Blefarokonjyunktivit - it is an inflammation of edges a century in combination with defeat of a palpebralny and orbital conjunctiva. Main symptoms of a disease: reddening of eyes, feeling of "sand" or foreign matters under centuries, a photophobia, the increased lachrymation. Fizikalny inspection, a laboratory research of allocations from a conjunctiva cavity, a vizometriya, biomicroscopy, ultrasonography of an eye, flyuorestseinovy test is applied to diagnosis. Treatment is based on application of antibiotics, antihistamines, NPVS, antiviral medicines, vitamins of group C, B and A.
Blefarokonjyunktivit – a polietiologichesky disease at which the conjunctiva and edges is involved a century in inflammatory process. Prevalence of a disease in the general structure of ophthalmologic pathologies makes about 30%. Blefarokonjyunktivit diagnose everywhere for people of all age, however most often it occurs at female persons on the fourth decade of life. Every third patient suffers from a syndrome of a dry eye". Pathology develops in 25% of cases again against the background of infectious diseases. About 17% of patients note a recidivous current.
Reasons of a blefarokonjyunktivit
Leads influence of a set of factors to development of a disease, however it is possible to establish an etiology not always. Blefarokonjyunktivit - it is the acquired pathology. Detection of a disease in the neonatal period is caused by infection of a mucous membrane of eyes of the baby at the time of delivery. Are the main reasons for a blefarokonjyunktivit:
- Infectious diseases. Gonorrhea, a rubella, herpes, syphilis can provoke damage of a forward segment of eyes. Perhaps hematogenic distribution of infectious agents or infection with a contact and household way.
- Allergic reactions. Clinical manifestations of an allergic form are caused by allocation of mediators with vazoaktivny action. At this option of pathology in blood of patients immunoglobulin E is synthesized.
- Defeat by pincers of the sort Demodex. Secondary changes a century and conjunctivas arise at a skin demodekoza. The causative agent of a disease lives in sebaceous glands (Tseysa and meybomiyevy). Infection demodekozy can be complicated by development of a secondary halyazion and keratit.
- Traumatic damages. Injuries of an organ of vision promote infection of a wound surface. In 98% of cases the wound channel passes through a conjunctiva. The reflex smykaniye at the sight of danger leads a century to their additional traumatizing.
- Fungal defeats. The symptomatology of a blefarokonjyunktivit often comes to light at patients with candidiasis, aspergillomycosis or actinomycosis in the anamnesis. At the chronic course of mycosis the accompanying damage of a back segment of an eye is quite often observed.
The pathogenesis depends on an etiology of a blefarokonjyunktivit. At an oftalmodemodekoza toksiko-allergic impact of a parasite on structures of a forward pole of an eye provokes an injection of vessels of a conjunctiva and the strengthened secretion of mucous allocations. Development of a bacterial form is often preceded by nasopharynx pathologies, damage of a middle ear or the general infectious diseases. Reproduction of microorganisms leads to damage of fabrics by bacterial toxins. The thin mucous membrane of a conjunctiva is most vulnerable to their influence. Fungal defeat of forward departments of an eyeball is often caused by contact infection at mycosis of other localization. Development of symptomatology at traumatic damages is connected with mechanical entering of pathogenic flora to the wound canal.
The key part in pathogenesis of an allergic blefarokonjyunktivit is assigned to hypersensibility of an organism to separate anti-genes. Reception of medicines, inhalation of pollen of plants, contact with tovy allergens becomes the starting trigger of development of reaction of hypersensitivity. The contributing factors are the metabolic disorder, irritation of a conjunctiva chemicals, dust or smoke. Children who were subject to pre-natal infection with viruses of herpes, rubellas, are more predisposed to developing of a disease further. At the same time often it is possible to diagnose multiple malformations of visual system (, , a koloboma of an iris).
Symptoms of a blefarokonjyunktivit
Patients show complaints to an itch and burning in an eye-socket, a photophobia, feeling of "sand" or a foreign matter under centuries. The increased lachrymation at a view of a light source is characteristic. Performance of visual work results in bystry fatigue of eyes. Visually reddening and puffiness of an orbital conjunctiva is defined. At defeat of a cornea visual acuity decreases. At a bacterial form patients note allocation from an eye crack of purulent masses with an unpleasant smell. Separated becomes the reason of pasting of eyelashes, their losses. Instability of a plaintive film leads to visual dysfunction.
At a virus origin of a disease conjunctival separated has a mucous or watery consistence. Patients note the expressed eye pain. Increase in regionarny lymph nodes is characteristic. Feature of an allergic blefarokonjyunktivit is the bilateral damage of eyes which is combined with expressed blefarospazmy. Allocation of a mucous secret of a viscous consistence, the accompanying defeat of integuments is noted. Lymph nodes are not increased. Use of contact lenses provokes strengthening of clinical manifestations, the increased irritability of eyes.
The long current of a blefarokonjyunktivit can lead to development of a secondary ektropion, the entropiona of a century is more rare. Patients with this pathology in the anamnesis are more subject to risk of accession of infectious and bacterial complications (keratit, horioretinit). Distribution of pathological agents to the nososlezny channel provokes dakriotsistit. Most of patients has kseroftalmiya symptoms. Formation of cicatricial defects on skin not only breaks a century process of a smykaniye of an orbital crack, but also is cosmetic defect. The most terrible consequence of a heavy current of a blefarokonjyunktivit – orbit phlegmon. In rare instances there is thrombosis of a sigmovidny sine.
Diagnosis is based on results of specific methods of researches, analyses of allocations from an orbital crack and fizikalny inspection. At visual survey the ophthalmologist reveals hyperaemia and puffiness of a conjunctiva, reddening of edges a century. From the anamnesis usually it becomes clear that patients connect emergence of the first symptoms with allergic or infectious pathologies. The plan of tool diagnostics includes:
- To Vizometry. At the easy course of pathological process visual dysfunction is absent. The progressing decrease in visual acuity arises at damage of a cornea.
- Eye biomicroscopy. Hypostasis and an injection of vessels of a conjunctiva is visualized. Eyelids are hyperemic, edematous, with a congestion of pathological offices on peripheral edge. At the accompanying defeat of a cornea its ulceration and turbidity is defined.
- Ultrasonography of an eye. Ultrasonography allows to measure eyeball parameters, to reveal signs of defeat of a back segment of an eye at turbidity of optical environments.
- Flyuorestseinovy instillyatsionny test. When conducting test it is possible to find violation of integrity of an epitelialny layer of a cornea. When studying a structure of a plaintive film multiple gaps are visualized.
Definition of an etiology requires conducting laboratory tests. At bacterial genesis in contents of allocations from eyes neutrophils prevail. At patients with a virus form of a disease when carrying out a cytologic research mononuclear cages come to light. Detection of eosinophils at a microscopic research testifies to an allergic origin of a blefarokonjyunktivit. The cultural method of diagnostics gives the chance to reveal growth of cultures of pathogens in crops of contents from a conjunctival cavity. Consultation of the infectiologist and allergist is in addition shown.
Treatment of a blefarokonjyunktivit
Therapeutic tactics is defined by an etiology and character of a course of disease. The treatment purpose – elimination of the activator and knocking over of inflammatory process. Imposing of an aseptic bandage is contraindicated because of increase in probability of development of a secondary keratit. Mechanical removal separated from a conjunctival cavity is carried out by washing of eyes by antiseptic solutions. Medicamentous therapy includes:
- Antibiotics. Antibacterial therapy is carried out by a short course (3-7 days). Instillations of antimicrobic means are carried out each 2-4 hours. In process of subsiding of signs of an inflammation frequency rate of application of drops decreases to 3-6 times a day.
- Nonsteroid resolvents. It is shown local (instillations) or system introduction of NPVS. Drops of diclofenac of sodium are used at the noninfectious nature of a disease. At insufficient efficiency or the heavy course of pathology glucocorticosteroids are applied.
- Antihistaminic medicines. Purpose of means from the H1-gistaminoblokatorov group is expedient at an allergic form. Application of eye drops of an olopatadin of a hydrochloride or sodium of a kromoglikat is recommended to patients.
- Antiviral means. The indication to use of eye drops is virus blefarokonjyunktivit. Duration of a course of treatment makes 12-14 days. At a sharp current the instillation of medicine of 6-10 times a day is recommended.
- Vitamin therapy. Regardless of a pathology form oral administration of vitamins of group B, A and Page is shown to all patients. When involving in pathological process of a cornea stimulators of regeneration of a cornea are in addition appointed (metiluratsilovy ointment, solkoserit).
Forecast and prevention
The forecast for life and working capacity at a blefarokonjyunktivita favorable. A pathology outcome at timely diagnostics and treatment – an absolute recovery. Specific preventive actions are not developed, nonspecific are directed to the prevention of secondary defeat of forward department of eyes at infectious and allergic diseases in the anamnesis. Patients with the recidivous course of a disease should increase the general reactivity and resistance of an organism by means of natural (correction of a food allowance, a hardening) or medicamentous means (immunomodulators).