Blefarit – a bilateral recidivous inflammation of a ciliary edge a century. Blefarit the century, heavy feeling and an itch a century, hypersensibility to bright light, bystry fatigue of eyes, the wrong growth and loss of eyelashes is shown by reddening and puffiness of edges. In diagnostics of a blefarit the leading role is played by external examination a century, visual acuity definition, biomicroscopy, bacteriological crops, a research of eyelashes on . Treatment of a blefarit is directed to elimination of a cause of illness and, as a rule, includes conservative actions (a toilet a century, massage a century, an instillation of eye drops, a mortgaging of ointments and ).
Prevalence of a blefarit in population is quite high - about 30%. Blefarit can develop at children, however the maximum peak of incidence is the share of age from 40 to 70 years. In ophthalmology of a blefarita make big group of an etiologicheska of the non-uniform inflammatory diseases a century which are followed by defeat of their ciliary edges having a recidivous current and which are difficult giving in to medical influence. The heavy and persistent current of a blefarit can lead to formation of a halyazion, conjunctivitis, a keratit, sight easing.
Reasons of a belefarit
Development of a blefarit can be caused by the mass of the reasons. Infectious blefarita are caused by bacteria (epidermalny and golden staphylococcus), fungi, pincers; noninfectious – allergic agents, ophthalmologic diseases.
As the leading reason of infectious blefarit serves the staphylococcal infection affecting hair sacks of eyelashes. Existence of the chronic centers of an infection in almonds (tonsillitis), additional bosoms (antritis, plays the dandy), oral cavities (caries), on skin (impetigo) and so forth contributes to emergence of a blefarit. Quite often blefarit the century is caused by defeat of edges a tick of Demodex (). At most of people ticks live on the surface of skin, in hair follicles, sebaceous glands, and at decrease in the general reactivity of an organism can become more active and get on skin a century, causing blefarit. More rare as etiologichesky agents at a blefarita herpes viruses I, II and III types, a contagious mollusk, a hemophilic stick, bacteria of intestinal group, drozhzhepodobny fungi, etc. act. At a combination of a blefarit to conjunctivitis develops blefarokonjyunktivit.
Development of a noninfectious blefarit quite often happens is accompanied by nekorrigirovanny pathology of sight (far-sightedness, short-sightedness, an astigmatism), a syndrome of a dry eye. At the people having hypersensibility to irritants (pollen of plants, cosmetics, means of hygiene, drugs) the allergic form of a blefarit can develop. Defeat quite often arises a century at contact dermatitis. The endogenous allergization of an organism is possible at helminthoses, gastritis, colitis, cholecystitis, tuberculosis, diabetes at which the structure of a secret of meybomiyevy glands changes.
Decrease in the immune status, chronic intoxications, hypovitaminoses, anemia, the increased smoke and dust content and air, stay in a sunbed, in the sun, on wind contributes to emergence and an aggravation of a blefarit of any etiology.
Classification of a blefarit
According to an etiology of a blefarita are divided into two groups: noninfectious and infectious. When involving in inflammatory process only of a ciliary edge of a century speak about a forward regional blefarit; at defeat of meybomiyevy glands – about a back regional blefarit; in case of prevalence of the inflammatory phenomena in corners of eyes – about an angular or angulyarny blefarit.
On a clinical current allocate several forms of a blefarit:
- Seboreyny or scaly (usually accompanies seboreyny dermatitis).
- Or staphylococcal (ostiofollikulit) ulcer.
- Or rozatsea-blefarit acne (it is often combined with pink eels).
Symptoms of a blefarit
The current of any form of a blefarit is followed by typical manifestations: puffiness and reddening a century, an itch, bystry fatigue of eyes and hypersensibility to irritants (light, wind). Constantly formed plaintive film causes a sight illegibility. The eye allocations which are especially accompanying a current of infectious blefarit lead to emergence on a century of a raid, to pasting of eyelashes. The patients who are usually using contact lenses note that they cannot carry their so long time as earlier.
Idle time blefarit the century, the congestion in corners of eye cracks of a whitish-gray secret moderated by reddening of a conjunctiva, expansion of channels of meybomiyevy glands is characterized by hyperaemia and a thickening of edges.
At a scaly blefarit at reinforced and hyperemic edge of a century scales of slushchenny epidermis and an epithelium of sebaceous glands which are densely attached to the basis of eyelashes accumulate. Skin scales are also defined on eyebrows and a hairy part of the head. The current of a seboreyny blefarit can be followed by loss and a posedeniye of eyelashes.
The ulcer form of a blefarit proceeds with formation of yellowish crusts at which removal sores open. After healing of ulcerations hems because of which the normal growth of eyelashes is broken () are formed. In hard cases of an eyelash can become colourless () and drop out (), and first ciliary line to become hypertrophied and wrinkled.
Demodekozny blefarit proceeds with the constant intolerable itch a century which was more expressed after a dream. Edges are thickened a century in the form of the reddish roller. In the afternoon the gripes in eyes, the allocation of a sticky secret leading to drying up separated and to its congestion between eyelashes are noted that gives to eyes a slovenly look.
Symptoms of an allergic blefarit, in most cases, appear suddenly and are accurately connected with any exogenous factor. The disease is followed by hypostasis and a persistent itch a century, dacryagogue, mucous separated from eyes, a photophobia, gripes in eyes. Darkening of skin a century (so-called "allergic bruise") is typical for an allergic blefarit.
At a rozatsea-blefarita on skin a century the small grayish-red small knots topped with gnoynichka are visible.
Blefarit the keratita, a sharp meybomit, development of a halyazion, formation of barley, and ulcers of the cornea menacing with sight loss can proceed with the phenomena of conjunctivitis, a syndrome of "a dry eye". Practically always blefarita accept a chronic current, tend to a retsidivirovaniye for many years.
Diagnostics of a blefarit
Recognition of a blefarit is made by the ophthalmologist on the basis of the complaints given survey a century, detection of associated diseases, laboratory researches. During diagnostics of a blefarit definition of visual acuity and the biomicroscopy of an eye allowing to estimate a condition of edges a century, conjunctivas, an eyeball, a plaintive film, a cornea and so forth is carried out. For the purpose of identification not distinguished before a gipermetropiya, a miopiya, a presbiopiya, an astigmatism the condition of a refraction and accommodation is investigated.
The microscopic research of eyelashes on a tick of Demodex is made for confirmation of a demodekozny blefarit. At suspicion on infectious blefarit carrying out bacteriological crops of dab from a conjunctiva is shown. At allergic character of a blefarit consultation of the allergist-immunologist with carrying out is necessary. For the purpose of an exception of a helminthic invasion purpose of the analysis a calla on eggs a worm is expedient.
It is long existing blefarit, the century which is followed by a hypertrophy of edges, demands an exception of cancer of sebaceous glands, planocellular or bazalnokletochny cancer for what the biopsy with a histologic research of fabric is carried out.
Treatment of a blefarit
Treatment of a blefarit conservative, long, demanding integrated local and system approach, and also the accounting of etiologichesky factors. Quite often for elimination of a blefarit consultations of narrow experts (the otolaryngologist, the stomatologist, the dermatologist, the allergist, the gastroenterologist), carrying out sanitation of the chronic centers of an infection and expulsion of helminths, normalization of food, improvement of sanitary and hygienic conditions of the house and at work, increase in immunity are required. At identification of violations of a refraction carrying out their-point or laser correction is necessary.
Topichesky therapy of blefarit demands the accounting of a form of a disease. At treatment of a blefarit of any etiology the careful hyena a century, clarification from crusts and scales a damp tampon after preliminary imposing of penicillinic or sulfatsilovy ointment, an instillation in a cavity of a conjunctiva of solution of a sulfatsetamid, processing of edges a century solution diamond green, performing massage a century is necessary.
At an ulcer blefarit apply the ointments containing kortikosteroidny hormone and an antibiotic (dexamethasone + gentamycin, dexamethasone + Neomycinum + In). At conjunctivitis and a regional keratit treatment is supplemented with similar eye drops. In cases of an ulceration of a cornea apply eye gel with dekspanteoly.
At a seboreyny blefarit greasing is shown a century by gidrokortizonovy eye ointment, to instillation of "an artificial tear". In therapy of a demodekozny blefarit, except all-hygienic actions, special antiparasitic ointments (metronidazolovy, tsinko-ikhtiolovy), alkaline drops are used; system therapy is carried out by metronidazole.
Allergic blefarit demands elimination of contact with the revealed allergen, instillations of antiallergic drops (, sodium ), processings a century kortikosteroidny eye ointments, reception of antihistaminic medicines. At a meybomiyevy and acne blefarit appointment in a tetratsiklin or doxycycline as a course from 2 to 4 weeks is expedient.
System therapy at blefarita includes the vitaminoterpiya immunostimulating therapy, an autogemoterapiya. The combination of local and general medicinal treatment to physical therapy (UVCh, magnetotherapy, an electrophoresis, a darsonvalization, Ural federal district), radiation by Bukki's beams is effective.
Prevention and the forecast at a blefarita
At timely and persistent therapy of a blefarit the forecast for safety of sight favorable. In some cases the disease gets the long, retsidiviruyueshchy current leading to emergence of barley, halyazion, deformation of edges a century, to development of a trikhiaz, chronic blefarokonjyunktivit and keratit, deterioration in function of sight.
Prevention of a blefarit requires treatment of chronic infections, an exception of contact with allergens, carrying out correction of anomalies of a refraction, timely treatment of dysfunction of sebaceous glands, respect for hygiene of sight, improvement of sanitary and hygienic working conditions and life.