Pingvekula is the small formation of yellow color which is localized in a nasal half of a conjunctiva. Depending on diameter can proceed latentno or provoke discomfort, feeling of dryness and a foreign matter, hyperaemia of eyes. Diagnostics of a pingvekula includes carrying out external examination, a fluorescent angiography, biomicroscopy, the ferning-test, OCT. Conservative treatment comes down to application of the moistening drops, ointments, medicines of an artificial tear. Anti-inflammatory and antibacterial therapy is shown at development of secondary complications. In the absence of effect of drug treatment surgical removal of a pingvekula is recommended.
Pingvekula is a disease in ophthalmology which main display is a formation of yellowish consolidation on an orbital conjunctiva. The first data on this pathology are dated 1550 BC. In medical records of ancient Egyptians the pingvekula was described as "fatty deposits in an eye". The disease can proceed separately or to be one of displays of genetically determined disease to Gosha. In 95% of cases the pingvekula is revealed aged from 50 up to 60 years. At long contact of a conjunctiva with the factors provoking development of this pathology emergence of a new growth at the age of 20-30 years is possible. Pingvekulu equally diagnose among persons men's and female. The persons living in conditions of roast and an arid climate are more subject to risk of development of a disease.
The pingvekula etiology is up to the end not studied. As a rule, the disease develops against the background of age or dystrophic changes of a conjunctiva. With age intensity of processes of metabolism decreases that leads to accumulation of products of exchange of fats and proteins in an organism. Decrease in level of a metabolism is associated with development of a pingvekula. Also in pathogenesis of this pathology the degeneration of collagenic fibers in a stromalny part of a conjunctiva with the subsequent reduction of thickness of an epithelium is noted. The trigger of a disease is long influence of ultraviolet rays. UF-radiation stimulates synthesis of a fibroblastama of abnormal fibrillyarny protein (elastin) which aggravates dystrophic changes of a conjunctiva. Therefore people whose work is connected with long stay in the sun enter into risk group.
Besides, development of a pingvekula provokes periodic irritation of a conjunctiva of eyes strong wind, smoke, exhaust gases, toxic evaporations, production chemicals. Some experts believe that the risk of development of pathology increases at long carrying contact lenses. Pingvekula can be formed against the background of traumatic damages of a conjunctiva, cicatricial changes or chronic conjunctivitis. Negative influence of infrared radiation on developing of a disease is proved. At the same time sclero, having the reflecting ability, exponentiates negative influence of infrared and ultra-violet radiation on a conjunctiva and aggravates progressing of a pingvekula.
Pingvekula in 50% of cases is a bilateral disease with localization in the field of medial departments of a conjunctiva. Tendency to slow progressing is noted that is shown by increase in a new growth in a size. The good-quality current is characteristic of pathology. Cases of malignant regeneration of a pingvekula were not observed. As a rule, patients independently find emergence of the small yellow site of consolidation against the background of not changed bulbarny conjunctiva. Development of a disease does not lead to decrease in visual acuity, at the small size does not influence quality of life of patients.
At the initial stages the latent current is characteristic of a pingvekula. Clinical manifestations are noted at increase in diameter of a new growth. Patients show complaints to the discomfort which is followed by feeling of dryness in the affected eye. The periodic irritation of a pingvekula leads to conjunctiva hyperaemia. Patients note feeling of a foreign matter which provokes development of dacryagogue. In rare instances a symptom of a pingvekula is turbidity of a cornea. The long irritation of a zone of consolidation on a conjunctiva leads to emergence of a pingvekulit. Again against the background of this disease conjunctivitis can develop. At formation of defects of trailer arcades of a limb transformation of a pingvekula in is possible. Patients with pingvekulity report that eyes after development of this pathology became more sensitive to dust, at a view of a light source or hit in an eye of firm particles.
Diagnostics of a pingvekula
Diagnostics of a pingvekula is based on anamnestichesky yielded, results of external examination, a fluorescent angiography, biomicroscopy, the ferning-test, the optical coherent tomography (OCT). When carrying out external examination small yellowish formation of rounded shape comes to light. The method of a fluorescent angiography possible to visualize violations in microcirculation of medial department of a conjunctiva. At transformation of a pingvekula in changes in a zone of terminal arcades of a limb are defined. This research indicates passing of a forward tsiliarny artery under a consolidation zone. In the central departments of a pingvekula vessels are a little expressed.
Carrying out biomicroscopy allows to reveal the yellow translucent education which is almost deprived of blood supply. Prelimbalny is characteristic of this pathology, limbalny localization is more rare. At the initial stages of transformation in by method of biomicroscopy it is possible to find insignificant subepitelialny growing of a pingvekula into area of a cornea. When carrying out OCT the form, the size, extent of introduction in underlying structures of an eye is defined. At transformation in subepitelialny growth of a stroma of a conjunctiva which passes into a cornea in the direction of a boumenovy membrane is noted. Results of the ferning-test indicate presence of abnormal components at the plaintive film covering a pingvekula. Differential diagnostics is carried out with a limbalny sarkoidny small knot.
Treatment of a pingvekula
At an asymptomatic current of a pingvekula therapy is not required. In the presence of discomfort, complaints to dryness, hyperaemia and feeling of a foreign matter conservative treatment is recommended. In the absence of signs of an inflammation and existence only local application of the moistening means is shown to dryness. At development of hyperaemia of a pingvekula or surrounding conjunctiva local purpose of anti-inflammatory or antibacterial drops is necessary. During treatment it is necessary to refuse carrying contact lenses as they in addition injure a conjunctiva and a cornea.
Expeditious removal of a pingvekula is carried out in case of lack of effect of conservative therapy, frequent development of a pingvekulit, secondary conjunctivitis, transformation signs in . Besides, resort to surgical intervention at patients with the asymptomatic course of pathology for elimination of cosmetic defect. Operation on removal of a pingvekula is performed under regional anesthesia by means of the excimer laser. In the postoperative period it is recommended to use sterile bandages on the operated eye. The purpose of a bandage is protection of an organ of vision against ultra-violet radiation, dust, toxins and other substances which irritate eyes and can lead to repeated formation of a pingvekula. After performing surgery the disease is not inclined to a retsidivirovaniye.
Forecast and prevention of a pingvekula
For prevention of development of a pingvekula it is recommended to wear sunglasses at long stay in the sun. Patients should normalize a metabolism by correction of a diet. At accommodation in the territory with arid and hot climate it is necessary to moisten eyes with special drops, ointments or medicines of an artificial tear. At emergence of discomfort or accession of secondary complications of a pingvekula it is necessary to address for consultation the ophthalmologist. At the expert all patients with the advent of neoplaziya on a conjunctiva surface for establishment of the diagnosis and the choice of tactics of treatment are surveyed.
The forecast for life and working capacity at the pingvekul favorable. As a rule, this new growth does not influence quality of life of patients and does not lead to decrease in visual acuity.