centuries – anomaly of an arrangement of a century at which there is a traumatizing a conjunctiva and cornea by its resnitchaty region. Clinically the disease is shown by feeling of a foreign matter, dacryagogue, photophobia and painful feelings which amplify during the blinking or a smykaniye of eyes. The diagnosis is established on the basis of data of the anamnesis, objective inspection, a vizometriya and biomicroscopy. Specific treatment comes down to carrying out a blefaroplastika. Conservative therapy is effective only at early stages and includes use of medicines of an artificial tear, gels and ointments for moistening of a conjunctiva and a cornea.
Entropion – the disease which is characterized by the wrong provision of a century at which eyelashes are turned to an eyeball. In ophthalmology a lower eyelid the zavorota of an upper eyelid meets much more often. The disease is widespread among elderly people. Racial or sexual predisposition is not noted. The congenital form meets only in total other genetic anomalies at Larsen's syndrome or against the background of a congenital mikroftalmiya. Pathology seldom leads to total decrease in visual acuity and an invalidization of patients, but causes daily discomfort and becomes the reason of the expressed cosmetic defect. Along with growth of number of patients with medicinal hypersensitivity the increasing distribution gets centuries at Layell's syndrome and Stephens-Johnson's syndrome.
Reasons of a zavorot of a century
The most common cause of an entropion in old age – an involutional degeneration of muscular and connecting tissue. After 60 years orbital fat intensively collects, and skin loses elastichesky properties therefore even the usual smykaniye of eyes can provoke an abnormal arrangement of a century. Congenital is a consequence of spastic reduction of a circular muscle of an eye or deformation of a cartilage. At a spasm of a circular muscle the resnitchaty edge is displaced towards an eyeball. Horizontal deformation arises at a spasm of a bunch of Riolan. Normal this anatomical structure owing to a high tone provides a dense prileganiye of a century, spastic reduction strengthens influence even more and provokes . The abnormal hyper tone of a ciliary muscle meets at early children's age more often. Congenital comes to light in total with other manifestations (a gipertelorizm, multiple dislocations, violations of a structure of a skeleton) of Larsen's syndrome, point more than 5 stigmata of a dizembriogenez to the genetic nature of a disease. Also the eyelid can be wrapped inside at a mikroftalma.
Acquired develops against the background of a toxic epidermalny nekroliz or a malignant ekssudativny eritema which in most cases become manifestation of medicinal hypersensitivity. Chronic conjunctivitis – one of the reasons of periodic irritation of a muscular bunch of Riolan provoking his spastic reductions. The expressed spasm leads to a cartilage reversing towards an eyeball. Besides, as etiologichesky factors of an entropion hems a century, damages of a conjunctiva as a result of a mechanical injury of an eye, a chemical or thermal burn can act.
Symptoms of a zavorot of a century
Distinguish cicatricial, involutional (spastic, atonichesky) and congenital . The clinical picture of a zavorot of a century at all forms has similar manifestations, features of a current are defined by pathology type. Continuous friction of eyelashes becomes a starting factor of development of all symptoms of a disease. At contact of resnitchaty edge of a century with a conjunctiva her irritation with the subsequent hypostasis, the expressed hyperaemia and microscopic damages increases. Most of patients has a feeling of a foreign matter in an eye. One more early symptom is dacryagogue which develops both owing to mechanical friction of eyelashes, and because of violation of a normal way of hypostasis of plaintive liquid. Damage of a cornea is demonstrated by emergence of a photophobia. Symptoms of a disease accrue during the blinking and a zazhmurivaniye of eyes.
Patients with a cicatricial zavorot of a century point to traumatic damages or burns, is more rare – on conjunctivitis in the anamnesis. These factors become the reason of formation of hems between a conjunctiva and a century. The disease develops gradually. Usually the eyelid takes a form of a convex kpereda of an arch, and the resnitchaty edge is wrapped inside and constantly injures an eye. Degree of expressiveness of clinical manifestations depends on a location and the size of a hem, even small defects lead to the expressed discomfort.
The main difference of an involutional entropion from other forms – lack of cicatricial unions. At a spastic zavorot in a disease debut patients can independently return normal situation to resnitchaty edge. Symptoms amplify at an intensive smykaniye of eyes. The long course of pathology leads to formation of valikoobrazny consolidation of a circular muscle of an eye in the field of a tarzalny plate. Feature of an atonichesky zavorot is what the bottom edge of a century prolabirut forward while top is turned to an eyeball. Clinically the disease reminds .
centuries at Stephens-Johnson and Layell's syndromes is followed expressed blefarospazmy and photophobia. The symptomatology is caused by an epidermis dysplasia a century with its subsequent increase on a back edge and a surface a century. Severe forms of a disease lead to a cicatricial union of a bulbarny and palpebralny conjunctiva, perhaps full zarashcheniye of plaintive points. Progressing of a zavorot of a century becomes the reason of development of secondary chronic conjunctivitis. In the subsequent at damage of a cornea the keratopatiya develops, dot erosive defects appear. In the absence of timely treatment the minimum dystrophic manifestations are replaced by an ulcer keratit and formation of a cataract. Growing of neogenic vessels into a cornea leads to decrease in visual acuity.
Diagnostics of a zavorot of a century
Diagnostics of a zavorot of a century is based on data on the anamnesis of life and a disease, data of objective survey, a vizometriya and biomicroscopy. Anamnestichesky data can indicate injuries, burns a century or medicinal hypersensitivity. In some cases the burdened heredity on an abnormal arrangement comes to light a century. At external examination centuries towards an eyeball, hyperaemia and hypostasis of a conjunctiva, the expressed dacryagogue are defined . Skin around eyes is angry, hyperemic.
At biomicroscopy of an eye erosive defects of a cornea, damage of a bulbarny conjunctiva, union between bulbarny and palpebralny departments are visualized. For more accurate visualization of defects carrying out biomicroscopy with fluorescein is recommended. The plaintive film is, as a rule, unstable that is confirmed at additional conducting test of Norn. Visual acuity is defined by method of a viziometriya. Decrease in this indicator happens only at intensive growing of neogenic vessels and at the zavorot a century complicated by turbidity of a cornea in the form of a cataract.
Treatment of a zavorot of a century
Specific treatment of a zavorot of a century comes down to carrying out a blefaroplastika. In the preoperative period use of special leykoplastyrny bandages for prevention of intraoperative complications is shown. At early stages of a disease imposing of P-shaped seams from the site of integuments under resnitchaty edge to the lower departments of a tarzalny plate is recommended. These measures provide the correct anatomic provision of a century, the effect remains for 3-4 months. Technology of surgery at a spastic entropion assumes carrying out a small section of a circular muscle of an eye in pretarzalny area or full excision of a muscular bunch of Riolan. At an atonichesky form it is necessary to remove the triangular site of a tarzalny plate together with adjacent layers of muscles and integuments. This technique provides fixing of a century in horizontal position.
At a cicatricial entropion it is necessary to replace a small part of a mucous membrane to the area of a back edge of a century or an intercostal zone (Sapezhko's method). The surgery technique across Uis is ineffective as it in most cases leads to repeated formation of a keloidny hem. For elimination of a zavorot of a century after a trauma or a burn it is necessary to carry out reconstruction of a back plate of a century with the subsequent change of own mucous membrane from lips to the damaged sites. This equipment is also recommended at Layell and Stephens-Johnson's syndromes.
Conservative treatment is based on daily use of medicines of an artificial tear, the gels containing and eye ointments for the night (alternation of tiaminovy ointment with antibacterial means). At a spastic entropion at early stages it is recommended to carry out instillations of topichesky anesthetics. Medicamentous therapy is incapable to eliminate organic pathology a century and is used only at early stages for decrease in clinical displays of pathology.
Forecast and prevention of a zavorot of a century
The forecast at a zavorota of a century in case of timely treatment for life and working capacity favorable. Only irreversible damages of a cornea (formation of a cataract, growing of neogenic vessels) lead to decrease in visual acuity. At the entropiyena, created as a result of a toxic epidermalny nekroliz or a malignant ekssudativny eritema, the forecast doubtful.
Specific measures for prevention of a zavorot of a century it is not developed. For the prevention of further progressing of pathology it is necessary to observe hygiene a century, to carry out their timely moistening together with moistening of a conjunctiva and cornea. At early stages of a disease survey at the ophthalmologist with a frequency of 2 times a year is shown. An obligatory stage of inspection is carrying out biomicroscopy of eyes.