Cornea ulcer – the destructive process in an eye cornea which is followed by formation of the crateriform ulcer defect. The ulcer of a cornea is followed by sharply expressed corneal syndrome, pain and considerable decrease in sight of the affected eye, turbidity of a cornea. Diagnosis of an ulcer of a cornea is based on data of survey of an eye by means of a slot-hole lamp, conducting instillyatsionny test with flyuorestseiny, a bacteriological and cytologic research of scrapes from a conjunctiva, IFA of plaintive liquid and serum of blood. The principles of treatment of an ulcer of a cornea demand carrying out specific (antiviral, antibacterial, antifungal, anti-parasitic), metabolic, anti-inflammatory, immunomodulatory, hypotensive pharmacotherapy. At threat of perforation of an ulcer of a cornea carrying out a keratoplasty is necessary.
The cornea of an eye has five-layer structure and the endoteliya includes an epitelialny layer, a boumenova a cover, to Strom, a destsemetov a cover and the lower layer. At damage of an epithelium there is a cornea erosion. Speak about an ulcer of a cornea in case destruction of fabrics of a cornea extends more deeply than a boumenovy cover. Ulcer defeats of a cornea are among severe damages of an eye which will difficult respond to treatment in clinical ophthalmology and often lead to considerable violations of visual function, up to a blindness.
As cornea ulcer outcome in all cases serves formation of a hem of a cornea (cataract). Ulcer defect can be localized in any part of a cornea, however defeat of the central area most hard proceeds: it will more difficult respond to treatment, and scarring of this area is always followed by sight loss.
Cornea ulcer reasons
On an etiology of an ulcer of a cornea can have infectious and noninfectious character. Infectious ulcers arise against the background of gerpesvirusny, bacterial, fungal, parasitic damage of a cornea. From a surface of an ulcer of a cornea diplococcuses, streptococci, pneumococci, a sinegnoyny stick, a virus of simple herpes and chicken pox, a mikobakteriya of tuberculosis, an akantameba, fungi, hlamidiya are in most cases allocated staphylococcus. Noninfectious ulcers of a cornea can be caused by immune genesis, a syndrome of a dry eye, primary or secondary dystrophy of a cornea. Development of an ulcer of a cornea requires a combination of a number of conditions: damage of a corneal epithelium, decrease in local resistance, defect colonization by infectious agents.
Refer long carrying contact lenses to the exogenous factors promoting development of an ulcer of a cornea (including use of the polluted solutions and containers for their storage); irrational topichesky pharmacotherapy corticosteroids, anesthetics, antibiotics; use of the polluted eye medicines and tools when holding medical ophthalmologic procedures. In respect of the subsequent developing of an ulcer of a cornea dryness of a cornea, burns of eyes, hit in eyes of foreign matters, fotooftalmiya, mechanical injuries of eyes, earlier carried out surgical interventions on a cornea, etc. are extremely dangerous.
For development of an ulcer of a cornea various violations of the auxiliary device of an eye can be a favorable background: conjunctivitis, trachoma, blefarita, kanalikulit and dakriotsistit, , an eversion or a century, damages of glazodvigatelny and trigeminal craniocereberal nerves. Danger of an ulcer of a cornea exists at any forms of a keratit (allergic, bacterial, virus, meybomiyevy, neurogenetic, nitchaty, chlamydial, etc.), and also not inflammatory defeats of a cornea (a bullous keratopatiya).
Except local factors, in pathogenesis of an ulcer of a cornea the important role belongs to the general diseases and violations: to diabetes, atopic dermatitis, autoimmune diseases (to Shegren's syndrome, rheumatoid arthritis, nodular polyarthritis, etc.), to exhaustion and avitaminosis, immunosupression.
Classification of ulcers of a cornea
By a current and depth of damage of an ulcer of a cornea are classified on sharp and chronic, deep and superficial, neprobodny and probodny. On an arrangement of ulcer defect distinguish a peripheral (regional), paracentral and central ulcer of a cornea.
Depending on a tendency to distribution of ulcer defect to width or in depth allocate the creeping and corroding cornea ulcer. The creeping ulcer of a cornea extends towards one of the edges whereas from other edge defect epitelizirutsya; at the same time there is a deepening of an ulcer to involvement of deep layers of a cornea and an iris, formation of a hypopeony. The creeping ulcer usually develops against the background of infection of microinjuries of a cornea with a pneumococcus, diplobatsilly, sinegnoyny stick. The etiology of the corroding ulcer of a cornea is unknown; it is characterized by formation of several peripheral ulcers which then merge in uniform semi-lunar defect with the subsequent scarring.
Among the main, most often found clinical forms allocate infectious (gerpesvirusny, bacterial, fungal, parasitic, regional infectious and allergic, trakhomatozny) cornea ulcers, and also the noninfectious ulcers of a cornea associated with spring conjunctivitis, system immune diseases, a syndrome of a dry eye, primary dystrophy of a cornea, a recurrent erosion of a cornea.
Cornea ulcer symptoms
The cornea ulcer, as a rule, has unilateral localization. The earliest sign signaling about danger of development of an ulcer of a cornea is eye pain which arises at a stage of an erosion and amplifies in process of progressing of an ulceration. At the same time the expressed corneal syndrome which is followed by plentiful dacryagogue, photophobia, hypostasis a century and blefarospazmy, the mixed injection of vessels of an eye develops.
At a cornea ulcer arrangement in the central area the considerable decrease in sight caused by turbidity of a cornea and the subsequent scarring of defect is noted. A hem on a cornea as the result of ulcer process, can be expressed in various degree - from a gentle scar to a rough cataract.
The clinic of a creeping ulcer of a cornea is characterized by severe pains of the cutting character, dacryagogue, a gnoyetecheniye from an eye, blefarospazmy, hemozy, the mixed eyeball injection. On a cornea infiltrate of yellowish-gray color which, breaking up, forms the crateriform ulcer with regressing and progressing edges is defined. At the expense of the progressing edge the ulcer quickly "creeps away" on a cornea in width and deep into. When involving intraocular structures Irit's joining, an iridotsiklita, a panuveita, an endoftalmita, a panoftalmita is possible.
At a tubercular ulcer of a cornea in an organism there is always primary center of a tuberculosis infection (pulmonary tuberculosis, genital tuberculosis, tuberculosis of kidneys). In this case on a cornea infiltrates with fliktenozny rims which progress further in roundish ulcers are found. The course of a tubercular ulcer of a cornea long, recidivous, followed by formation of rough corneal hems.
Herpetic ulcers are formed on the place of treelike infiltrates of a cornea and have the irregular, branched shape.
The cornea ulceration caused by insufficiency of vitamin A (keratomalyation) develops against the background of milky-white turbidity of a cornea and is not followed by pain. Formation of dry xerotic plaques on a conjunctiva is characteristic. At hypovitaminosis of B2 epithelium dystrophy, a cornea neovaskulyarization, ulcer defects develop.
Cornea ulcer complications
At in due time taken medical measures it is possible to achieve regress of an ulcer of a cornea: clarifications of its surface, the organization of edges, defect fillings with fibrinozny fabric with the subsequent formation of cicatricial turbidity - cataracts.
Rapid progressing of an ulcer of a cornea can lead to defect deepening, formation to a destsemetotsela (gryzhepodobny protrusion of a destsemetovy membrane), perforation of a cornea with infringement of an iris of the eye in the formed opening. Scarring of a probodny ulcer of a cornea is followed by formation of forward sinekhiya and goniosinekhiya which interfere with outflow of VGZh. Over time it can lead to development of secondary glaucoma and an atrophy of an optic nerve.
In case the punched opening in a cornea does not tamponirutsya by an iris, the purulent infection freely gets into a vitreous body, leading to emergence of an endoftalmit or panoftalmit. In the most adverse cases development of phlegmon of an eye-socket, thrombosis of a cavernous bosom, abscess of a brain, meningitis, sepsis is possible.
Diagnosis of an ulcer of a cornea
For detection of an ulcer of a cornea resort to survey of an eye by means of a slot-hole lamp (biomicroscopy), to coloring of a cornea solution of a flyuorestsein (flyuorestseinovy instillyatsionny test). Defect coloring is in bright green color a sign of existence of an ulcer of a cornea. In this case survey allows to reveal even insignificant ulcers of a cornea, to estimate quantity, extensiveness and depth of damages of a cornea.
Reaction of deep structures of an eye and their involvement into inflammatory process are estimated by means of a diafanoskopiya, by gonioskopiya, measurements of VGD, an oftalmoskopiya, ultrasonography of an eye. If necessary the research of function of a slezoproduktion and slezootvedeniye (color plaintive and nasal test, Norn's test, Shirmer's test) is made.
Identification of the etiologichesky factors which caused a cornea ulcer requires a cytologic and bacteriological research of dab from a conjunctiva, definition of immunoglobulins in serum of blood and plaintive liquid, scrape microscopy from a surface and edges of an ulcer of a cornea.
Treatment of an ulcer of a cornea
At an ulcer of a cornea rendering the specialized stationary help under control of the ophthalmologist is necessary. For the purpose of prevention of deepening and expansion of an ulcer of a cornea the defect tushirovaniye by spirit solution of diamond greens or iodic tincture, diatermo-or a lazerkoagulyation of an ulcer surface is made. At an ulcer of the cornea caused dakriotsistity urgent washing of the plaintive and nasal channel or performance of the emergency dakriotsistorinostomiya is necessary for elimination of the purulent center in close proximity to a cornea.
Depending on an etiology of an ulcer of a cornea therapy is appointed specific (antibacterial, antiviral, anti-parasitic, antifungal). Pathogenetic therapy of an ulcer of a cornea includes purpose of midriatik, metabolic, anti-inflammatory, antiallergenic, immunomodulatory, hypotensive medicines. Medicines enter locally - in the form of instillations, mazevy applications, subconjunctival, parabulbarny injections, and also is system - intramuscularly and intravenously.
In process of clarification of an ulcer of a cornea for stimulation of reparative processes and prevention of formation of a rough hem the rassasyvayushchy physical therapy is appointed: magnetotherapy, electrophoresis, .
At threat of a perforation of an ulcer of a cornea carrying out a through or layer-by-layer keratoplasty is shown. After healing of an ulcer eksimerlazerny removal of superficial hems of a cornea can be required.
Forecast and prevention of an ulcer of a cornea
As in the outcome of an ulcer of a cornea permanent turbidity (cataract) is always formed, the prospect for visual function is adverse. In the absence of complications, after subsiding of an inflammation, carrying out an optical keratoplasty for the purpose of sight restoration can be required. At a panoftalmita and phlegmon to an eye-socket danger of loss of an organ of vision is high. Fungal, herpetic and other ulcers of a cornea difficult give in to treatment and have a recidivous current.
For prevention of an ulcer of a cornea it is necessary to avoid eye microinjuries, to follow necessary rules during the using and storage of contact lenses, to carry out preventive antibacterial therapy at threat of infection of a cornea, to carry out treatment of the general and eye diseases at early stages.