Kanalikulit - it is the polietiologichesky disease which is shown an inflammation of plaintive tubules. The general symptoms for all forms of a kanalikulit are hyperaemia, hypostasis and morbidity in a defeat zone. Diagnostics is based on data of fizikalny survey, a microscopic and cultural research of allocations, a diafanoskopiya and radiographic techniques. Conservative treatment includes washing of tubules, instillation by antiseptics, corticosteroids and etiotropny medicines depending on a disease form. If necessary surgical intervention – sounding or a section of tubules is shown.
Kanalikulit represents an acute or chronic inflammation of plaintive tubules. This pathology arises against the background of other diseases of the bacterial, virus or fungal nature more often. The disease is more widespread among persons of middle and old age. At primary address to the ophthalmologist diagnose for 2,4% of patients mikoticheskiya kanalikulit. The first description of fungal defeat of plaintive tubules was submitted in 1854 Gref. This form women are ill more often. Kanalikulit meets in 70% of patients with trachoma. In 1934 Rubert described a phenomenon of merge of two cystous cavities at a trakhomatozny etiology. Defeat of plaintive tubules of the syphilitic and tubercular nature meets extremely seldom today.
Reasons of a kanalikulit
Kanalikulit can be a bacterial, fungal or virus etiology. Often the disease arises against the background of conjunctivitis or a blefarit that complicates diagnosis. Infectious agents can get into a plaintive tubule from surrounding structures of an organ of vision (a conjunctiva, eyelids) or a retrograde way (through a plaintive bag and a nososlezny channel). The most widespread activators are piogenny staphylococcus, streptococci, sinegnoyny or colibacillus. Virus kanalikulit it is observed at persons with herpetic or adenoviral conjunctivitis. The virus of simple herpes leads to destruction of blankets of a plaintive tubule that promotes formation of hems and . The long persistention of a virus in a human body can cause a full obliteration.
Mikotichesky kanalikulit Wolf-Izrael's actinomycetes provoke, is more rare – sporotrikhiyella and aspergilla. If the disease is caused by actinomycetes, it is considered as pseudo-mycosis as activators belong to prokariota. Mushrooms of the sort Candida lead to candidiasis of plaintive tubules, activators most often get from a mouth. Syphilitic kanalikulit develops at infection pale treponemy, tubercular – Koch's stick. Mikobakteriya get to plaintive tubules from the lower nasal sink during sneezing. The chlamydial infection (trachoma) is a common cause of emergence of a kanalikulit. Accession of vulgar flora leads to an illegibility of a clinical picture and often imitates symptomatology of a purulent kanalikulit.
The mechanical barrier on the way of outflow of a tear at obstruction by eyelashes or foreign matters can become the reason of an inflammation of plaintive tubules. Less often total obstruction is observed at formation of concrements as a result of calcification of colonies of a fungus. The adverse current of a kanalikulit is noted at a toxic epidermalny nekroliz or a malignant ekssudativny eritema.
Symptoms of a kanalikulit
From the clinical point of view distinguish sharp and chronic kanalikulit. At a sharp current hyperaemia and hypostasis of integuments on the tubule course come to light. Patients show complaints to pain at a contact and the expressed discomfort. An early symptom of a disease – the raised dacryagogue. Progressing of inflammatory process leads to reddening and puffiness of mouths of plaintive points that is shown by a nipple eminence over surrounding fabrics. When pressing in a zone of a projection of a tubule slime which in the subsequent is replaced by purulent exudate is emitted.
Thanks to a wide choice of medicines for treatment of a sharp form of a kanalikulit, the chronic form meets rather seldom. Allocate tubercular, syphilitic, mikotichesky and trakhomatozny chronic kanalikulit. The expressed consolidation of a zone of hypostasis, hyperaemia and an intensive pain syndrome are characteristic of an inflammation of plaintive tubules of the tubercular nature. Purulent contents appear only at disintegration of a tubercular hillock. In some cases destruction leads to formation of erosive defect which long does not begin to live, bleeds, can become covered by granulations or punch. Kanalikulit the syphilitic nature it is diagnosed only at tertiary syphilis. The chronic current leads to formation of a gumma with formation of multiple ulcers.
Primary symptom of a mikotichesky kanalikulit – insignificant dacryagogue which reason is an irritation of a conjunctiva. Over time hyperaemia of medial departments of an eyeball develops. Further hyperaemia extends to a semi-lunar fold, a zone of plaintive meat and a tubule. Patients show complaints to a congestion of dry crusts in an internal corner of eyes after awakening, an itch and burning. These phenomena are caused by release of viscous exudate. The intensive hyperaemia which is followed by hypostasis develops on average in 3-4 weeks after emergence of the first symptoms of a disease. Because of puffiness a century the plaintive point is turned out outside, increases in volume and takes a deepening form. The eversion of a plaintive point leads to strengthening of dacryagogue. Over time viscous exudate is replaced by pus and kashitseobrazny fungal masses. Unilateral defeat which is followed by discomfort without the expressed pain syndrome is characteristic of a mikotichesky kanalikulit.
Clinically chlamydial kanalikulit differs from other forms of a disease of education resistant and an obliteration of plaintive tubules. The adhesive and catarrhal form develops on 1-2 stages of trachoma. Pathology is shown by hyperaemia and a thickening of medial departments a century. In plaintive liquid impurity of slime or purulent masses come to light. Pus complicates outflow of contents. Stagnation leads to stretching of walls of a tubule with the subsequent formation of a cystous cavity. Often similar cysts happen multiple and affect 2-3 courses at the same time.
Diagnostics of a kanalikulit
Diagnostics of a sharp kanalikulit is based on results of a palpation, conducting kanaltsevy test and diagnostic washing of plaintive tubules. At a palpatorny research a tubule dense, painful. Pressing is followed by release of mucopurulent exudate. The result of kanaltsevy test is ambiguous. It can be both negative, and slabopolozhitelny. Liquid at diagnostic washing freely passes in a nasal cavity.
At a tubercular kanalikulit in the anamnesis at most of patients tuberculosis comes to light. It is possible to confirm the diagnosis by means of microscopic and cultural methods of researches. In dab at microscopy Koch's sticks come to light. The cultural method allows to find colonies of mikobakteriya. To verify syphilitic kanalikulit at patients with tertiary syphilis it is possible only by means of serological diagnostics (IFA).
At a mikotichesky kanalikulit the palpation is, as a rule, painless and is followed by allocation of fungal colonies with a purulent masses. For more detailed research it is necessary to carry out by a glass stick from the inside of a century from a nose to a plaintive point. Externally colonies of a fungus can have different color (gray, greenish, brown) and a consistence (kashitsepodobny, firm). At late stages washing cannot be executed because of an obturation of tubules calcification products.
At a diafanoskopiya of an eye the blackout centers corresponding to fungal masses are observed. Dakriolita which represent products of a kaltsination of colonies are most clearly visible. At a microscopic research in dab mycelium threads come to light. Crops on nutrient mediums allow to confirm growth of culture. For differential diagnostics with papillomatozy the X-ray analysis with use of contrast agent is recommended. At a mikotichesky kanalikulit uneven expansion of a tubule is found, and at a papillomatoza – defect of filling.
At early stages of a chlamydial kanalikulit when washing liquid is emitted with frequent drops or a stream. At a long current obstruction of tubules is observed. Using a diafanoskopiya or a X-ray analysis, it is possible to visualize cystous cavities.
Treatment of a kanalikulit
The general medical action for all forms of a kanalikulit is mechanical removal of pathological masses by pressing on the tubule course. After removal the conjunctiva and a kanaltsevy cavity are washed out antiseptics. For removal of an inflammation recommend instillations of corticosteroids. Hormonal ointments in a small amount can be entered into a tubule cavity by means of a special cannula. Antibacterial therapy is shown at a sharp kanalikulit. She is led by instillation of gentamycin or a levomitsetin to a conjunctival cavity.
At a trakhomatozny, syphilitic, tubercular and mikotichesky kanalikulit a priority is treatment of the main pathology. Conservative therapy of a trakhomatozny kanalikulit assumes oral administration of antimicrobic means from groups of macroleads and sulfanylamides together with instillations. At a stenosis or an obturation it is necessary to carry out sounding of a tubule. Mikotichesky kanalikulit demands a tubule section with removal of fungal masses, the following stage is instillation of anti-septic tanks and antifungal medicines. Treatment of a tubercular kanalikulit includes local application of an isoniazid and rifampicin. At tertiary syphilis include antibiotics of a penicillinic row in a complex of medical actions.
Forecast and prevention of a kanalikulit
Specific measures for prevention of a kanalikulit in ophthalmology it is not developed. For early screening it is necessary to perform inspection and a palpation of a zone of a projection of plaintive tubules at viral or bacterial diseases of a conjunctiva and a century. Patients are recommended to observe hygiene of eyes, to perform timely treatment of candidiasis, syphilis, trachoma and tuberculosis, capable to become the reason of development of a chronic kanalikulit.
The forecast for life and working capacity at a sharp kanalikulit favorable. Chronic forms of a disease will hard respond to treatment, are followed by dysfunction of tubules, lead to formation of hems and and are considered as less favorable from the point of view of the forecast.