic, fabric and medicinal allergens, intracutaneous and focal tests with a herpetic vaccine, tuberculine, brucellin and other antigens.

Clinicodiagnostic characteristic of some forms K. and their treatment is given in the table.

Treatment

Treatment is usually carried out in the conditions of a hospital, especially at sharply proceeding and purulent To. also it is directed to the disease which caused To.

For the purpose of reduction of the inflammatory phenomena and pains, and also the prevention of an union and fusion of a pupil requires early purpose of mydriatic means — instillations of 1% of solution of sulfate of atropine of 4 — 6 times a day, 1 — 2 time a day atropine in eye to a medicinal film (see), for night of 1% atropinic ointment, an electrophoresis from 0,25 — 0,5% solution of atropine. Appoint also 0,25% solution of Scopolaminum. Both of these means it is possible to combine with instillations 0,1% of solution of adrenaline which is applied also on the cotton plugs entered for a lower eyelid for 15 — 20 min. or administration of this solution subkonjyunktivalno in number of 0,2 ml.

For treatment of patients bacterial To. y ulcers of a cornea appoint streptocides and antibiotics of a broad spectrum of activity in the form of solutions, ointments, and also in an eye medicinal film 2 times a day. The choice of an antibiotic is carried out depending on sensitivity to it pathogenic microflora. At heavy helcomas antibiotics in addition enter subkonjyunktivalno. At insufficient efficiency of a local antibioticotherapia appoint antibiotics inside.

After the end of inflammatory process carry out osmotherapy and resorptional treatment. Solutions of potassium iodide in the form of an electrophoresis apply 2 — 3%. From the general means use biogenic stimulators (extract of an aloe liquid, FIBS, pelloidodistillit, a vitreous, etc.) and an autohemotherapy.

At the corresponding indications resort to operational treatment (a keratoplasty, optical corectomy, antiglaukomatozny operation).

The forecast

the Forecast depends on an etiology of a disease, localization and character of infiltrate. At timely and correct treatment small surface infiltrates, as a rule, resolve completely or leave easy oblachkovidny opacifications. Deep and ulcer To. in most cases come to an end with formation of more or less intensive opacifications of a cornea and decrease in visual acuity, especially considerable in case of the central arrangement of the center. However even at leykoma it must be kept in mind a possibility of return of sight after successful keratoplasty (see).

Prevention

Prevention consists in the prevention of injuries of the eyes, timely treatment of a blepharitis, conjunctivitis and general diseases promoting development To. For prevention adenoviral To. the exception of contact with patients, careful implementation of rules of an asepsis is necessary at to lay down. procedures — individual pipettes and sticks, daily shift of drugs, disinfection of medical tools and devices.

Separate forms of a keratitis

Traumatic keratitis develop at not getting injuries of a cornea, hit in an eye of foreign bodys, at burns and penetration into a wound of microorganisms. The wedge, a picture depends on weight of an injury, a species of microorganism and is similar about a wedge, a picture bacterial To.

A bacterial keratitis

the Most serious illness is the creeping helcoma, edges before opening of antibiotics and streptocides quite often terminated in a blindness and death of an eye. The activator most often is the pneumococcus, the streptococcus, staphylococcus, a pyocyanic stick is more rare. Developing of an ulcer almost always contacts disturbance of an integrity of an epithelium of a cornea, a cut can be caused by small foreign bodys, leaves and branches of trees, acute awns of cereals and grains.

Fig. 8 — 15. Various forms of a keratitis. Fig. 8. Creeping helcoma: a deep ulcer with the subdug edge (1) and the site of perforation in the center (2). Fig. 9. Deep diffusion tubercular keratitis: the multiple centers of infiltrates of a cornea (1) with deep neogenic vessels in a look "metelochek" (2). Fig. 10. Tubercular and allergic (fliktenulezny) keratitis: dot infiltrate of a cornea (1) with a bunch of superficial neogenic vessels (2). Fig. 11. A parenchymatous keratitis at inborn syphilis: and — the extensive infiltrate of a cornea spreading from the periphery to the center is specified by an arrow) with neogenic vessels; — diffusion vaskulyarizirovanny opacification of a cornea. Fig. 12. Herpetic treelike keratitis: infiltrate of a cornea in the form of a branch of a tree. Fig. 13. Discal herpetic keratitis: infiltrate of a cornea of a discal form (1), sites of opacification of a cornea on cross section (2). Fig. 14. Neuroparalytic keratitis: in the center of a cornea extensive infiltrate with defect of surface layers of a cornea. Fig. 15. A keratitis at acne rosacea: group of small infiltrates with a clear boundary (1) and bunches of superficial neogenic vessels (2).

Cases of a creeping helcoma in the summer and in the early fall in the period of page are especially frequent - x. works. The activator is seldom brought by a foreign body, more often the pneumococcus is in a conjunctival sac as a saprophyte and at disturbance of an integrity of an epithelium of a cornea is implemented into the damaged cornea, causing rough inflammatory and necrotic process thanks to powerful proteolytic properties. The disease begins sharply and is followed by the severe cutting pains, dacryagogue, the photophobia, a nictitating spasm expressed by the mixed injection and hemozy conjunctivas. In the center of a cornea infiltrate with a yellowish shade appears, as a result of disintegration to-rogo the ulcer of a discal form with a purulent crateriform bottom is formed (tsvetn. fig. 8). One edge of an ulcer is raised, podryt, progressing, another - smooth, regressing. Quite often under the influence of the correct treatment the ulcer is cleared and the formed defect of a cornea is epithelized, and on site ulcers there is a deepening which is carried out further by connecting fabric, forming permanent intensive opacification of a cornea. In hard cases the progressing edge of an ulcer quickly increases and within several days the ulcer can capture the most part of a cornea. The iris very much is early involved in process; at the same time its color changes, pus in an anterior chamber appears, the pupil is narrowed, back synechias are formed. A lysis of a cornea can lead to its perforation. After a perforation there occurs healing of an ulcer with the subsequent scarring and formation of the cataract spliced with an iris. In very hard cases the cornea quickly melts, the infection gets inside, causes abscess of a vitreous and further a purulent inflammation of all covers of an eye (see. Panophthalmia ) with the subsequent subatrophy of an eyeglobe.

Patients with a creeping helcoma are subject to immediate hospitalization.

Active antiinflammatory topical and general treatment using antibiotics of a broad spectrum of activity, streptocides in instillations, in the form of subconjunctival injections, in an eye medicinal film is appointed. For increase in epithelization of a cornea appoint instillations of 2% of solution of sulfate quinine of 5 — 6 times a day. Midriatik are applied to prevention of an iridocyclitis: 1% solution of sulfate of atropine in combination with 0,1% solution of adrenaline and 3% solution of cocaine. If in the next 3 days inflammatory process does not respond to treatment, it is recommended cryoapplications. In extremely hard cases resort to diathermocoagulation of the Progressing edge of an ulcer with capture of boundary healthy fabric At emergence hypopyon (see), opening of an anterior chamber of an eye (paracentesis) with the subsequent washing by its weak solution of antibiotics is recommended. At threat of a perforation in certain cases carry out to lay down. keratoplasty.

The superficial regional keratitis arises against the background of inf. conjunctivitis or a blepharitis It is also characterized by emergence on edge of a cornea of dot infiltrates. Infiltrates have tendency to merge and an ulceration; in such cases there is a regional helcoma with a torpid current. Gradually there is substitution of an ulcer cicatricial fabric.

Treatment first of all shall be directed to elimination of the reason which caused regional To., for the rest it same, as at all ulcer To.

An adenoviral Sander's disease — see. Conjunctivitis .

A fungal keratitis

Keratomycoses — rather rare diseases of a cornea caused by different types of the fungi living in a conjunctiva and the lacrimal ways. Use of antibiotics and corticosteroids causes activation of fungal flora, edges gains pathogenic properties. More often than others they are called by mold fungi, more rare a radiant fungus — actinomycetes and barmy fungi. Infection of a cornea quite often happens after its small damages. On site erosion the grayish-white center with a kroshkovidny friable surface with a yellowish bordering appears. For fungal To. availability of hypopyon is characteristic. The disease can last for weeks, destruction goes slowly, vascularization, as a rule, is absent. Perforation of a cornea are rare, though are possible. Diagnosis is difficult. If the helcoma a long time does not respond to treatment antibiotics, it is necessary to think of a fungal infection. The diagnosis is made on the basis of microscopic examination patol. material, at Krom threads of a mold fungus or druse of a radiant fungus are found.

Removal of an affected area of a cornea by a knife with the subsequent cauterization by a galvanocauter or 5% spirit solution of iodine is recommended. In the absence of effect resort to lay down. to a keratoplasty. From anti-mycotic means Amphotericinum in drops (0,2% solution) 6 — 8 times a day, inside trichomycin on 1 tablet (50 000 PIECES) 4 times a day, nystatin on 1 dragee 4 times a day within 10 — 14 days are used. At an actinomycosis Sulfadimezinum on 0,5 — 1 and 4 times a day is effective.

The tubercular keratitis

the Tubercular keratitis is subdivided on 2 pathogenetic by various groups - hematogenous To., arising from the bacterial centers of a vascular path, and tubercular and allergic To. owing to a sensitization of a cornea to mycobacteria.

Two forms tubercular hematogenous meet To. — deep diffusion and sclerosing. Deep diffusion tubercular To. (tsvetn. fig. 9) is characterized by diffusion infiltration of average and deep layers of a cornea, against the background of a cut characteristic more dense centers of infiltrate of yellowish-pinkish color without bent to merge are allocated. Along with deep vessels in a cornea also superficial meet. One eye is surprised, as a rule. The current is long, remissions alternate with the periods of an aggravation that considerably tightens a current.

Sclerosing tubercular To. develops often at a deep sclerite; from a limb to the center of a cornea yellow-white infiltrates in the form of triangles slowly spread. Vascularization of a cornea is expressed poorly. Process continues months and even years.

Tubercular and allergic, or fliktenulezny, scrofulous To. (tsvetn. fig. 10) is observed usually at children and teenagers, the wedge, forms differs in a big variety, in duration of a current, frequent aggravations and a recurrence. A characteristic symptom of this disease is the phlyctena — a small knot of infiltration, the consisting hl. obr. from lymphoid cells and a small amount epithelioid and plasmocytes. Unlike a true tubercle in phlyctenas there are neither tubercular bacilli, nor caseous disintegration. Phlyctenas develop more often at a limb, but can be on any site of a cornea, they have an appearance of grayish translucent eminences. The number and their size are various: from the smallest multiple {miliary) to large single (solitary) phlyctenas. The bunch of superficial vessels usually approaches them. Phlyctenas sometimes break up, turning into fliktenulezny ulcers.

Treatment tubercular To. complex. Antitubercular himiopreparata and antibiotics are widely used (see. Tuberculosis, treatment ), etc. Specific treatment is carried out against the background of general desensibilizing (Dimedrol, polyvitamins, intravenously Calcium chloratum). Locally appoint streptomycin subkonjyunktivalno on 100 000 PIECES, 5% solution of Saluzidum, a hydrocortisone and Dexasonum in drops and under a conjunctiva of an eyeglobe. At a fliktenulezny keratoconjunctivitis yellow mercury ointment is effective 1%. At deep To. in order to avoid formation of back synechias midriatik, dry heat are shown. Treatment is carried out against the background of the balanced diet rich with fats and proteins with restriction of carbohydrates. Are shown radiation by quartz and a climatotherapy.

The syphilitic keratitis

At inborn syphilis most often meets parenchymatous diffusion To., at acquired — deep dot To., pustuliformny deep To. and a gumma of a cornea (see. Syphilis ).

In typical cases parenchymatous To. (tsvetn. fig. 11, and, b) has 3 stages of development. During an initial stage (3 — 4 weeks) in average and deep layers of a cornea there are diffusion gray opacifications consisting of separate dot infiltrates. They are located on the periphery of a cornea and only further extend to its center. The second stage (6 — 8 weeks) is characterized by progressing of process. Sharply infiltration of a cornea amplifies, its plentiful vascularization appears. All cornea becomes diffusion and muddy and sometimes gains saturated-white color. In the third, regressive, stages of the phenomenon of irritation decrease, infiltration resolves. Rassasyvaniye of infiltrates proceeds apprx. 1 year and more.

Treatment is carried out depending on a stage of syphilis by antibiotics, drugs of bismuth, iodine, according to the established schemes (see. Syphilis ).

Locally appoint 1% yellow mercury ointment, midriatik, corticosteroids in drops and subkonjyunktivalno. Paraffin applications, UVCh, sollyuks, a medicinal electrophoresis are useful.

A herpetic keratitis

the Herpetic keratitis proceeds in the form of herpes corneae simplex and herpes corneae zoster. Falloff or total absence of sensitivity of a cornea and absence or late emergence of its vascularization, and also tendency to a recurrence is characteristic of them.

At herpes corneae zoster defeat of the first branch of a trifacial is observed. Most a typiform is deep To., the deep ulcer with grayish ochazhka of infiltration is sometimes formed. The inflammation of a cornea is followed by an iritis (herpes iridis) or an iridocyclitis, also more extensive damages of an eye (a sclerite, an optic neuritis, paralyzes of eye muscles) are sometimes observed. On the frequency and weight herpetic To., the caused herpes corneae simplex, are high on the list among To. other etiology.

Distinguish primary herpetic To., arising at children's age at the first penetration of a virus of herpes into a human body, and postprimary, developing at adults against the background of a latent viral infection.

Primary herpetic keratitis meets in the form of epithelial To. and a keratoconjunctivitis with an ulceration and vascularization. Epithelial To. it is combined with conjunctivitis and characterized by emergence of the dot whitish or grayish ochazhok of infiltration and vesiculation raising an epithelium, rejection to-rogo leads to an erosion of a cornea.

At a keratoconjunctivitis with an ulceration and vascularization diffusion opacification of an epithelium with the subsequent its destruction and the rejection leading to ulceration is observed. Inflammatory process proceeds against the background of the expressed vascularization of a cornea and from the outcome in its permanent opacification.

One of the most frequent forms of postprimary herpetic keratitis are different types treelike To. — vesicular, star-shaped, dot and transitional forms — treelike with defeat of a stroma and kartoobrazny («geographical» To.). At treelike To. (tsvetn. fig. 12) against the background of acute symptoms of irritation in a cornea on the course of nervous trunks appear the small bubbles of gray color at merge reminding a branch of a tree. This form seldom proceeds favorably, often there comes the ulceration, inflammatory process passes to a stroma and is complicated by development of an iridocyclitis.

Stromal (deep) To. always are followed by defeat of a vascular path and therefore are called herpetic keratoirites.

Metaherpetic To. arise at distribution treelike To. in deep layers of a stroma that is quite often connected with broad use of corticosteroids. Distribution of infiltration to deep layers of a cornea leads to development of an extensive metaherpetic ulcer with landkartoobrazny outlines. Process differs in a long current, in the outcome extensive opacification of a cornea forms.

Discal To. (tsvetn. fig. 13) patognomonichen for herpetic To., though sometimes meets also at other diseases of a cornea. Availability of deep roundish infiltrate of grayish-white color in the center of a cornea is characteristic. The cornea is sharply thickened, vascularization appears rather late. The iridocyclitis with precipitated calcium superphosphates on a back surface of a cornea according to a disk of infiltrate is almost always observed. Infiltrates, as a rule, do not break up and do not leave defects in an epithelium. The current is persistent, chronic.

Deep herpetic diffusion To. always proceeds against the background of a heavy iridocyclitis therefore more often is called keratouveity. Is followed by diffusion opacification of a cornea with hypostasis of an epithelium of a stroma and endothelium and education in a stroma of inflammatory necrobiotic focuses, availability of precipitated calcium superphosphates, neogenic vessels in an iris, exudate, it is frequent development of a violent form with the advent of bubbles and erosion in an epithelium, with frequent increase in intraocular pressure in the acute period of a disease.

The greatest value for diagnosis herpetic To. the method of fluorescent antibodies (MFA) and focal test with herpetic antigen has.

Treatment is based on complex use of the funds of etiotropic action allocated for restriction of a reproduction of a virus in tissues of an eye (Kerecidum, Oxolinum, tebrophenum, Florenalum) on strengthening of immunity of cells to an infection (interferon, interferonogena), and use of various means of metabolic and symptomatic action.

At superficial To. apply one of antiviral drugs — Kerecidum in drops of 6 times a day. The deoxyribonuclease is appointed 4 — 5 times a day, oxolinic ointment of 0,25% 3 times a day, interferon in drops of 4 — 5 times a day (150 — 200 PIECES of activity), florenalevy and tebrofenovy ointments by 2 — 3 times a day in 0,25 — 0,5% of concentration.

Similar treatment is carried out also at deep forms K. Good results are received at use of various inductors of interferon. Topical administration of corticosteroids in the form of instillations of 0,5% of solution of a hydrocortisone is shown. It is possible to appoint corticosteroids only in the absence of defects of an epithelium of a cornea, at deep stromal forms with involvement in process of a vascular path. At treatment of various forms herpetic To. cryotherapy, a lazerkoagulyation and physical therapy is applied (a medicinal electrophoresis, microwave therapy, a diathermy, fonoforez). In the absence of effect — a medical keratoplasty.

The neuroparalytic keratitis

the Neuroparalytic keratitis develops owing to primary defeat of a trifacial. A characteristic symptom neuroparalytic To. falloff or total loss of sensitivity of a cornea is. The photophobia, dacryagogue and a nictitating spasm usually are absent. Severe neuralgia is often observed. In uncomplicated cases process begins with opacification of surface layers of a cornea and exfoliating of an epithelium in the center. At the same time the superficial ulcer is formed, edges long does not heal (tsvetn. fig. 14). Development of such complications as secondary glaucoma is possible, entophthalmia (see) and panophthalmia (see).

Treatment shall be directed to improvement of a trophicity of a cornea. For this purpose apply ATP on 1 ml intramusculary 25 — 30 injections, Nerobolum on 1 tablet 3 times a day within a month, vitamins of group B. Locally appoint 1% solution of quinine of a hydrochloride, 30% solution a sulfatsilnatriya, 1% Unguentum Tetracyclini.

Hypo - and avitamonous To. there are owing to a lack of an organism of vitamin A, in rare instances vitamins B more often 1 , B 2 and C. Avitaminosis And can be shown in shape xerosis (see) and keratomalacias (see).

Rozatsea-keratit

Rozatsea-keratit develops at elderly people at acne rosacea of the person. The etiology and a pathogeny are finally not found out. A part in a pathogeny of acne rosacea is played by disturbance of acid-forming function of gastric glands. In a cornea, a thicket the limb, has infiltrates of grayish-white color which are accurately delimited from normal fabric of a cornea and slightly towering over its surface. From a limb to infiltrates superficial vessels in the form of several large stipitates which break up to small loops only near infiltrates (tsvetn burgeon. fig. 15). The last can ulcerate on deep or smaller water, but perforation of a cornea happens seldom. In hard cases the ulcer can slowly progress.

Treatment is carried out by corticosteroids in the form of instillations and subconjunctival injections; appoint the A1, B2, B6 vitamins desensibilizing means, novocainic periorbital blockade.

Beam keratitis

Defeat of a cornea as a result of professional radiation by the cathode electrons: small dot infiltrates on all surface of a cornea (given to biomicroscopy).

The beam keratitis can arise at radiation of an eye in connection with tumoral diseases, during the work with sources of ionizing radiation and at pilot studies. After direct radiation of a cornea enough arises soon To. Degree of manifestation To. happens different and depends on a dose of radiation. The minimum dose of radiation causing To., makes 200 I am glad. At the same time by method of biomicroscopy of an eye initial signs of K. V the most mild cases can be revealed the photophobia, dacryagogue appear; in surface layers of a cornea there are dot sites (fig.) which are painted flyuorestseiny. In the field of a limb redistribution of a pigment can be observed. Sensitivity of a cornea decreases. Surface erosions, dot To. pass completely if at the same time infection does not join.

At application beta-ray therapies (see) single dose approximately about 1000 I am glad can cause superficial To. about a wedge, recovery by the end of the 3rd week. Transparency of a cornea, its sensitivity are recovered completely.

In an experiment at rabbits in the conditions of the fractioned influence in doses 5000 — 10000 I am glad can arise deep To. with the subsequent opacification of a cornea. These opacifications have most often rounded shape and are located subepitelialno. Epithelization proceeds very slowly. Sensitivity of a cornea long is not recovered; hypostasis on the expressiveness leads it to loss of visual functions of an eye.

At total doses in 20 000 I am glad and above in a cornea already in early terms there come the profound changes which are shown as parenchymatous or ulcer K. Chuvstvitelnost of a cornea is absent. As a rule, similar To. are followed by secondary changes in an iris of the eye. Plentiful growth of vessels in a cornea both during radiation by high doses, and in the remote terms after it can be observed. The vaskulyarizirovanny cataract of a cornea arising at the same time can ulcerate. Sometimes there is a necrosis of a cornea. In rare instances at similar severe forms beam To. there can occur death of an eye.

Treatment beam To. presents great difficulties. It shall be directed to the prevention of infection and include the drugs improving fabric exchange of a cornea (vitamins, citral, tiaminovy ointment, sea-buckthorn oil). At heavy To. the medical keratoplasty is shown.


Table. Short clinicodiagnostic characteristic of some forms of a keratitis and their treatment

Bibliography: Age features of an organ of sight are normal also at pathology at children, under the editorship of E. I. Kowalewski, page 112, M., 1975; Wolves V. V. Beta and beam damages, L., 1970, bibliogr.; Eye diseases, under the editorship of T. I. Eroshevsky and A. A. Bochkaryova, M., 1977; Fireplace of Skye H. N. K to a question of treatment of a herpetic keratitis, Oftalm, zhurn., No. 5, page 372, 1973; Katsnelson A. B. Herpetic diseases of eyes, L., 1969, bibliogr.; Krasnov M. M., Kasparov A. A. and to Bolsh A. V is new. Experience of use of the argon laser for treatment of patients with a herpetic keratitis, Vestn, oftalm., No. 2, page 34, 1976; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 2, book 1, page 211, M., 1960, bibliogr.; Pereslegin I. A. and Sargsyan Yu. X. Clinical radiology, M., 1973; Der Augenarzt, hrsg. v. To. Velhagen, Bd 3, Lpz., 197 5; System of ophthalmology, ed. by S. Duke-Elder, v. 8, pt. 2, p. 729, L., bibliogr.

A. I. Volokonenko; T. D. Kostyukova (I am glad.), author of tab. E. I. Kowalewski.

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