Bacterial keratit – an acute inflammation of a cornea of an eye of bacterial genesis. It is clinically shown by the acute pain in an eye, hypostasis, a kornealny syndrome expressed by an inflammatory injection of an eyeball, existence of mucopurulent allocations, turbidity of a cornea, superficial or deep ulcerations. Diagnostics of a bacterial keratit includes eye biometrics, a microbiological research of dab from a cornea, confocal and endotelialny microscopy, a pakhimetriya, a keratometriya, a keratotopografiya, definition of sensitivity of a cornea. In treatment of a bacterial keratit the local and system antibiotic treatment added with application of keratoprotektor, epiteliziruyushchy means, midriatik at complications is prime - surgical intervention.
Bacterial keratit is the most widespread disease of a cornea of an eye. Distinguish primary and secondary, endogenous and exogenous, superficial and deep bacterial keratita. At microbic damage of a cornea, besides hypostasis and purulent infiltration, in it the strengthened vaskulyarization, formation of stromalny abscess, an erozirovaniye and an ulceration with a possible necrosis of fabric is noted.
Reasons of a bacterial keratit
Conditions for development of a bacterial keratit are existence of pathogenic microflora on surfaces of a cornea and violation of integrity of its epitelialny layer. More than 80% of cases bacterial keratita are caused by golden staphylococcus, a streptococcus, a pneumococcus, a sinegnoyny stick. More rare activators of a keratit are colibacillus, proteas, gramotritsatelny diplococcuses (causative agents of gonorrhea, meningitis).
Distinguish its traumatic damages from exogenous risk factors of a bacterial keratit (including at burns, hit of foreign matters, surgeries), irrational use of medicines in treatment of herpetic keratit and dystrophies of a cornea, carrying contact lenses and their wrong storage.
Development of a bacterial keratit can be promoted by endogenous factors which treat presence at the patient of eye pathology (a lagoftalm, a syndrome of a dry eye, a trikhiaz, dystrophy of a cornea, a neurotrophic keratopatiya, a blefarit, a konjyuktivit, barley), the centers of a chronic infection (sinusitis, carious teeth), a condition of an immunodeficiency and diabetes.
Symptoms of a bacterial keratit
Beginning of a bacterial keratit sharp: the disease demonstrates from sharp eye pain, the expressed kornealny syndrome (dacryagogue, photophobia, a blefarospazm). The perikornealny or mixed inflammatory injection of an eyeball caused by expansion of superficial and deep vessels is noted; development various in a form, size and depth of an arrangement of infiltrates of a yellowish or rusty shade. Mucopurulent allocations from eyes are observed, transparency and gloss of a cornea is broken - it gets an opaque shade, its surface izjyazvlyatsya, sight worsens. Bacterial keratit has tendency to bystry progressing.
Bacterial keratit, the caused sinegnoyny stick, proceeds especially hard, the inflammation usually extends to internal covers and causes development of a serious urgentny condition.
At gonoblennory keratit it is shown by a gnoyetecheniye, turbidity of an epithelium, formation of the purulent ulcer of whitish color extending on a surface and in cornea depth.
In case of a diphtheritic keratit on a cornea the superficial and deep ulcers of lurid color covered with a film at which removal the bleeding surface is visible are found.
Diagnostics of a bacterial keratit
Diagnostics of a bacterial keratit does not cause difficulties. It begins with consultation of the ophthalmologist including studying of data of the anamnesis and complaints of the patient, survey of structures of an eye for identification of a typical clinical picture, purpose of necessary diagnostic testings.
Carrying out biometrics of an eye at a bacterial keratit allows to find pathological inflammatory changes of various layers of a cornea: epithelium ulcerations, infiltrates, a purulent stromalny inflammation, hypostasis of fabrics, strengthening of reaction of the forward camera of an eye (with a hypopeony or without it), mucopurulent exudate, etc.
For a cornea research also carry out confocal and endotelialny microscopy of a cornea, a pakhimetriya (measurement of thickness of a cornea), a keratometriya (determination of parameters of a cornea), a keratotopografiya (identification of corneal distortion), definition of sensitivity of a cornea (a cornea algezimetriya).
Laboratory diagnostics of a bacterial keratit includes a microscopic and bacteriological research of dab from a conjunctiva and corneas (from infiltrate, edges and a bottom of an ulcer). Crops of dab on the corresponding environments allow to define the activator of a bacterial keratit and its sensitivity to antibiotics.
Differential diagnostics is carried out between different types of keratit: bacterial, gerpesvirusny and fungal.
Treatment of a bacterial keratit
Due to the threat of bystry progressing of a bacterial keratit its treatment is carried out in the conditions of a hospital under constant medical control. The favorable outcome of a disease depends on timeliness of diagnostics and the appointed treatment.
Antibacterial therapy is the cornerstone of treatment of a bacterial keratit. Appoint instillations of the eye drops containing antibiotics of a broad spectrum of activity (aminoglycosides, ftorkhinolona, tsefalosporina). In hard cases of a bacterial keratit introduction of antibiotics, and also their reception inside is recommended injection (under a conjunctiva) and parabulbarny (under an eyeball). Also local application of anti-septic tanks (solution of a sulfatsetamid), nonsteroid anti-inflammatory medicines, glucocorticoids is possible (dexamethasone, a beta metazone).
Treatment of a bacterial keratit at gonoblennory is carried out together with the venereologist. Diphtheritic keratit treat in an infectious hospital: besides antibiotic treatment, surely enter antidiphtherial serum intramuscularly, and also dig in in eyes.
For the prevention of an iridotsiklit and adhesive process in an eye appoint the means expanding a pupil (midriatik). In the period of a rassasyvaniye of inflammatory infiltrates appoint keratoprotektorny and epiteliziruyushchy means (hydrochloride quinine solution, haemo dialyzates of blood of dairy calfs); in addition, locally and inside - antihistaminic medicines, immunoproofreaders, vitamins.
When progressing an ulcer of a cornea carry out electrothermic coagulation, cryocoagulation or a diatermokoagulyation of edges of an ulcer, tushirovany ulcers solution of iodine or diamond green.
Even at timely and effective therapy an outcome of a bacterial keratit usually is the cataract (turbidity of a cornea in the form of a white spot) arising owing to development of cicatricial fabric and a vaskulyarization of the damaged site of a cornea. As surgical treatment of a cataract and restoration of visual function the eksimerlazerny procedure at superficial hems of a cornea is shown. The method of phototherapeutic correction of a cornea (FTK) allows to eliminate or to reduce considerably superficial turbidity and cornea hems. If necessary carry out a keratoplasty.
Forecast and prevention of a bacterial keratit
The forecast of a bacterial keratit always serious both for sight, and for preservation of an eye.
Upon transition of an inflammation to other covers of an eyeball (to a skler, an iris, a tsiliarny body) develops keratosklerit, keratoiridotsiklit, keratouveit, and also there is a pus congestion in the lower part of the forward camera (hypopeony).
Because of uneven healing of a stroma the wrong astigmatism demanding further carrying special lenses or carrying out FTK can be a possible consequence of a bacterial keratit.
The greatest danger at an adverse current of a bacterial keratit is constituted by the perforation of a cornea capable to develop into purulent endoftalmit and panoftalmit (an inflammation of all tissues of eye), to lead to a sympathetic oftalmiya, a subatrophy (wrinkling) of an eyeball up to total loss of sight or even an eye.
Prevention of a bacterial keratit consists in protection of tissue of eye against injuries, burns, hit of foreign matters, toxic substances; use of special goggles at construction repair work; careful observance of rules of hygiene when carrying contact lenses. At the begun bacterial keratit it is very important to carry out strictly appointments and recommendations of the doctor not to allow development of an ulcer of a cornea and its complications.