Good day, dear readers! One of the most serious ophthalmological problems is considered to be damage to the tissue of the cornea, as a result of which the lens becomes cloudy, crater-shaped defects form and vision is significantly reduced.
These symptoms are characterized by an ulcer of the cornea of the eye, which causes discomfort and painful sensations. This disease requires urgent treatment - this is the only way to prevent the development of complications and preserve vision.
An ulcer or ulcerative keratitis is an inflammation of the cornea that occurs infectious nature. With this pathology, the epithelial layer of the cornea is damaged. The insidiousness and danger of this disease lies in the fact that its development can begin even after minor trauma to the organ of vision, and the consequences can be very sad, including blindness in both eyes.
One of the main factors provoking the development of corneal ulcers is a lack of vitamin A. This disease is characterized by the formation of a large number of cracks at the site of damage. After receiving microtrauma, the cornea is colonized by bacteria that “move over” from neighboring parts of the organ of vision or enter from external environment.
In most cases, ulcerative keratitis occurs in a person suffering from inflammatory eye diseases such as uveitis, etc. The disease can have both acute and chronic course.
One of the most dangerous forms pathology is a purulent corneal ulcer that occurs as a result of pneumococcal infection entering the injured area. A purulent ulcer can be recognized by the formation of a small yellow-gray infiltrate in the central part of the cornea, which is clearly visible in the photo. Within 24 hours, clouding and swelling of the cornea occurs.
Is it possible to cure a corneal ulcer with medication?
Drug treatment of corneal ulcers is carried out strictly under the supervision of a qualified ophthalmologist. For this purpose, the following medications are used:
- strengthening antibiotics;
- cycloplegic drops (provide rest to the eyes);
- painkillers.
Cycloplegic drops help dilate the pupil and relieve painful muscle spasms. Ointments and injections, which are often supplemented with physiotherapy (magnetic therapy, electrophoresis and ultraphonophoresis) to quickly achieve the desired effect, help to achieve a good result.
Thanks to properly selected drug therapy, a superficial corneal ulcer heals in literally a week, and a persistent one - within several weeks or months. In especially severe cases, surgery is required - sometimes this is the only way to preserve the organ of vision.
Treatment regimen for corneal ulcers
There is a certain treatment regimen for corneal ulcers, which is followed by most ophthalmologists. When selecting it, the patient’s medical history and the severity of the disease are taken into account.
Traditional scheme Treatment of corneal keratitis is based on the use of the following groups of drugs:
- Drops to moisturize the surface of the eyeball. This is necessary if there is a deficiency of tear fluid.
- Antibiotic eye drops (Vigamox, Signicef,). They need to be instilled up to 7-8 times a day.
- Ointments that contain a broad-spectrum antibiotic (, gentamicin, detetracycline).
- Non-steroidal anti-inflammatory drugs (Diclo-F, Indocollir).
- Reparative drugs (Oftolik). They stimulate regenerative processes in the cornea.
- Vitamins. Patients diagnosed with a corneal ulcer should eat properly and take vitamins of groups A (up to 50,000 IU), B (0.5 g) and C (10-20 mg) daily.
In addition to drug therapy, subcutaneous injections and osmotherapy are prescribed - this is a type of treatment that involves osmotic intraocular pressure. At the stage of corneal regeneration, corticosteroids are prescribed to promote scarring of the healing tissue.
Treatment can be carried out in parallel with traditional therapy traditional methods. Plantain is considered an excellent natural remedy. To cure ulcerative keratitis, try putting plantain juice in your eyes, 1-2 drops three times a day.
Surgical methods for treating ulcerative keratitis
If trophic ulcer The cornea is rapidly progressing, and keratoplasty is prescribed - an operation during which the cornea is transplanted. To be more precise, its damaged area is replaced with donor material or a special corneal graft. Surgery carried out both under general and under local anesthesia.
Duration rehabilitation period depends on the characteristics of the patient’s cornea. As a rule, the recovery process continues for 6-12 months. During this period, constant monitoring by your eye doctor is necessary.
It is very important that treatment for this pathology begins immediately after its diagnosis, when only the upper layers of the cornea are damaged. If the ulcer penetrates deeply into the tissue of the cornea, there is a high probability that a scar will remain after it heals.
But that's not the worst thing. Lack of timely treatment can lead to the development of more serious pathologies of the visual organ. We are talking about iridocyclitis, endophthalmitis and panuveitis - these diseases often cause complete blindness, so you cannot joke with them.
Video: Why does corneal keratitis occur and how to fix it?
I recommend that you watch a video about the causes and treatment of corneal keratitis. Keratitis is a fairly complex eye disease with a difficult outcome to predict; often it ends with a significant decrease in vision due to (cataract). Why this happens and how to fix it is explained in the video. Enjoy watching!
How is corneal ulcer in animals treated?
It is no secret that ulcerative keratitis often occurs not only in humans, but also in animals. Conservative treatment of eye pathology in cats and dogs is based on the use of anti-inflammatory drugs - ointments and drops. The animal needs to put drops in its eyes up to 6 times a day. The optimal dosage is prescribed by the attending veterinarian.
The following are also prescribed for the treatment of corneal ulcers in animals: medicines:
- antibacterial drops (Tsiprolet, Iris, Levomycetin);
- antiviral drops (Tobrex, Trifluridine, Idoxuridine);
- ointments (tetracycline, streptomycin);
- immunomodulators (Roncoleukin, Anandin, Fosprenil, Gamavit).
When conservative therapies do not work desired result, the veterinarian prescribes surgery to remove necrotic corneal tissue.
conclusions
Corneal ulcer is a serious ophthalmological disease requiring emergency treatment. This is the only way to slow down the progression of the inflammatory process and prevent vision loss. Take care of yourself and be healthy, friends!
I will be glad to see your comments and questions! Sincerely, Olga Morozova.
The cornea of the human eye is a complex five-layer “instrument”. It is represented by epithelium, Bowman's and Descemet's membranes, stroma and endothelium. A corneal ulcer is damage to the deep layers of tissue. A scar (cataract) forms on the affected area.
Corneal ulcer - causes
The following factors can provoke the appearance of this disease:
- mechanical injury to the eye;
- damage to the cornea by caustic chemical agent or too hot composition;
- the result of exposure to pathogenic bacteria, viruses and fungi;
- increased dryness eyeballs caused by a lack of vitamins A and B or a neurological disorder;
- uncontrolled use of anti-inflammatory and analgesic drugs produced in the form of drops.
Corneal ulcers can be caused by improper wearing and care errors. Products designed to improve vision can cause serious damage to delicate tissues. Over time, severe inflammation will begin to develop here, which will then degenerate into ulcers. Recent surgery increases the likelihood of this problem occurring.
Corneal ulcer - symptoms
This disease is characterized by certain symptoms. So, an ulcer on the eye is accompanied by the following symptoms:
- painful sensations that arise from the moment erosion appears and intensify as the disease progresses;
- blurred vision due to the fact that the tissue that surrounds the erosion site swells;
- There is photophobia and profuse
Corneal ulcers are differentiated according to the following criteria:
This disease can have the following pathogens:
- Pneumococcus;
- staphylococcus;
- streptococcus and other microorganisms.
This disease is characterized acute development. This type of corneal ulcer has a progressive infiltrate. Beyond its edge there is an intensive spread of the disease. There is another infiltrate, which is significantly less progressive. This is a regressing area. This is where the process of tissue scarring and healing occurs. In severe cases, the iris may even fall out due to a creeping corneal ulcer. However, much more often she becomes soldered with a cataract.
Purulent corneal ulcer
Such keratitis ranks second in prevalence, second only to herpetic lesions. This corneal ulcer is characterized by severity and transience. It often leads to loss of vision and death of the eye. A bacterial corneal ulcer can have a different nature of development:
- tissue injury;
- conjunctivitis;
- eyelid diseases;
- operations performed on the cornea;
- incorrectly selected lenses and so on.
Peripheral corneal ulcer
This is an inflammatory reaction that is non-infectious in nature. A peripheral ulcer is caused by bacterial toxins. More often, this disease is diagnosed in those who wear contact lenses. It may be asymptomatic, but patients complain of eye redness and pain. The infiltrate itself is small in size (diameter ranges from 2 to 10 mm). It's round.
Corneal marginal ulcer
This type of keratitis is a reaction to an inflammatory process that spreads from the edges of the eyelids or tear ducts. This type of corneal ulcer in humans has the following features:
- The formation of point infiltrates, which then merge into a single keratitis.
- If the lower eyelid does not close the eye well enough, the cornea dries out and the cells do not receive sufficient nutrition. As a result, a grayish infiltrate forms on the surface.
Perforated corneal ulcer
This form of keratitis has its own peculiarity. Such an eye ulcer in humans spreads to all layers of the cornea. It leaves behind a persistent cloudiness. If the problem is not detected in a timely manner or medical care is not provided, a rough scar forms at the site of keratitis. A patient diagnosed with this pathology faces complete blindness.
Treatment of corneal ulcers
Therapy for such a disease should be comprehensive and carried out in a hospital. The course lasts from 2 to 5 weeks. A corneal ulcer involves treatment, which should combine local, systemic and physical therapy. Thanks to teamwork and high qualifications medical personnel the patient recovers quickly. Local therapy includes the following:
- instillation of antibacterial (Chloramphenicol, Ciprofloxacin) and anti-inflammatory (Diclofenac sodium) drugs into the conjunctival area;
- administration of antibiotics (Lincomycin, Gentamicin);
- instillation of glucocorticoids (Dexamethasone);
- instillation of drugs that dilate the pupils (Atropine);
- administration of a medication that promotes the regeneration of damaged tissue (Methylethylpyridinol and Dexpanthenol).
Systemic treatment involves prescribing the following medications:
- detoxification solutions (Dextrose + Ascorbic acid);
- anti-inflammatory drugs (Nimesulide);
- intramuscular injection antibiotics (cephalosporins or aminopenicillins);
- in case of poor healing of ulcers, drugs with a regenerating effect are used;
- if the cornea becomes cloudy, glucocorticoids are used.
In the most severe cases, when drug therapy is powerless, surgical intervention is resorted to. During this procedure, the anterior eye chamber is washed. Antimicrobial drugs are used for this. Keratoplasty is also performed. During this procedure, the pathologically altered cornea is replaced.
Physiotherapeutic procedures are represented by the following manipulations:
- electrophoresis using antiviral and antibacterial drugs;
- low frequency magnetic therapy;
- ultraphonophoresis, during which enzymes (Lidase, Fibrinolysin) are used to dissolve fibrin and promote gentle tissue scarring;
- antibacterial baths.
Reparative physiotherapy is also practiced. Among its methods the following can be distinguished:
- Low-intensity work stimulation endocrine system, resulting in an increase in the level of cortisol and other hormones that reproach metabolic processes in organism.
- Exposure of the affected area to short pulses of alternating current.
Cosmetic actions for corneal ulcers
Keratoplasty is used to treat this disease. This is a cosmetic transplant of damaged tissue. This procedure is performed on blind eyes when the treatment for a creeping corneal ulcer does not give the expected result. During this operation, the cataract is excised and the area is replaced with transparent tissue. If white dots remain outside the trepanation area, they are masked with special mascara. This procedure is very similar to a tattoo.
The ulcer got its name from its tendency to spread throughout the cornea: both on the surface and deep. The development of an ulcer can be so rapid (especially when infected with Neisseria gonorrhoeae and Pseudomonas aeruginosa) that the ulcer covers the entire cornea within 2-3 days.
The causative factor is pneumococcus (Streptococcus pneumoniae), less commonly other streptococci, staphylococci, gonococci, Pseudomonas aeruginosa, Morax-Axenfeld diplobacillus (Moraxella lacunata, etc.), which penetrate into the thickness of the cornea after minor trauma.
The source of infection is most often the lacrimal ducts (chronic purulent dacryocystitis), the conjunctival sac, the edge of the eyelids, the nasal cavity, the paranasal sinuses, and instruments used to remove foreign bodies of the cornea.
Clinical picture
The disease begins acutely with decreased vision, photophobia, lacrimation, closure of the palpebral fissure, and a feeling of severe pain. The conjunctiva is sharply hyperemic and edematous. A rounded grayish-yellow infiltrate appears in the center of the cornea, which quickly ulcerates.
A purulent ulcer is formed with a undermined edge, surrounded by a strip of purulent infiltrate (progressive edge of the ulcer). The cornea around the ulcer is edematous. Pus appears in the anterior chamber, indicating that the iris and ciliary body are involved in the inflammatory process.
Adhesions are formed between the inner membranes and structures of the eye.
The progressive edge of the ulcer sometimes spreads so quickly that within a few days the ulcer can cover most of the cornea. At the same time, the opposite edge of the ulcer begins to epithelialize and the pus gradually resolves. In some cases, the ulcer spreads not only over the area of the cornea, but also in depth, which can lead to necrotization of the entire corneal tissue and infection of the inner membranes of the eye. This causes the development of endophthalmitis and panophthalmitis.
Further, if the process progresses, orbital phlegmon, thrombosis of the orbital veins and cavernous sinus may occur. If the process stops at the level of ongoing endophthalmitis, the outcome is atrophy or subatrophy of the eyeball.
A creeping ulcer is characterized by a triad of symptoms:
- specific type of ulcer- the ulcer has a progressive infiltrated edge, beyond which the inflammatory process spreads and regresses, is much less infiltrated, where the reverse process occurs - healing. Around the ulcer, the cornea is edematous, thickened, grayish, and folds of Descemet's membrane (descemetitis) are visible in its thickness.
- hypopyon
- iridocyclitis- often this is secondary fibrinous-purulent iridocyclitis with the presence of posterior synechiae of the iris.
All 4 stages of an ulcer can be present at the same time. Newly formed vessels may appear in the scarring area.
- For a creeping ulcer gonococcal etiology The pathogen very often penetrates through intact epithelium and within 3-4 days a descemetocele can form and perforation of the cornea occurs with insertion of the iris and the formation of anterior synechiae. In this case, infection may penetrate into the internal membranes with the development of endo- and panophthalmitis.
- For a creeping ulcer, caused by Pseudomonas aeruginosa, characterized by the presence of chemosis, rapid progression like a circular abscess, involving the entire cornea. It is not uncommon for the front layers of the cornea to peel off and droop. All patients have abundant liquid hypopyon of a grayish color. Within 2-3 days, infiltration of the entire cornea occurs, it thickens 3-5 times. A large, deep, crater-shaped ulcer forms in its center, then necrosis and extensive perforation quickly develop, and the eye dies.
After corneal perforation, further development can occur in two directions.
- In some cases, after perforation, the ulcer heals with the formation of a cataract adhering to the iris.
- In other cases, the infection penetrates into the eye cavity, where a severe inflammatory process develops - endophthalmitis or panophthalmitis, which leads to the death of the eye.
Treatment
Self-help involves promptly consulting a doctor about blepharitis, dacryocystitis, abnormal eyelash growth (trichiasis), washing the eyes if contaminated foreign particles get into them, and instilling a solution of sodium sulfacyl. If symptoms of keratitis appear, you should immediately consult a doctor. A doctor of any specialty must put preliminary diagnosis keratitis and urgently hospitalize in an eye hospital.
The preliminary procedure is washing the lacrimal ducts with a weak antibiotic solution for the purpose of sanitation and diagnosis of possible obstruction of the nasolacrimal canal. If chronic inflammation of the lacrimal sac is detected, urgent dacryocystorhinostomy is indicated.
If possible, before using local antibiotics and sulfonamides, a culture should be performed from the conjunctiva of the diseased eye and from the surface of the ulcer to isolate the causative agent of the disease and subsequently carry out etiotropic treatment, taking into account the greatest sensitivity of the flora to a particular chemotherapy drug.
Local treatment creeping corneal ulcer consists of instilling antibiotic solutions into the conjunctival sac: 0.25-0.5-1% solutions of neomycin, monomycin, kanamycin, chloramphenicol, benzylpenicillin, polymyxin (when sowing Pseudomonas aeruginosa) 6-8 times a day, applying an antibacterial ointment or medicinal films. Solutions of sulfonamides are instilled: 20-30% sodium sulfacyl, 10-20% sodium sulfapyridazine. Antibiotics are injected under the conjunctiva wide range actions. If necessary, antibiotics are prescribed orally and intramuscularly. Distraction agents, mustard plasters on the back of the head, hot foot baths, etc. are recommended.
In connection with secondary iridocyclitis, instillation of a 1% solution of atropine sulfate, 2 drops 3 times a day, is prescribed. Antibiotics and sulfonamides are prescribed intramuscularly or orally.
Upon receipt of the results of the bacteriological study, an appropriate correction in treatment is carried out - drugs are prescribed to which the identified microflora is sensitive.
Stimulating and restorative treatment is also recommended. If the hypopyon does not resolve for a long time and the ulcer progresses, a corneal paracentesis is performed, rinsing the anterior chamber with antibiotics and injecting them into the anterior chamber. If there is a threat of ulcer perforation, keratoplasty (tectonic, therapeutic) or biocovering is necessary.
As infiltration decreases, anti-inflammatory therapy is reduced, reparative therapy is added and intensified, physiotherapeutic treatment (magnetic therapy), laser stimulation and resorption therapy are added.
Source: https://eyesfor.me/home/eye-diseases/diseases-of-the-cornea/ulcus-serpens.html
The cornea of the eye has a five-layer structure and includes the epithelial layer, Bowman's membrane, stroma, Descemet's membrane and the lower layer of the endothelium. When the epithelium is damaged, corneal erosion occurs.
A corneal ulcer is said to occur when the destruction of corneal tissue extends deeper than Bowman's membrane.
Ulcerative lesions of the cornea are considered in clinical ophthalmology to be severe eye lesions that are difficult to treat and often lead to significant impairment of visual function, including blindness.
The outcome of a corneal ulcer in all cases is the formation of a corneal scar (cataract). An ulcerative defect can be localized in any part of the cornea, but damage to the central zone is most severe: it is more difficult to treat, and scarring in this area is always accompanied by loss of vision.
Causes of corneal ulcers
In most cases, staphylococci, diplococci, streptococci, pneumococci, Pseudomonas aeruginosa, and virus are isolated from the surface of a corneal ulcer. herpes simplex And chickenpox, mycobacterium tuberculosis, acanthamoeba, fungi, chlamydia. Non-infectious corneal ulcers can be caused by immune origin, dry eye syndrome, primary or secondary corneal dystrophy.
For the development of a corneal ulcer, a combination of a number of conditions is necessary: damage to the corneal epithelium, a decrease in local resistance, colonization of the defect by infectious agents.
Exogenous factors contributing to the development of corneal ulcers include prolonged wearing of contact lenses (incl.
use of contaminated solutions and containers for their storage); irrational topical pharmacotherapy with corticosteroids, anesthetics, antibiotics; use of contaminated eye preparations and instruments during medical ophthalmic procedures.
In terms of the subsequent occurrence of corneal ulcers, dryness of the cornea, eye burns, foreign bodies entering the eyes, photoophthalmia, mechanical damage to the eyes previously carried out are extremely dangerous. surgical interventions on the cornea, etc.
A favorable background for the development of a corneal ulcer can be various disorders of the auxiliary apparatus of the eye: conjunctivitis, trachoma, blepharitis, canaliculitis and dacryocystitis, trichiasis, eversion or entropion of the eyelids, lesions of the oculomotor and trigeminal cranial nerves. The danger of corneal ulcer exists in any form of keratitis (allergic, bacterial, viral, meibomian, neurogenic, filamentous, chlamydial, etc.), as well as non-inflammatory lesions of the cornea (bullous keratopathy).
In addition to local factors, an important role in the pathogenesis of corneal ulcers belongs to general diseases and violations: diabetes mellitus, atopic dermatitis, autoimmune diseases(Sjogren's syndrome, rheumatoid arthritis, polyarthritis nodosa, etc.), exhaustion and vitamin deficiency, immunosuppression.
According to the course and depth of damage, corneal ulcers are classified into acute and chronic, deep and superficial, non-perforated and perforated. Based on the location of the ulcerative defect, peripheral (marginal), paracentral and central corneal ulcers are distinguished.
Depending on the tendency for the ulcerative defect to spread in width or depth, a creeping and corroding corneal ulcer is distinguished.
A creeping corneal ulcer spreads towards one of its edges, while on the other edge the defect becomes epithelialized; in this case, the ulcer deepens with the involvement of the deep layers of the cornea and iris, forming a hypopyon.
A creeping ulcer usually develops against the background of infection of microtraumas of the cornea with pneumococcus, diplobacillus, and Pseudomonas aeruginosa. The etiology of corrosive corneal ulcers is unknown; it is characterized by the formation of several peripheral ulcers, which then merge into a single crescentic defect with subsequent scarring.
Symptoms of a corneal ulcer
Corneal ulcers usually have a unilateral localization. The earliest sign signaling the danger of developing a corneal ulcer is pain in the eye, which occurs even at the stage of erosion and intensifies as the ulceration progresses. At the same time, a pronounced corneal syndrome develops, accompanied by profuse lacrimation, photophobia, swelling of the eyelids and blepharospasm, mixed injection of eye vessels.
When a corneal ulcer is located in the central zone, there is a significant decrease in vision due to clouding of the cornea and subsequent scarring of the defect. A scar on the cornea, as an outcome of the ulcerative process, can be expressed in varying degrees- from a delicate scar to a rough cataract.
The clinical picture of a creeping corneal ulcer is characterized by severe cutting pain, lacrimation, suppuration from the eye, blepharospasm, chemosis, and mixed injection of the eyeball.
A yellowish-gray infiltrate is detected on the cornea, which, when disintegrating, forms a crater-shaped ulcer with regressive and progressive edges. Due to the progressive edge, the ulcer quickly “spreads” across the cornea in width and depth.
When intraocular structures are involved, iritis, iridocyclitis, panuveitis, endophthalmitis, and panophthalmitis may occur.
With a tuberculous corneal ulcer, the body always has a primary focus of tuberculosis infection (pulmonary tuberculosis, genital tuberculosis, renal tuberculosis). In this case, infiltrates with phlyctenous rims are found on the cornea, which further progress into round ulcers. The course of a tuberculous corneal ulcer is long-term, recurrent, accompanied by the formation of rough corneal scars.
Herpetic ulcers are formed at the site of tree-like infiltrates of the cornea and have an irregular, branched shape.
Corneal ulceration caused by vitamin A deficiency (keratomalacia) develops against the background of a milky-white clouding of the cornea and is not accompanied by pain. The formation of dry xerotic plaques on the conjunctiva is characteristic. With hypovitaminosis B2, epithelial dystrophy, corneal neovascularization, and ulcerative defects develop.
With timely taken therapeutic measures, it is possible to achieve regression of the corneal ulcer: cleansing its surface, organizing the edges, filling the defect with fibrinous tissue with the subsequent formation of cicatricial opacification - a cataract.
Rapid progression of a corneal ulcer can lead to deepening of the defect, the formation of a descemetocele (hernia-like protrusion of Descemet's membrane), perforation of the cornea with pinching of the iris in the resulting hole. Scarring of a perforated corneal ulcer is accompanied by the formation of anterior synechiae and goniosynechiae, which prevent the outflow of intraocular fluid. Over time, this can lead to the development of secondary glaucoma and atrophy optic nerve.
If the perforation hole in the cornea is not plugged by the iris, the purulent infection easily penetrates the vitreous body, leading to endophthalmitis or panophthalmitis. In the most unfavorable cases, the development of phlegmon of the orbit, thrombosis of the cavernous sinus, brain abscess, meningitis, and sepsis is possible.
Diagnosis of corneal ulcer
To detect a corneal ulcer, they resort to examining the eye using a slit lamp (biomicroscopy), staining the cornea with a fluorescein solution (fluorescein instillation test). A sign of the presence of a corneal ulcer is the staining of the defect. bright green. In this case, the examination allows you to identify even minor corneal ulcers and assess the number, extent and depth of corneal damage.
The reaction of the deep structures of the eye and their involvement in the inflammatory process is assessed using diaphanoscopy, gonioscopy, IOP measurement, ophthalmoscopy, and ultrasound of the eye. If necessary, the function of tear production and drainage is examined (colored nasolacrimal test, Norn test, Schirmer test).
To identify the etiological factors that caused a corneal ulcer, cytological and bacteriological examination smear from the conjunctiva, determination of immunoglobulins in blood serum and tear fluid, microscopy of scrapings from the surface and edges of a corneal ulcer.
Treatment of corneal ulcers
For corneal ulcers, it is necessary to provide specialized inpatient care under the supervision of an ophthalmologist.
In order to prevent the deepening and expansion of the corneal ulcer, the defect is shaded alcohol solution brilliant green or iodine tincture, diathermo- or laser coagulation of the ulcer surface.
In case of a corneal ulcer caused by dacryocystitis, it is necessary to urgently rinse the nasolacrimal canal or perform an emergency dacryocystorhinostomy to eliminate the purulent focus in close proximity to the cornea.
Pathogenetic therapy for corneal ulcers includes the prescription of mydriatics, metabolic, anti-inflammatory, antiallergic, immunomodulatory, and antihypertensive drugs.
Medications administered locally - in the form of instillations, ointment applications, subconjunctival, parabulbar injections, as well as systemically - intramuscularly and intravenously.
As the corneal ulcer clears, absorbable physiotherapy is prescribed to stimulate reparative processes and prevent the formation of a rough scar: magnetic therapy, electrophoresis, ultraphonophoresis.
If there is a threat of perforation of a corneal ulcer, penetrating or layered keratoplasty is indicated. Once the ulcer has healed, excimer laser removal of superficial corneal scars may be required.
Since a corneal ulcer always results in a persistent clouding (cataract), the outlook for visual function is unfavorable. In the absence of complications, after the inflammation subsides, optical keratoplasty may be required to restore vision. With panophthalmitis and phlegmon of the orbit, there is a high risk of loss of the organ of vision. Fungal, herpetic and other corneal ulcers are difficult to cure and have a recurrent course.
In order to prevent corneal ulcers, it is necessary to avoid microtraumas of the eye, follow the necessary rules when using and storing contact lenses, and carry out preventive antibacterial therapy if there is a threat of corneal infection, treat general and eye diseases in the early stages.
Source: http://www.krasotaimedicina.ru/diseases/ophthalmology/corneal-ulcer
More often it occurs after trauma or microtrauma of the cornea.
Symptoms of a corneal ulcer
The so-called creeping corneal ulcer is characterized by severe cutting pain, lacrimation and suppuration, photophobia, blepharospasm, severe mixed injection and chemosis. The infiltrate in the cornea is grayish-yellowish in color.
Sometimes the corneal infiltrate, located in the superficial layers, has a yellowish-green color and central (most often) localization, and when examined in the light of a slit lamp or a combined method with a binocular loupe, two edges are revealed: one, undermined and infiltrated with purulent elements (progressive), and the opposite is clear, with a more subtle haze (regressive).
In such cases, there is reason to think about purulent keratitis, or a creeping corneal ulcer (ulcus comeae serpens). Its etiology is confirmed by bacteriological examination of material taken from the edges and bottom of the ulcer. The progressive edge grows rapidly, and within a few days the ulcer covers most of the cornea; deep or superficial vessels not suitable for ulcers.
As a rule, with purulent keratitis, the choroid (iris and ciliary body), often with symptoms of severe exudation, which is manifested by the formation of hypopyon (pus in the anterior chamber) and posterior synechiae (adhesions of the iris to the lens). Pain in the eye increases, the color of the iris becomes yellowish-green, it swells, the pupil narrows and takes on an irregular shape due to the appearance of powerful posterior adhesions (synechias) of the iris.
Somewhat later, as a result of the coagulation of fibrin (which is contained in the hypopyon), the exudate turns into a film fused to the cornea. Sometimes lysis (dissolution) of the cornea and its perforation may occur. If an infection enters the eye through a perforation, acute inflammation occurs internal structures eyes - endophthalmitis. In children, corneal ulcer - a rare event. It occurs predominantly in agricultural workers.
The occurrence of an ulcer is almost always associated with a violation of the integrity of the corneal epithelium during the harvesting and threshing of spike structures, when working in sawmills, repair shops, etc. Plasma-coagulating strains of bacteria located in the conjunctival cavity (most often pneumococci, staphylo- and streptococci, diplococci, Pseudomonas aeruginosa etc.) penetrate into the damaged cornea, exerting a powerful proteolytic effect, resulting in the development of a violent and lightning-fast inflammatory-necrotic process.
Treatment of corneal ulcers
First medical assistance consists of prescribing antibiotics orally (tetracycline, oletethrin, erythromycin) and intramuscularly (benzylpenicillin sodium salt 3-4 times a day, streptomycin sulfate 2 times a day, etc.) in doses appropriate to age. Analgesics and hyposensitizing agents are also prescribed internally.
Locally, after washing the eye with disinfectant solutions and instilling anesthetics, antibiotics (neomycin, gentamicin, monomycin, kanamycin, chloramphenicol, benzylpenicillin sodium salt) are used in the form of instillations of 0.25-0.5-1.0% solutions hourly before bedtime, as well as 0.5% ointments at night. Treatment is carried out in a hospital; in case of severe ulcers, it is supplemented by the administration of antibiotics under the conjunctiva.
Treatment with antibiotics is combined with the administration of sulfonamide drugs orally.
In addition, they instill drops into the sore eye vitamin drops, 1% solution of atropine sulfate or 1% solution of pilocarpine hydrochloride (depending on the depth and location of the ulcer in relation to the limbus and the condition intraocular pressure).
During the period of subsidence of the process, resorption therapy is carried out using ethylmorphine hydrochloride, lidase and other drugs in the form of drops and electrophoresis. However, opacities always remain, which reduce vision, therefore, as a rule, keratoplasty is indicated. It must be kept in mind that pathogenic flora, which causes corneal ulcers, develops in a certain environment and is not sensitive to all antibiotics and sulfonamide drugs.
For example, antibiotics and sulfonamides are not effective for diplobacillary ulcers. Prescribing them without laboratory data will only delay the timely use of the required drugs (zinc sulfate), and therefore create conditions for aggravating the process. The development of pneumococcus is favored by an alkaline environment, so eye rinsing with a 2% solution of boric acid is recommended.
Retinal rupture and detachment occur in children on average in 2%, and in adults in 10% of cases of all blunt injuries to the organ of vision. They can appear immediately after the injury or at a later date.
Retinal contusions are a constant companion to blunt eye injuries; they occur with penetrating and non-penetrating eye injuries. Their most minor manifestations are accessible to ophthalmological examination.
Retinal degeneration is a common pathology in older people, but retinal degeneration (retinodystrophy, dystrophy) in children is a relatively rare phenomenon. They are congenital or hereditary.
Source: http://medic-enc.ru/glaznye-bolezni/rogovicy-jazva-polzuchaja.html
Corneal ulcer - causes, symptoms and treatment (photo)
A purulent corneal ulcer is an eye disease that is caused by extensive destruction of the corneal tissue of the eye with the release of pus. It is a crater-shaped ulcerative defect, accompanied by decreased vision and clouding of the membrane. In ophthalmology, a corneal ulcer is a severe eye lesion that is difficult to treat. At the same time, it is significantly disrupted visual function.
Causes
A corneal ulcer in humans can be caused by various factors:
- eye burns, which include damage caused by exposure to caustic chemical substances, high temperatures;
- mechanical injury to the eyes (for example, foreign body penetration);
- viruses, pathogenic bacteria, fungal infections, herpes virus - all this can cause inflammation of the layers of the cornea of the eyes; Initially, keratitis often develops, leading to serious tissue destruction;
- dry eye syndrome, when tear production is impaired;
- neurological disorders;
- inability to close eyelids;
- vitamin deficiency (especially vitamins A and B);
- uncontrolled use of eye drops (anti-inflammatory and painkillers), leading to disruption of metabolic processes in the cornea and its destruction;
- improper processing and violation of the use of contact lenses, which can cause mechanical damage to the corneal tissue and provoke a severe inflammatory process;
- A favorable background for the formation of corneal ulcer is the presence of disorders of the auxiliary functioning of the organ of vision (trachoma, conjunctivitis, blepharitis, trichiasis, dacryocystitis, entropion of the eyelids, damage to the trigeminal and oculomotor cranial nerves).
In the development of corneal ulcers important role are assigned to general disorders and diseases of the body: atopic dermatitis, diabetes mellitus, autoimmune diseases (rheumatoid arthritis, Sjogren's syndrome), vitamin deficiency and exhaustion.
Symptoms
Immediately after the appearance of corneal erosion, the patient experiences pain in the eye. This is due to the fact that irritation of the nerve fibers of the cornea occurs. The pain is accompanied by profuse lacrimation. At the same time, patients note:
- photophobia;
- redness of the eye, which is manifested by the reaction of local vessels to irritation of nerve endings;
- When the cornea is located in the central zone, there may be a significant decrease in vision due to tissue swelling and clouding.
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With an ulcer, the corneal stroma is often deformed and when it is restored, a scar is formed, which can be invisible or very pronounced (until the formation of a cataract).
Often with extensive and deep ulcers and simultaneous manifestation infectious process intraocular structures are affected - the ciliary body and the iris. Ulcerative keratitis develops, which leads to loss of vision.
Classification
According to the depth and course of corneal ulcers, they are divided into:
- chronic;
- spicy;
- superficial;
- deep;
- perforated;
- unperforated.
According to the position of ulcerative defects there are:
- peripheral (marginal);
- paracentral;
- central ulcers.
According to the area of distribution of the defect in depth or width, ulcers are distinguished:
- creeping, which spreads towards one edge, and on the other edge the defect epithelializes; such an ulcer develops against the background of infected microtraumas of the organ with diplobacillus, pneumococcus, Pseudomonas aeruginosa;
- corrosive, the etiology of which has not been established; This type of corneal ulcer is characterized by the formation of several peripheral ulcers, which subsequently merge into one crescentic defect, which then scars;
- purulent, arising due to the development of pneumococcal infection, which penetrates the site of corneal erosion; the main symptom is the appearance of a white infiltrate in the central part, which then turns into an ulcer with yellowish pus discharged;
- herpetic - this type of ulcer is characterized by a long and sluggish course; the ulcerative lesion is clean, completely devoid of any discharge component; pain may not bother you.
Among the dangerous ophthalmological diseases that lead to significant impairment of the quality of vision is a corneal ulcer. Often this disease arises from a safer one - erosion and in case of untimely treatment medical care or when poor quality treatment develops into a more complex pathology.
Treatment of this disease always depends on the cause of its occurrence and takes place in a hospital.
The cornea of the eye is designed to protect the internal structures of the eye from infection and mechanical damage; this thin transparent structure consists of five layers:
- The anterior epithelium, a multicellular layer on the surface of the eye, is formed from several layers of cells;
- Bowman's membrane is a thin network of cells that separates the epithelium and the stromal substance and supports it;
- The cornea itself is the stroma. This is the most voluminous layer, its cells are arranged in a strict order, they allow a ray of light to pass unhindered;
- Descemental membrane, a very thin and dense membrane that holds the cornea and serves as a support for other layers;
- Endothelium, a thin layer of cells (there is only one) that separates the cornea from the internal structures of the eye.
If the integrity of the upper epithelium is damaged, corneal erosion is diagnosed, but if the destruction penetrates through Bowman's membrane into the stroma, a corneal ulcer develops.
A corneal ulcer is always treated in a hospital. If the size is small, a scar appears after healing. The presence of a small scar significantly impairs the quality of vision, since the transparency of the cornea is impaired, and consequently, the movement of the beam onto the retina is slowed down or distorted.
The formation of a large scar can cause blindness. More dangerous will be those ulcers that are located in the center of the eye and deeply penetrating.
Causes and symptoms of eye ulcers
Among the factors causing corneal ulcers, erosion that is not treated in time is often cited.
Ulcers are characterized by most of the causes that provoke erosion:
- eye injuries;
- burns;
- ophthalmological diseases causing dry eyes;
- influence of pathogens;
- dry eye syndrome.
Among the most common are misuse contact lenses, injury to the eye from foreign objects and excessive dryness of the eyes.
A corneal ulcer in humans causes several characteristic symptoms.
- A feeling of sand, pain, severe pain in the eye, which appears with corneal erosion and only increases over time.
- Gradually, light intolerance joins the pain, which is associated with the exposure of nerve endings.
- Redness of the cornea, its swelling, and, over time, its cloudiness.
- Decreased visual acuity due to corneal clouding, swelling and redness.
All symptoms are pronounced, and as the ulcerative processes spread, they only increase.
Types and forms of corneal ulcers
Ulcers are divided according to many parameters: acute and chronic - according to their course, non-perforated and perforated - according to quality, deep and superficial. Based on their location on the cornea, they are divided into peripheral (located closer to the eyelids), paracentral (closer to the center) and central.
The nature of the disease is recognized as follows.
- Creeping lesions that spread along the stroma in one direction, while scarring of the edge occurs on the other side. Infected ulcers often creep.
- Corrosives appear as several separate lesions, which then merge together in the shape of a crescent. The cause of their occurrence has not yet been established.
Most often, ophthalmologists use two terms. Infectious, caused by pathogens and non-infectious - they are provoked by excessive dryness of the eyes.
The most dangerous pathologies there will be central creeping and perforated ones. They lead to permanent vision loss.
Any type of ulcer after healing forms a scar, which impairs the quality of vision.
Treatment of corneal ulcers
The diagnosis is made in the ophthalmologist's office after examination using a special device - a slit lamp. If there are small ulcers that are difficult to see, a special dye, fluoriscein, can be used.
After making a diagnosis, the doctor may prescribe additional tests (cytology, culture of a smear from the conjunctiva) to clarify the nature of the infection that provoked the infectious form of the ulcer.
To assess deep-seated lesions, a number of diagnostics are used:
- diaphanoscopy,
- Ultrasound of the eye,
- gonoscopy,
- ophthalmoscopy.
If lacrimation disorders are suspected, use special tests: Schirmer test, color nasolacrimal test, Norn test.
Tests of blood serum and tear fluid for immunoglobulins may be prescribed.
Treatment of corneal ulcers is always carried out in an ophthalmology hospital and requires certain skills in carrying out specific procedures.
For an infectious ulcer
At the beginning of treatment, the defect is extinguished using iodine or brilliant green. The procedure is complex and requires special skills of an ophthalmologist. Its modern analogues are laser and diathermocoagulation.
For non-infectious ulcers
If the appearance of an ulcer is caused by a violation of the outflow of tears and the formation of pus in the lacrimal canal, then the nasolacrimal canal is washed, and the purulent focus is surgically removed.
General treatment
Must be carried out complex treatment, which includes the assignment:
- antiallergic drugs (to relieve inflammation and swelling);
- keratoprotectors (to moisturize affected structures);
- metabolites (to improve nutrition of affected structures);
- immunostimulants (to improve recovery processes);
- antihypertensive drugs (to reduce swelling and redness).
Treatment of corneal ulcers in humans involves systemic administration of drugs intravenously and intramuscularly.
The whole range of measures is applied locally: instillation of drops, application of ointments, parabulbar and subconjunctival injections.
After the exacerbation is relieved, at the scarring stage, physiotherapeutic therapy is indicated: ultraphonophoresis, electrophoresis. These procedures stimulate well the reparative (restorative processes) in the cornea and prevent the formation of a rough scar.
To improve nutrition (trophism) of the affected area, Taufon, Korneragel, etc. are prescribed.
If there is a danger of perforation of the cornea, purulent forms For corneal ulcers, keratoplasty (corneal transplant) is used.
Keratoplasty can be penetrating or layer-by-layer, but in any case it is a complex operation. During this procedure, the affected area is excised, and a healthy cornea from a donor is transplanted in its place.
To remove rough scars, excimer laser scar removal is used, which is an expensive operation.
Possible complications after an ulcer
A healed corneal ulcer forms a scar, which in any case affects the quality of vision. With extensive ulcers, a cataract (clouding of the cornea) is formed, which leads to complete or partial blindness.
Other complications include the proliferation of corneal vessels and the occurrence of corneal vascularization, which also forms a cataract.
When a corneal ulcer reaches deep structures, it forms a descemetotele, a protrusion of the descemental membrane.
When it is perforated and a perforated corneal ulcer is formed, the iris is pinched into its opening, which provokes the formation of anterior and posterior synechea. Over time, this leads to optic nerve atrophy and secondary glaucoma.
When infection penetrates into the deep structures of the eye (vitreous body), endophthalmitis and panophthalmitis occur, which lead to complete loss of vision and the eyeball.
Prevention of disease
Treatment of a corneal ulcer is very long and takes from 1.5 to 5 months. In most cases, it is not possible to completely restore vision, and if complications arise, it is completely impossible.
In the prevention of corneal ulcers, safety measures come to the fore when carrying out various work that is potentially hazardous to health, as well as timely treatment ophthalmological diseases. Often, the appearance of ulcerative processes can be prevented if corneal erosion is treated in time.
The causative agent of creeping corneal ulcers is considered to be pneumococcal infection. Much less commonly - diplobacillus Morax-Axenfeld, streptococcus, staphylococcus.
A creeping ulcer occurs only after microtraumas of the cornea, which are sometimes so insignificant that patients, and often medical workers, do not attach much importance to them. Damage to the corneal epithelium is caused by small foreign bodies (at work and at home), scratches from tree branches, dry leaves, straw, hay, etc.
For a creeping ulcer to occur, in addition to superficial trauma, infections must also penetrate into the corneal wound. The causative agent of infections rarely penetrates the wound with the damaging agent itself. foreign body. In most cases (50%) the source of infection is the conjunctiva and tear ducts, especially in the presence of purulent inflammation of the lacrimal sac (dacryocystitis).
The disease begins acutely with the appearance of a characteristic corneal syndrome. A grayish-yellow infiltrate appears on the cornea, most often in the center, which soon disintegrates and turns into a crescent-shaped or disc-shaped ulcer with a purulent-infiltrated bottom and characteristic appearance edges: one edge of the ulcer (regressive edge) is cleared, becomes smooth and covered with epithelium, and the opposite edge (progressive) is sharply infiltrated, raised by a roller, hangs over the ulcer and is undermined in the form of a pocket. The cornea around this edge is infiltrated and diffusely cloudy. The progressive edge quickly spreads, creeps along the surface of the cornea and within 3-5 days the entire cornea becomes infiltrated and molten.
Often, the ulcer spreads not only over the surface, but also deeper, reaching the posterior limiting membrane (Descemet's membrane). This membrane is resistant to the lytic action of infection and does not melt. But under the influence of pressure inside the eye, it stretches and a black bubble (descemetocelle) appears in the area of the destroyed stroma. There is a threat of perforation, which can occur with the slightest pressure on the eyeball, straining, sneezing, blowing the nose, etc.
Vascularization of the cornea with a creeping ulcer is absent or very weakly expressed. Usually, already in the first days of the disease, the iris and ciliary body are involved in the process as a result of the action of toxins penetrating deep into the eye through the cornea. Pain in the eye sharply increases, the color of the iris changes, the pupil narrows and its reactions disappear, and when the pupil dilates with mydriatics, its irregular shape (scalloped) is revealed due to the formation of posterior synechiae.
As a consequence of the development of purulent inflammation of the ciliary body (purulent cyclitis), purulent exudate appears at the bottom of the anterior chamber (hypopyon), consisting of fibrin and leukocytes. But it remains sterile until the ulcer perforates. Initially, the hypopyon looks like a yellow stripe (in the form of a horizontal level) at the bottom of the chamber. Being liquid, the pus moves when the position of the patient's head changes. Subsequently, sometimes very quickly, the amount of exudate increases; due to the coagulation of fibrin, the pus becomes viscous and turns into a film fused to the posterior surface of the cornea.
Sometimes perforation of the ulcer quickly occurs due to the lytic effect of the hypopyon on the epithelium and Descemet's membrane. After perforation of the ulcer, it usually clears and recovers, but with the formation of a corneal cataract (leukoma) fused to the iris or flattening of the cornea, or the formation of staphyloma. Secondary glaucoma often develops, which leads to excruciating pain, as a result of which it is necessary to resort to surgical treatment it, and if ineffective - to enucleation (removal of the eyeball).
In some cases, after the ulcer perforates, the infection penetrates into the eye and causes endophthalmitis (purulent inflammation vitreous), panophthalmitis - purulent inflammation of all membranes of the eye. In this case, there is a need for eviceration (removal of all contents) of the eyeball. Or the process ends with eye atrophy.
Treatment of patients with a creeping corneal ulcer should be carried out in a hospital. Before
treatment, it is necessary to conduct a bacteriological study of scrapings from a corneal ulcer and determine sensitivity to antibiotics. However, without waiting for the result of the study, broad-spectrum antibiotics are prescribed, according to the principles of treatment of keratitis: penicillin, streptomycin, gentamicin, cyclosporins or others, affecting staphylococci, Pseudomonas aeruginosa and other pyogenic flora (neomycin 0.1 per 1 kg of weight 6 times a day, polymyxin 250,000 units 4 times a day, monomycin 250,000 units 4-6 times a day, morphocycline, etc.). At the same time, tetracycline drugs and chloramphenicol are also prescribed orally. Locally:-6 times a day instillation of a 30% solution of albucid, a solution of penicillin (10,000 units per 1 ml), application of 1-2.5% synthomycin emulsion, 30% albucid ointment. You can use nitrofuran preparations: a solution of furazolin 1:3000, which often has even stronger therapeutic effect than albucid - 6 times a day, at the same time furazolidone 0.1 is also prescribed orally 4 times a day. It is recommended to prescribe antifungal drugs locally: a solution of nystatin 100,000 units in 1 ml, amphotericin 3-5 mg in 1 ml dist. water, etc.
Currently, physical methods of treating ulcers are also used.
cornea (diathermocoagulation of the ulcer, scarification of its bottom followed by cauterization of 5% alcohol tincture of iodine, cryotherapy and cryocoagulation of the ulcer, laser coagulation).
Now there are possibilities for conservative cleansing of ulcers using
enzymes. Ribonuclease obtained from the pancreas of cattle has a particularly good effect. This enzyme is capable of breaking down polypeptides of necrotic tissues, sputum, fibrinous deposits, mucus and, thereby, liquefying them, which helps cleanse the ulcer. In addition, RNase also has an anti-inflammatory effect. RNase powder is applied to the ulcer once a day. Other types of treatment are used at the same time.
Another proteolytic enzyme is also used - collagenase (1
An ampoule of the dry preparation is dissolved in 3-5 ml of saline. solution). Collagenase not only helps cleanse corneal ulcers and reduce the inflammatory reaction, but also prevents the formation of intense corneal cataracts, as it delays collagen formation in the area of inflammation. Collagenase has a highly specific ability to digest collagen. The treatment method consists of instilling solutions of various concentrations (1 ampoule of dry preparation per 3-5 ml of physic solution, 4-5 times a day). After 1-3 days there is a noticeable cleansing of the ulcer and a decrease in inflammation.
Antibiotics and enzymes can be administered using electrophoresis. Good
the effect is provided by lidase in the form of an ointment (32 units of lidase per 20.0 tetracycline or other ophthalmic ointment).
For concomitant iridocyclitis, mydriatics are prescribed; for dacryocystitis, surgical treatment is prescribed.
Application of a bandage is contraindicated. Instead, a curtain or mesh is recommended.
If the hypopyon occupies a significant part of the anterior chamber and does not resolve under the influence of treatment, then they resort to opening the anterior chamber and washing it with physical fluid. solution with penicillin.
In some cases, when conservative treatment is ineffective and the ulcer quickly
progresses both on the surface and in depth, they resort to therapeutic layered keratoplasty.
Prevention. The most important measure to prevent creeping corneal ulcers
is: 1) prevention of eye injuries in production and agriculture; 2) urgent medical care for the slightest damage to the cornea (albucid, antibiotic ointments); 3) timely treatment of conjunctivitis and dacryocystitis.
If improvement from outpatient treatment does not occur within 1-2 days, it is necessary to
refer for inpatient treatment.
