OPHTHALMOMYCOSES (ophthalmomycosis; grech, ophthalmos of eyes + mycoses) — the inflammatory diseases of an organ of sight caused by parasitic fungi, pathogenic for the person. The first description of O. belongs to Leber (Th. Leber, 1879).
Infection occurs at pollution of eyes, microtraumas, wounds, operations. Spread of an infection from the next fabrics is possible, and at system mycosis — from the remote sites of mycotic defeat. More often workers of agriculture since many pathogenic fungi are saprophytes of plants (see get sick. Fungi parasitic ). O.'s emergence is promoted by weakening of protective forces of an organism at various diseases (a diabetes mellitus, leukemia, cirrhosis, etc.), disturbance of normal balance of a fungal and bacterial flora at irrational use of antibiotics and corticosteroid therapy, and also unlimited purpose of vitamins of group B.
At O. develops hron, the inflammation, is frequent with education in the struck fabrics of the granulomas inclined to disintegration and an ulceration. Histologically they are similar to granulomas at foreign bodys, tubercular and syphilitic granulomas.
Clinical picture it is characterized by slow development of process, unsharp external signs of an inflammation, the persistent course, resistance to any kinds of antibacterial and antiinflammatory therapy. Lakes can strike all anatomic formations of an organ of sight. Among clinical forms the following has the greatest value.
The fungal canaliculitis is followed by persistent conjunctivitis with a preferential hyperemia and hypostasis of the lacrimal meat and a semi-lunar fold of a conjunctiva. Only one is surprised always, the lower tubule is more often, in Krom the dense kroshkovidny masses consisting of a mycelium of a fungus is found.
Mycoses are characterized a century by formation of the ulcerating or abscessing granuloma, fistulas; rough cicatricial deformation is possible a century.
Fungal conjunctivitis also blefarokonjyunktivit — more often bilateral. Depending on a type of a fungus can proceed in various forms, napr, at a tsefalosporioza — in erosive, at candidiasis at the weakened children — in pseudomembranous, at a rhinisporidiosis — in psev-doopukholevy etc. Quite often are followed by an adenopathy.
A keratomycosis (see. Keratitis ) proceeds most often in the form of the fungal helcoma having a clear boundary, a regional shaft of yellowish color and a gray bottom. The ulcer can be executed by the dry kroshkovaty mycelium which is easily removed a needle. Quite often the ulcer reminds creeping, is followed by education hypopyon (see) also tends to distribution as on the area, and deep into. Process can lead to perforation of a cornea, to an entophthalmia (see) and need enucleation of an eye (see).
The fungal entophthalmia develops after perforated wounds of an eye (including operating rooms) and is very rare — at hematogenous infection. Unlike bacterial it begins in late terms (in 2 — 4 weeks after implementation of a fungus). Can be the first symptoms «causeless» hemophthalmia (see), decrease in sight, opacification of moisture of an anterior chamber of an eye at smoothly healing wound of an eyeglobe. Further there is a hypopyon, the accruing focal opacification and abscess of a vitreous.
Mycoses of an eye-socket develop after its wounds or complicate the course of system mycosis. At the same time the picture of inertly proceeding phlegmon is observed eye-sockets (see) or subperiosteal abscess with the corresponding symptoms (an exophthalmos, formation of fistulas, etc.).
The diagnosis and Treatment
the Diagnosis is established on the basis of laboratory methods of a research and identification of the fungal activator. Material for microscopic examination and cultivation on mediums is taken by scrapings, by aspirations (from an eyeglobe) or excisions patholologically of the changed sites.
Treatment conservative or combines use of conservative and operational methods. At conservative treatment use drugs of a wide range of anti-fungal action (potassium iodide inside in the maximum dosages, locally drops of 3% of solution of potassium iodide; Iodinolum in drops; Amphotericinum In intravenously and in a circle patol, the center; Mycoheptinum, etc.). At defeats barmy fungi locally appoint nystatin, levorinum; at defeats by dermatophytes — griseofulvin, Amicazolum, etc. Conservative treatment shall be long (not less than 1 month).
Operational methods: a scraping of a helcoma, at threat of perforation — through keratoplasty (see), at an entophthalmia — a vitreoektomiya (see. Vitreous ), at defeats a century — excision, processing by spirit solution of iodine and drainage, at canaliculites — a section of the lacrimal tubule, removal of contents and careful processing of a cavity spirit solution of iodine.
The forecast and Prevention
the Forecast at fungal infections of a cornea is always serious concerning safety of sight, at entophthalmias — bad as concerning visual functions, and safety of an eyeglobe.
At other types of O. the forecast is more favorable.
Prevention: respect for personal hygiene, prevention of microtraumas and wounds of eyes; a research of flora of the material taken at roughing-out of wounds and preventive anti-fungal therapy in case of detection of fungi; a careful sterilization of instruments and talc for gloves in surgery blocks.
See also Mycoses .
Bibliography: Eye diseases, under the editorship of T. I. Erosheveky and A. A. Bochkaryova, page 127, M., 1977; Karimov M. K. Histopathology of keratomycoses, Oftalm, zhurn., No. 2, page 99, 1979; it, Ophthalmomycoses as complication of hormonal therapy, Vestn, oftalm., No. 1, page 67, 1980; Merkulov I. I. Clinical ophthalmology, book 1, page 53, Kharkiv, 1966; Der Augenarzt, hrsg. y. K. Velhagen, Bd 3, S. 238, 897, Bd 4, S. 93, Lpz., 1975 — 1976; Jones D. B. Therapy of postsurgical fungal endophthalmitis, Ophthalmology (Rochester), y. 85, p. 357, 1978, bibliogr.; Savir H., Henig E. Lehrer N. Exogenous mycotic infections of the eye and adnexa, Ophthal. Chron., v. 10, p. 1013, 1978; Theodore F. H. Etiology and diagnosis of fungal postoperative endophthalmitis, Ophthalmology (Rochester), v. 85, p. 327, 1978, bibliogr.; Wood T. O. a. Williford W. Treatment of keratomvcosis with amphotericin B of 0,15%, Amer. J. Ophthal., v. 81, p. 847, 1976.
V. G. Shilyaev.