SYMPATHETIC OPHTHALMIA

From Big Medical Encyclopedia

SYMPATHETIC OPHTHALMIA (Greek sympathes sympathizer susceptible to influence; Greek ophthalmos of eyes) — an inflammatory disease of the second, till this time healthy, eyes, caused by defeat (usually wound) the first. It is shown most often in the form of a front uveitis — iridocyclitis (see).

The term «sympathetic» an inflammation (despite usually identical a wedge, and patogistol. a picture of damage of both eyes) carry only to the second, consistently involved in patol. process to an eye whereas apply the term «sympathizing» to the first (injured) eye an inflammation; for the second time involved in patol. process of eyes is called also this-patiziruyemym. With a relative frequency of the getting wounds of eyes of S. of the lake it is observed seldom. On materials patogistol. researches of the eyes removed in connection with an injury, S. of the lake meets approximately in 1 — 2% of cases.

Great practical value has a question of time of possible emergence of S. of the lake. As showed a wedge, observations, between the moment of an injury of the first eye and emergence of initial signs of an inflammation in the second eye there is always an eclipse («incubatory») period, duration to-rogo can fluctuate in very wide limits. The village of the lake develops usually not earlier than in 10 — 12 days after an injury, the maximum limit in time for S.'s development by the lake practically does not exist: S.'s cases of the lake many months later and even years after an injury of the first eye were observed. Most often S. of the lake begins in 4 — 8 weeks after injury of the first eye.

Etiology and pathogeny Villages of the lake are not finalized. Process on the second eye results from damage of the first eye — most often the getting wound, in rare instances in connection with the perforating helcoma of the first eye, the breaking-up tumor of a choroid, etc. Many researchers incline to recognition of the infectious nature of S. of the lake, it is more probable than everything virus. According to M. I. Averbakh (1949) and Dyyuk-Helder (W. S. Duke-Elder, 1954), this virus, perhaps, lives in a conjunctival sac as a saprophyte, but, getting into an eye at the time of the getting wound, is capable to cause inflammatory process. The disease of the second eye can be explained with a direct hematogenous drift in it of the virus possessing a uveotropnost. I. V. Davydovsky (1969),L. T. Arkhipova (1979), etc. consider development With, the lake is preferential from positions of immunity, treating this disease as manifestation of an autoallergy (see. Autoallergichesky diseases , Autoallergy ). Nek-ry researchers consider that a part in S.'s emergence by the lake is played by disturbances of a nervous trophicity.

In patogistol. to a picture of a sympathetic inflammation note a number of specific characters. The main morfol. changes at S. of the lake are localized in fabric of a choroid of an eyeglobe and have character of a chronic proliferative inflammation. In typical cases find intensive infiltration of all uveal path (a choroid of an eyeglobe) lymphocytes, epithelioid, and also it is frequent also colossal cells. Usually observe full identity gistol. pictures in both eyes — in sympathizing and in simpatizi-ruyemy.

The front uveitis (iridocyclitis) in most cases has plastic, fibrinous character (a plastic form) and is shown along with the general signs of irritation of an eye (a photophobia, dacryagogue, a nictitating spasm, pains), the mixed injection of an eyeglobe, a hyperemia of an iris, narrowing of a pupil, gradual development of back synechias, opacification of watery moisture of an anterior chamber and vitreous. Further perhaps plane spayaniye of an iris with a front surface of a crystalline lens, fusion and an union of a pupil (occlusio et seclusio pupillae), formation of front peripheral synechias with closing of a corner of an anterior chamber (an angle of iris, T.) and development of secondary glaucomas (see). Persistent hypotonia at the long and adverse course of a disease can lead to a subatrophy of an eyeglobe.

The serous form of a sympathetic iridocyclitis is observed a little less than plastic. At the same time the general phenomena of irritation of an eye are expressed more weakly. Process is characterized by emergence on a back surface of a cornea of small precipitated calcium superphosphates of grayish color. A pericorneal injection insignificant, commissures can be absent, exudate has serous character. Fluctuations are possible intraocular pressure (see) and development of secondary glaucoma. The serous form C. of the lake proceeds more favorably, than fibrinous. But the serous sympathetic iridocyclitis in a typiform is observed seldom, the mixed serofibrinous form meets more often, at a cut signs of both forms are combined.

For wedge, currents sympathetic uveites typically slow progressing with the periods of a zatikhaniye and aggravation of process, to-ry can drag on for months and even years; in more exceptional cases the uveitis proceeds sharply.

Also others are described possible a wedge, S.'s manifestations by the lake — focal and diffusion choroidites (see), amotio of a retina (see) and a neuroretinitis (see. Retinitis ). The focal choroiditis is observed seldom and the lake of a diffusion form of a choroiditis can be only temporary, initial expression typical for S. Amotio of a retina represents usually secondary phenomenon — result of infiltrative and exudative changes in an idiovascular cover. At a sympathetic neuroretinitis preventive enucleation of the sympathizing eye involves, as a rule, involution of a neuroretinitis whereas removal of the first eye significantly does not affect in a current of uveal forms C. of the lake.

Diagnosis The village of the lake in most cases does not represent difficulties if process develops on the second eye after damage iyervo-go eyes, especially in the presence of a picture of a slow iridocyclitis. At patogistol. a research of the first (injured) eye (in case of his blindness and removal) morfol. the picture usually confirms the diagnosis.

Local treatment The village of the lake includes use of the pharmaceuticals expanding a pupil (atropine, etc.). Along with it carry out hormonal therapy. Corticosteroids are appointed as locally (in the form of instillations or injections under a conjunctiva), and intramusculary or orally. The role of hormonal therapy at S. of the lake is especially big since at the timely beginning carrying out in sufficient doses it exerts beneficial effect on the course of inflammatory process, allowing to achieve in some cases improvement or elimination of a disease. For S.'s treatment islands use also tsi-tostatik (Azathioprinum, etc.), antibiotics of a broad spectrum of activity, and also resorptional means and other methods of symptomatic therapy.

Forecast at S. of the lake serious. Heavy outcomes of a disease are observed often. According to M. I. Averbakh and Dyyuk-Helder, the blindness at S. of the lake comes in 40 — 50% of cases, and according to V. P. Odintsov — in 75 — 80% of cases.

Due to the gravity of the forecast the lake is of great importance at S. prevention. The main preventive measure is timely (made prior to development of process in other eye) enucleation of the first (injured) eye (see. Enucleation of an eye ). Enucleation of the injured eye is made in case of total loss of sight or at preservation of the wrong projection of light. If the injured eye keeps in a varying degree visual ability, it is necessary to refrain from enucleation and to continue its treatment.

Because cases of emergence of S. of the lake and after enucleation were observed (but usually not later than in 1 — 2 month after operation), it is considered to be the second eye the lake which are completely guaranteed against a disease to S. only after this term.

See also Ophthalmia .



Bibliography: Averbakh M. I. Ophthalmologic sketches, page 469, M., 1949; Arkhipova L. T., at N d about r the island and R. A. and Zaytsev N. S. Immunodepressive therapy of posttraumatic iridocyclites and sympathetic ophthalmia, M., 1979; Eye diseases, under the editorship of T. I. Eroshevsky and A. A. Bochkaryova, page 236, M., 1977; Davydovsky I. V. General pathology, M., 1969; Odintsov V. P. To a question of the newest theories of a sympathetic inflammation of eyes, M., 1917, bibliogr.; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 7, page 57, etc., M., 1951; Der Augenarzt, hrsg. v. K. Velhagen, Bd 5, Lpz., 1978; Duke-Elder W. S. Text-book of ophthalmology, v. 6, p. 6090, L., 1954.


M. L. Krasnov.

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