Horioretinit – an inflammation of back department of a horioidea and a retina. Main symptoms of a disease: emergence of "front sights" and "floating pomutneniye" before eyes, violation of dark adaptation, decrease in sight, a fotopsiya, macro - and mikropsiya. Diagnostics is based on carrying out bacteriological crops, IFA, definition of the S-jet protein, gonioskopiya, angiography, perimetry, an oftalmoskopiya. Conservative therapy includes purpose of antibacterial means, nonsteroid anti-inflammatory medicines, midriatik, glucocorticosteroids, biogenous stimulators and reparant.
Horioretinit – widespread pathology among persons of Caucasian race. The inflammation of anatomical structures of a uvealny path is possible at any age, however most often occurs at persons after 40 years. The ratio of prevalence of a disease among women and men makes 2,3:1. At 22% of patients the hidden defeat of a vascular cover (lack of the depigmented centers is noted at the first survey of an eye bottom). According to statistical data, the average term of a course of disease before establishment of the diagnosis makes 3 years. Horioretinit as "a shot in fraction" it is diagnosed for inhabitants of Northern Europe more often.
Reasons of a horioretinit
The inflammation of a horioidea and mesh cover is promoted by a set of factors. The virus, bacterial and parasitic nature of pathology is described. It is proved that the persons suffering from a miopiya of high degree are more subject to risk of development of a disease. The role of other anomalies of a clinical refraction in an etiology of defeats of a uvealny path is not studied. Main reasons for a horioretinit:
- Infectious diseases. The disease often arises against the background of tuberculosis, syphilis. At the tubercular nature of pathology of an oftalmoskopicheska the centers of defeat of different prescription which differ on coloring come to light. At change syphilis from back department of eyes are less expressed.
- Traumatic damages. At post-traumatic genesis inflammatory process is preceded by ruptures of a vascular cover and hemorrhage in suprakhorioidalny space. In most cases it is possible to reveal entrance gate of an infection. Horioretinit it is combined with defeat of a forward segment of eyes.
- Focal infections. Pathological agents can extend in the hematogenic way in the presence of the center of a sharp or chronic infection in a mouth, an eye-socket or damage of ENT organs. As the activator piogenny strains of bacteria, as a rule, act.
- Toxoplasmosis. The activator is capable to get into a back segment of an eyeball in the hematogenic way. Cases of pre-natal infection are most widespread. Pathology is often combined with other malformations of eyes (, ).
In the mechanism of development of a disease the leading value is allocated for influence of bacterial toxins which start allergic reactions, is more rare – autoimmune process. Bacteria or viruses can get into structures of a uvealny path in the endogenous or exogenous way. The contributing factors to development of pathology – anatomic (a wide vascular bed) and haemo dynamic (delay of a blood-groove) features of a structure. The first the retina is surprised. Distribution of pathological agents to a vascular cover happens again. The atrophy of anatomic formations of a uvealny path arises because of violation of blood supply which normal happens thanks to horiokapilyarny vessels. Allocate negranulematozny and granulematozny types of inflammatory process.
On character of a current in ophthalmology distinguish sharp and chronic forms of an inflammation. Depending on localization of a zone of defeat allocate panuveit, peripheral and back uveit which is subdivided on focal, multifocal, disseminirovanny, neyrokhorioretinit and endoftalmit. On activity horioretinit classify on the following stages:
- Active. It is characterized by the progressing decrease in visual acuity. Patients note increased fatigue when performing visual work which is combined with deterioration in health.
- Subactive. Is intermediate between active and inactive stages. Comes to light at infectious process of other localization. The clinical symptomatology is a little expressed. In the absence of timely treatment passes into a chronic form.
- Inactive. Signs of an inflammation are absent. At an oftalmoskopiya the chronic centers of an infection of a dense consistence are found. Patients note persistent visual dysfunction which does not progress. The inactive stage is a casual find.
In classification by localization of inflammatory process allocate the central and peripheral forms. Perhaps diffusion and focal defeat of a uvealny path. The pathological centers can be single and multiple.
Symptoms of a horioretinit
Patients show complaints to the progressing decrease in sight. Expressiveness of visual dysfunction varies in considerable limits. Patients note emergence of floating points, "fog" or "veil" before eyes. At an arrangement of the separate centers on the periphery of a vascular cover visual acuity is not reduced in the afternoon, however in twilight visual dysfunction accrues. At turbidity of optical environments of an eyeball patients have a miopichesky type of a clinical refraction. A common symptom – emergence of "pomutneniye" or "front sights" before eyes.
In case of a heavy current loss of certain sites of the visual field, a fotopsiya is noted. Development micro and makropsy leads to distortion of objects before eyes. Many patients point that emergence of clinical symptomatology is preceded by infectious, system and autoimmune diseases. Horioretinit arises after the postponed surgeries on an eyeball or an eye-socket less often. Visually pathological changes do not come to light. In view of the fact that visual acuity a long time can remain normal, diagnosis is often complicated.
The raised ekssudation leads to development of an oftalmogipertenziya, there is secondary glaucoma less often. Purulent horioretinit is complicated by neuritis of an optic nerve. The congestion of exudate and the organization of purulent masses lead to development the sir - and an endoftalmita. The retina atrophy is preceded often by its gap or an otsloyka. Massive hemorrhages become the cause of a gifema and gemoftalm. At damage of photoreceptors of an internal cover of an eye color sight is broken. At most of patients the gemeralopiya comes to light. In the predictive plan the most adverse complication is the total blindness.
Diagnosis is based on anamnestichesky yielded, results of tool and laboratory methods of a research. At objective survey pathological changes do not come to light. It is important criterion which allows to differentiate horioretinit with pathology of a forward pole of an eyeball. Laboratory diagnostics comes down to carrying out:
- Bacteriological crops. Serves as material for a research an orbital conjunctiva or conjunctival liquid. The method purpose – identification of the activator and definition of sensitivity to antibacterial therapy.
- Immunofermental analysis (IFA). Studying of a caption of antibodies (Ig M, Ig G) is applied to detection of causative agents of clamidiosis, simple herpes, toxoplasmosis, a cytomegalovirus. IFA allows to estimate a stage of activity of inflammatory process.
- Test for definition of S-jet protein. Identification of a protein in blood gives the chance to exclude or confirm the autoimmune nature of a disease. At positive test for the S-protein revmoproba are carried out.
For the purpose of diagnosis and assessment of volume of defeat the ophthalmologist applies tool methods. By means of a vizometriya decrease in visual acuity of different degree of expressiveness decides on tendency to miopichesky type of a refraction. Increase in the intraocular pressure (VGD) is observed only at average weight and a heavy current. Specific diagnostics includes:
- To Gonioskopy. In the forward camera of an eyeball the pus congestion comes to light that testifies to a hypopeony or exudate. Hemorrhage in the forward camera of an eye conducts to a gifema.
- To Oftalmoskopy. At oftalmoskopichesky survey the centers of defeat of a grayish-yellow shade with indistinct contours, dot hemorrhages are visualized. Detection of the limited site of white color testifies to an atrophy. The area of a yellow spot is pigmented.
- Fluorescent angiography of a retina (PHAGE). It is possible to visualize signs of a vaskulit of a retina. When carrying out the PHAGE with contrast dark stains in the place of a congestion of Indo-cyanine green come to light.
- Perimetry. At a peripheral form of a disease concentric narrowing of the visual field is noted. Focal defeat leads to loss of small sites from a field of vision.
Differential diagnostics is carried out with dystrophy of a yellow spot and malignant new growths of a vascular cover. Unlike a tumor at a horioretinita the perifokalny center of an inflammation with indistinct doghouses is found. At dystrophic changes of a yellow spot signs of an inflammation and turbidity of a vitreous body are absent. At a traumatic origin of a disease the X-ray analysis of an eye-socket which gives the chance to reveal pathological changes of pozadibulbarny cellulose and bone walls of an orbit (a change, shift of fragments) is carried out.
Treatment of a horioretinit
Etiotropny therapy is based on treatment of the main disease. At a traumatic etiology performing surgery which is directed to plasticity of a bone wall of an eye-socket, comparison of the displaced fragments is required. Before operation and in the early postoperative period the short course of antibiotics is shown. Conservative therapy comes down to appointment:
- Nonsteroid resolvents. Are applied for the purpose of knocking over of inflammatory process. To patients daily instillations on 5-6 times a day are carried out. At the complicated current retrobulbarny introduction is shown.
- Midriatikov. M-holinoblokatory and simpatomimetik are used for the purpose of prevention of formation of sinekhiya and for improvement of outflow of watery moisture. Timely purpose of midriatik reduces risk of development of glaucoma.
- Hormonal medicines. The indication to appointment – sharp horioretinit. The patient carries out installations or subconjunctival injections of a hydrocortisone. It is in addition possible to put 3-4 times a day under an eyelid gidrokortizonovy ointment.
- Antibiotikov. Antibacterial therapy is performed at the toksoplazmozny nature of a horioretinit, and also in case of accession of bacterial complications. At insufficient effect sulfanylamides are in addition shown.
- Reparantov and biogenous stimulators. Medicines of this group promote regeneration of a retina. Expediency of use of taurine, sulfatirovanny glikozaminoglikan is proved.
For increase in effect of conservative treatment in the subsharp period or at a chronic course of disease physiotherapeutic procedures are appointed. By means of an electrophoresis calcium chloride, antibacterial means, proteolytic enzymes of a phytogenesis is entered. At a stage of permission of pathology ultrasonic therapy on the party of defeat is used. Regardless of a form of an inflammation use of vitamins of group B, C and PP is shown. At increase in VGD purpose of hypotensive means is expedient.
Forecast and prevention
The forecast depends on an etiology, the immune status of the patient, localization and prevalence of pathological process. In the absence of timely diagnostics and treatment the atrophy of a vascular cover, and also a retina becomes an outcome of a disease that leads to a total blindness. Specific prevention is absent. Nonspecific preventive measures are directed to sanitation of the centers of a focal infection, the prevention of development of infectious and parasitic diseases. At high risk of traumatizing eyes it is necessary to apply individual protection equipment (glasses, a mask).