Conjunctivitis – polietiologichesky inflammatory defeat of a conjunctiva – the mucous membrane covering an internal surface a century and to a skler. Various forms of conjunctivitis proceed with hyperaemia and hypostasis of transitional folds and a century, mucous or purulent separated from eyes, dacryagogue, burning and an itch in eyes etc. Diagnosis of conjunctivitis is carried out by the ophthalmologist and includes: external examination, biomicroscopy, conducting instillyatsionny test with flyuorestseiny, a bacteriological research of dab from a conjunctiva, a cytologic, immunofluorescent, immunofermental research of scrape from a conjunctiva, additional consultations (the infectiologist, the dermatovenerologist, the ENT SPECIALIST, the phthisiatrician, the allergist) according to indications. Treatment of conjunctivitis mainly local medicamentous with application of eye drops and ointments, washing of a conjunctival bag, subconjunctival injections.
Konjyuktivita are the most widespread diseases of eyes - they make about 30% of all eye pathology. Frequency of inflammatory defeat of a conjunctiva is connected with its high reactivity on different exogenous and endogenous factors, and also availability of a conjunctival cavity to adverse external effects. The term "conjunctivitis" in ophthalmology the diverse diseases proceeding with inflammatory changes mucous an eye unite etiologichesk. The course of conjunctivitis can be complicated blefarity, keratity, by a syndrome of a dry eye, entropiony, scarring a century and corneas, perforation of a cornea, a hypopeony, decrease in visual acuity, etc.
The conjunctiva performs protective function and owing to the anatomic situation constantly contacts to a set of external irritants – dust particles, air, microbic agents, chemical and temperature influences, bright light etc. Normal the conjunctiva has a smooth, damp surface, pink color; it is transparent, through it illuminate vessels and meybomiyeva of gland; the conjunctival secret reminds a tear. At conjunctivitis mucous gets a turbidity, a roughness, on it hems can be formed.
All conjunctivitis shares on exogenous and endogenous. Endogenous defeats of a conjunctiva are secondary, arising against the background of other diseases (natural and chicken pox, a rubella, measles, hemorrhagic fever, tuberculosis etc.). Exogenous conjunctivitis arises as independent pathology at direct contact of a conjunctiva with the etiologichesky agent.
Depending on a current distinguish chronic, subsharp and sharp conjunctivitis. In a clinical form conjunctivitis can be catarrhal, purulent, fibrinozny (filmy), follicular.
Because of an inflammation allocate:
- conjunctivitis of a bacterial etiology (pnevmokokkovy, diphtheritic, diplobatsillyarny, gonokokkovy (), etc.)
- conjunctivitis of a chlamydial etiology (paratrachoma, trachoma)
- conjunctivitis of a virus etiology (adenoviral, herpetic, at viral infections, a contagious mollusk and so forth)
- conjunctivitis of a fungal etiology (at actinomycosis, a sporotrikhoza, a rinosporodioza, a koktsidioza, aspergillomycosis, candidiasis, etc.)
- conjunctivitis of an allergic and autoimmune etiology (at a pollinoza, spring Qatar, a puzyrchatka of a conjunctiva, atopic eczema, a demodekoza, gout, a sarkoidoza, psoriasis, a syndrome of Reuters)
- conjunctivitis of a traumatic etiology (thermal, chemical)
- metastatic conjunctivitis at the general diseases.
- Bacterial conjunctivitis, as a rule, arises at infection with a contact and household way. At the same time on mucous bacteria which are normal small begin to breed or are not a part of normal conjunctival microflora at all. The toxins emitted by bacteria cause the expressed inflammatory reaction. Most often as causative agents of bacterial conjunctivitis pneumococci, streptococci, a sinegnoyny stick, colibacillus, a klebsiyella, proteas, a tuberculosis mikobakteriya act staphylococcus. In some cases infection of eyes with causative agents of gonorrhea, syphilis, diphtheria is possible.
- Viral conjunctivitis can be transmitted in the contact and household or airborne way and is highly infectious diseases. Sharp faringokonjyunktivalny fever is caused by adenoviruses 3, 4, 7 types; epidemic keratokonjyunktivita - adenoviruses of 8 and 19 types. Viral conjunctivitis can be connected etiologichesk with viruses of simple herpes, the surrounding herpes, chicken pox, measles, enteroviruses, etc.
- Viral and bacterial conjunctivitis at children often accompanies nasopharynx diseases, otitises, sinusitis. At adults conjunctivitis can develop against the background of a chronic blefarit, a dakriotsistit, a syndrome of a dry eye.
- Development of chlamydial conjunctivitis of newborns is connected with infection of the child in process passing in patrimonial ways of mother. At sexually active women and men chlamydial damage of eyes is often combined with diseases of urinogenital system (at men – with uretrity, prostatitis, an epididymite, at women — with tservitsity, vaginity).
- Fungal conjunctivitis can be caused by actinomycetes, mold, drozhzhepodobny and other types of fungi.
- Allergic conjunctivitis is caused by hypersensitivity of an organism to any anti-gene and in most cases serves as local manifestation of system allergic reaction. As the reasons of allergic manifestations medicines, alimentary (food) factors, helminths, household chemicals, pollen of plants, a tick and so forth can act.
- Noninfectious conjunctivitis can arise at irritation of eyes chemical and physical factors, smoke (including tobacco), dust, ultraviolet; metabolic disorders, avitaminosis, ametropiya (far-sightedness, short-sightedness) etc.
Specific displays of conjunctivitis depend on an etiologichesky form of a disease. Nevertheless, the course of conjunctivitis of various genesis is characterized by a number of the general signs. Treat them: puffiness and hyperaemia mucous century and transitional folds; allocation of a mucous or purulent secret from eyes; itch, burning, dacryagogue; feeling of "sand" or a foreign matter in an eye; photophobia, . As often main symptom of conjunctivitis serves the impossibility to open eyelids in the mornings in view of their pasting the dried-up separated. At development of an adenoviral or ulcer keratit decrease in visual acuity is possible. At conjunctivitis both eyes, as a rule, are surprised: sometimes the inflammation arises in them serially and proceeds with different degree of expressiveness.
Sharp conjunctivitis demonstrates suddenly from pain and gripes in eyes. Against the background of hyperaemia of a conjunctiva gemorragiya are quite often noted. The conjunctival injection of eyeballs, hypostasis mucous are expressed; from eyes the plentiful mucous, mucopurulent or purulent secret is allocated. At sharp conjunctivitis the general health is often broken: there is an indisposition, a headache, body temperature increases. Sharp conjunctivitis can proceed from one to two-three weeks.
Subsharp conjunctivitis is characterized by less expressed symptomatology, than a sharp form of a disease. Development of chronic conjunctivitis happens gradually, and the current has persistent and long character. The discomfort and feelings of a foreign matter in eyes, bystry fatigue of eyes, moderate hyperaemia and friability of a conjunctiva which takes a velvety form are noted. Against the background of chronic conjunctivitis quite often develops keratit.
Serves as specific display of conjunctivitis of a bacterial etiology purulent opaque viscous separated yellowish or greenish color. The pain syndrome, dryness of eyes and integuments of okologlaznichny area is noted.
Viral conjunctivitis often proceeds against the background of upper respiratory tract infections and is followed by moderate dacryagogue, a photophobia and blefarospazmy, the poor mucous separated, submaxillary or parotid lymphadenitis. At some types of virus damages of eyes on mucous an eye follicles (follicular conjunctivitis) or pseudo-membranes (filmy conjunctivitis) are formed.
Allergic conjunctivitis, as a rule, proceeds with a severe itch, eye pain, dacryagogue, hypostasis a century, sometimes – allergic rhinitis and cough, atopic eczema.
Features of clinic of fungal conjunctivitis are defined by a type of a fungus. At actinomycosis catarrhal or purulent conjunctivitis develops; at a blastomikoza – filmy with the grayish or yellowish easily removed films. Formation of the small knots consisting of a congestion of epitelioidny and lymphoid cages is characteristic of a kandidamikoz; aspergillomycosis proceeds with hyperaemia of a conjunctiva and defeat of a cornea.
At the conjunctivitis caused by toxic influences of chemicals there are severe pains when moving a look, blinking, attempt to open or close eyes.
Diagnosis of conjunctivitis is carried out by the ophthalmologist on the basis of complaints and clinical manifestations. Data of the anamnesis are important for clarification of an etiology of conjunctivitis: contact with patients, allergens, the available diseases, connection with change of a season, impact of a sunlight, etc. External examination reveals hyperaemia and hypostasis of a conjunctiva, an eyeball injection, existence of separated.
For establishment of an etiology of conjunctivitis laboratory analyses are carried out: a cytologic research of scrape or dab print, a bacteriological research of dab from a conjunctiva, definition of a caption of antibodies (IgA and IgG) to the estimated activator in plaintive liquid or serum of blood, a research on . At allergic conjunctivitis resort to conducting skin and allergic, nasal, conjunctival, hypoglossal tests.
At detection of conjunctivitis of a specific etiology consultation of the infectiologist, venereologist, phthisiatrician can be required; at an allergic form of a disease – the allergist; at virus – the otolaryngologist. From special ophthalmologic methods of inspection at conjunctivitis the eye biomicroscopy, flyuorestseinovy instillyatsionny test, etc. is used.
Differential diagnosis of conjunctivitis is carried out with episklerity and sklerity, keratity, uveita (Irit, iridotsiklity, horioidity), a bad attack of glaucoma, a foreign matter of an eye, kanalikulyarny obstruction at a dakriotsistita.
Treatment of conjunctivitis
The scheme of therapy of conjunctivitis is appointed by the ophthalmologist taking into account the activator, sharpness of process, the available complications. Topichesky treatment of conjunctivitis demands frequent washing of a conjunctival cavity medicinal solutions, instillations of medicines, a mortgaging of eye ointments, performance of subconjunctival injections.
At conjunctivitis it is forbidden to apply bandages as they worsen evacuation of separated eyes and can promote development of a keratit. For an exception of an autoinfitsirovaniye it is recommended to a thicket to wash hands, to use disposable towels and napkins, separate pipettes and eye sticks for each eye.
Before introduction of medicines to a conjunctival cavity local anesthesia of an eyeball by novocaine solutions (lidocaine, a trimekain), then – a toilet of ciliary edges a century, conjunctivas and an eyeball antiseptics (solution of Furacilin, margantsovo-sour potassium) is carried out. Before obtaining data on a conjunctivitis etiology in eyes instillirut eye drops of 30% of solution of a sulfatsetamid, for the night put eye ointment.
At identification of a bacterial etiology of conjunctivitis locally apply gentamycin sulfate in the form of drops and eye ointment, eritromitsinovy eye ointment. For treatment of viral conjunctivitis use virusostatichesky and virusotsidny means: , , leykotsitarny interferon in the form of instillations and an acyclovir – locally, in the form of ointment, and orally. For prevention of accession of a bacterial infection antimicrobic medicines can be appointed.
At detection of chlamydial conjunctivitis, except local treatment, system reception of doxycycline, a tetratsiklin or erythromycin is shown. Therapy of allergic conjunctivitis includes purpose of vasoconstrictive and antihistaminic drops, corticosteroids, slezozamenitel, reception of the desensibilizing medicines. At conjunctivitis of a fungal etiology antimikotichesky ointments and instillations are appointed (, nystatin, In, etc.).
Timely and adequate therapy of conjunctivitis allows to achieve recovery without consequences for visual function. In case of secondary defeat of a cornea sight can decrease. The main prevention of conjunctivitis – implementation of sanitary and hygienic requirements in medical and educational institutions, respect for standards of personal hygiene, timely isolation of patients with virus defeats, holding anti-epidemic actions.
The prevention of developing of chlamydial and gonokokkovy conjunctivitis at newborns provides treatment of a chlamydial infection and gonorrhea at pregnant women. At tendency to allergic conjunctivitis the preventive local and general desensibilizing therapy on the eve of an estimated aggravation is necessary.