Angulyarny conjunctivitis – an inflammation of a conjunctiva of an eye which activator is Moraksa-Aksenfeld's diplobatsilla. The clinical picture of a disease includes an itch and burning in okologlaznichny area, reddening of eyes and a century, a sight zatumanivaniye. For confirmation of the diagnosis special diagnostic panels, the analysis with monoclonal antibodies, biomicroscopy, a vizometriya, a cytologic research are used. Therapeutic tactics comes down to purpose of sulfate of zinc, antibacterial medicines, immunostimulators and nonsteroid resolvents.
Angulyarny conjunctivitis was for the first time described in 1896 by two scientists – French and German ophthalmologists V. Moraks and K. Aksenfeld who studied morphology of a diplobatsilla and symptoms of defeat of eyeball covers by it. According to statistical data, 5-7% of total number of all bacterial conjunctivitis fall to the share of a diplobatsillyarny inflammation of a conjunctiva. About 78% of patients suffer from a chronic or recidivous form of pathology. The disease is mainly diagnosed for persons of middle and old age. Men and women suffer with an identical frequency.
Reasons of angulyarny conjunctivitis
Detailed researches in the field of ophthalmology allowed to exclude the staphylococcal and streptococcal nature of a disease. At the moment it is authentically known that the causative agent of angulyarny conjunctivitis is Moraksa-Aksenfeld's stick. Moraxella lacunata are a not fermenting aerobic gramotritsatelny diplobatsilla which lives on mucous membranes. In comparison with other representatives of a sort this microorganism has bigger aggression, strikes an external cover of an eye, is more rare – an epithelium of additional bosoms of a nose and . The bacillus is among opportunistic microorganisms, angulyarny conjunctivitis is observed at persons with the reduced immunological reactivity. The bacterium is steady against adverse conditions of the environment, there can be a long time at a temperature from-10 to 55 °C. Optimum conditions for growth arise at a temperature of 30-37 °C.
The main way of transfer of a disease – contact and household. Infection is implemented by means of use of objects of personal use. It is also possible to catch at handshake as when the sick person wipes eyes, the allocations from a conjunctival cavity containing microorganisms get on hands. In the mechanism of development of pathology the significant role is assigned to the progressing conjunctiva fabric necrosis with the subsequent transition to a cornea. Destructive type of an inflammation becomes the reason of further formation of deep ulcer defects.
Symptoms of angulyarny conjunctivitis
The cyclic current is characteristic of a diplobatsillyarny form of a disease. Duration of the incubatory period averages 4 days. Damage of eyes is always symmetric, expressiveness of clinical symptomatology amplifies by the evening. The first symptoms of a disease are strong burning and an itch in an eye-socket. In the period of a heat there are complaints to feeling of gripes in eyes, pain in periorbitalny area. The pain syndrome amplifies when blinking. Visually hyperaemia of an orbital and palpebralny conjunctiva in a zone of medial is defined, is more rare – lateral corners.
From a conjunctiva cavity in small volume foamy slime which consistence after 24-72 hours becomes viscous is emitted. Pathological allocations accumulate in corners of an eye crack. Insignificant deterioration in sight is defined. Patients note emergence of "veil" or "fog" before eyes. Over time in medial corners of eyes dense wax-like crusts are formed. Maceration of skin in a periorbitalny zone is observed. On integuments a century painful cracks are formed. A frequent recurrence is characteristic of a disease, there is a high probability of synchronization.
Spread of an infection on a cornea leads to development of a regional keratit who is followed by formation of infiltrates and deep ulcers. A frequent complication – an inflammation a century. Less often the nososlezny channel with the subsequent emergence of a dakriotsistit is involved in pathological process. Formation of cracks on skin of a palpebralny zone becomes the reason of emergence of dense cicatricial unions which limit mobility a century. At a hematogenic dissemination of pathogenic microflora the internal cover of heart is surprised. The heavy course of an endocarditis leads to the progressing valvate destruction and an embolism.
Use special commercial panels which allow to receive result of the complex analysis of the conventional tests to confirmation of a diplokokkovy etiology of angulyarny conjunctivitis (corrosion of an agar, , oxidation and fermentation, restoration of nitrates). For identification of type-specific proteins of an external membrane use monoclonal antibodies. Appoint the following tool methods of diagnostics:
- Eye biomicroscopy. At survey of a forward segment of an eyeball the injection of vessels and hypostasis stronger expressed at a medial corner comes to light. Congestions of viscous allocations in internal corners of an eye are visualized. At the accompanying defeat of a cornea single infiltrates and the centers of an ulceration are visible.
- Vizometriya. At the isolated diplokokkovy conjunctivitis visual acuity decreases slightly. At distribution of process on a cornea visual dysfunction accrues. In some cases additional performance of a computer keratometriya is required.
- Cytologic research of dab from a conjunctiva. For carrying out the analysis use scrape or dab print from a conjunctival surface. Diplobatsilla have an appearance of the short sticks located couples or small chains. Changes in cellular structure of an epitelialny layer correspond to bacterial damage.
Treatment of angulyarny conjunctivitis
Pathology will hard respond to treatment. At arrival of the patient with suspicion of angulyarny conjunctivitis before definition of an etiology of a disease empirically appoint antibiotics of a broad spectrum of activity. Need for use of etiotropny medicines on the basis of zinc within 1-2 weeks after disappearance of all symptoms of a disease is traced. Conservative therapy includes:
- Antiseptics. In complex treatment of angulyarny conjunctivitis the leading role is assigned to sulfate zinc solution. Instillations of eye drops carry out 4-6 times a day for 1-1,5 months. After elimination of symptomatology medicine is dug in by 7-10 more days. Edges carefully process a century zinc ointment.
- Antibacterial medicines. The individual scheme of treatment is selected taking into account test results of an antibiotikorezistentnost. Moraksa-Aksenfeld's bacterium is sensitive to macroleads, tetratsiklina and aminoglycosides. In the absence of effect of the appointed therapy use reserve medicines – ftorkhinolona and the combined antibacterial means.
- Nonsteroid resolvents. Apply instillations of 0,1% of solution of diclofenac of sodium to reduction of expressiveness of an inflammation. The average duration of a course – 5-7 days. At simultaneous defeat of a cornea of NPVS enter not less than 10-14 days. At the heavy course of pathology in addition appoint glucocorticosteroids.
- Immunostimulators. Immunomodulators are shown at a chronic course of disease or a frequent recurrence. Biologically active peptides, medicines of a timus are recommended. If conjunctivitis arose against the background of an immunodeficiency, include in the program of treatment interferona and interleykina.
Forecast and prevention
The pathology outcome directly depends on adequacy and timeliness of treatment. At observance of all recommendations of the doctor perhaps absolute recovery. At the same time, at most of patients a recurrence with transition to a chronic form is observed. Specific preventive measures are not developed. Nonspecific prevention is directed to observance of rules of personal hygiene. It is necessary to wash or process hands solutions of anti-septic tanks before touches to a periorbitalny zone. It is necessary to strengthen immune system, to normalize the mode of a dream and wakefulness, to pay due attention to a food allowance.