Sklerit - it is inflammatory process which strikes all thickness of an external soyedinitelnotkanny cover of an eyeball. It is clinically shown by hyperaemia, an injection of vessels, hypostasis, morbidity at a palpation of a zone of defeat or the movements of an eyeball. Diagnostics of a sklerit comes down to carrying out external examination, biomicroscopy, an oftalmoskopiya, vizometriya, tonometriya, fluorescent angiography, ultrasonography (BRIDLES) in the V-mode, a computer tomography. Depending on a disease form the scheme of treatment includes local or system application of glucocorticoids and antibacterial means. At a purulent sklerit opening of abscess is shown.
Sklerit - it is the inflammatory disease skler which is characterized by slowly progressing current. Among all forms forward is most widespread sklerit (98%). Defeat of back departments skler is observed only at 2% of patients. Options of a course of pathology without necrosis prevail over nekrotiziruyushchy that is associated with the favorable forecast. At rheumatoid and jet chlamydial arthritises diffusion options of a disease are widespread. In 86% of cases of an ankiloziruyushchy spondilit diagnose nodular sklerit. At 40-50% of patients pathological changes skler are combined with damage of joints of inflammatory genesis, and in 5-10% of cases accompanies arthritis sklerit. The disease meets at female persons (73%) more often. The peak of incidence is the share of age from 34 to 56 years. At children pathology is observed twice less often.
Reasons of a sklerit
The etiology of a sklerit is directly connected with system diseases in the anamnesis. Skler are defeat triggers rheumatoid arthritis, Wegener, juvenile idiopathic, jet chlamydial or psoriatichesky arthritis, nodular polyarthritis, ankiloziruyushchy spondilit also the polychondrite which is characterized by a recidivous current. Less often this pathology develops in the postoperative period after expeditious removal of a pterigium or traumatic damage. Clinical cases of an infectious sklerit at patients with vitreoretinalny surgical intervention in the anamnesis are described.
The process dissemination from an ulceration zone on a cornea often leads to a sklerit of an infectious etiology. Also the inflammation of additional bosoms of a nose can be a source of an infection. The most widespread causative agents of a disease are the sinegnoyny stick, a virus Varitsella-Zoster and golden staphylococcus. In rare instances sklerit has a fungal origin. Medicamentous defeat skler develops at reception of a mitomitsin of Page more often. Risk factors – bone and articulate forms of tuberculosis in the anamnesis, system inflammatory diseases.
Symptoms of a sklerit
From the clinical point of view in ophthalmology allocate forward (not nekrotiziruyushchiya, nekrotiziruyushchiya), back and purulent sklerit. Not nekrotiziruyushchy defeat skler happens diffusion or nodular. Nekrotiziruyushchy can be followed or not be followed by inflammatory process. In some cases the current of a sklerit is characterized by the short-term independently stopping episodes. At the same time, pathological process in a skler provokes its necrosis with involvement of the subject structures. For this disease the sharp beginning is peculiar, slow options are less often observed. At a diffusion sklerit all forward department of an external soyedinitelnotkanny cover of an eyeball is involved in inflammatory process. Nodular defeat is followed by decrease in visual acuity.
For a forward sklerit slowly progressing current is peculiar. This form is followed by binocular damage of an organ of vision. Patients note the expressed morbidity at a contact to a hypostasis projection zone, photophobia. The long course of a disease leads to defeat skler on a limb circle (ring-shaped sklerit) and emergence of a heavy keratit, Irit or an iridotsiklit. At a purulent sklerit the rupture of covers of abscess is possible that it leads to Irit's development or a hypopeony.
At necrotic defeat skler patients note the accruing pain which becomes further a constant, irradiates to the temporal area, a nadbrovny arch and a jaw. The pain syndrome is not stopped by reception of analgetics. Nekrotiziruyushchy sklerit is complicated by a perforation skler, endoftalmity or panoftalmity. At a back form of pathology patients show complaints to morbidity at the movement of an eyeball, restriction of its mobility. Postoperative sklerit develops for 6 months after surgical intervention. At the same time the site of a local inflammation which is replaced by a necrosis is formed. Decrease in visual acuity is observed only at distribution of inflammatory process on adjacent structures of an eyeball or development of secondary glaucoma.
Diagnostics of a sklerit
Diagnostics of a sklerit includes carrying out external examination, biomicroscopy, an oftalmoskopiya, vizometriya, tonometriya, fluorescent angiography, ultrasonography (BRIDLES) in the V-mode, a computer tomography. At external examination of patients with lobbies sklerity puffiness, hyperaemia and an injection of vessels is found. The zone of hypostasis has the outlined borders. At a palpatorny research morbidity is noted. Carrying out biomicroscopy at a "jellylike" sklerit allows to reveal a zone of an overhang of a hemozirovanny conjunctiva over a limb. This site has a red-brown shade and a zhelatinopodobny consistence. On the surface of a cornea it is possible to find infiltrates with the expressed vaskulyarization. Violation of the physiological radial direction of the vascular drawing decides on a slot-hole lamp at a diffusion sklerit by a biomicroscopy method. At a nodular form carrying out a viziometriya indicates decrease in visual acuity.
At a purulent sklerit external examination allows to reveal purulent infiltrate and an injection of vessels. Defeat of back departments skler is followed by puffiness a century, conjunctivas and an insignificant ekzoftalm. The pro-mining of a disk of an optic nerve, a subretinalny lipidic ekssudation, the peeling of a retina and a horioidea caused by an exudate congestion is defined by method of an oftalmoskopiya. Ultrasonography in the V-mode indicates a thickening of a back part of an external soyedinitelnotkanny cover of an eyeball, an exudate congestion in tenonovy space. Change of thickness skler can also be confirmed by means of KT.
At a nekrotiziruyushchy sklerit by means of a fluorescent angiography the course, sites of occlusion of vessels, avaskulyarny zones is defined wavy. Carrying out biomicroscopy with a slot-hole lamp allows to visualize necrotic changes skler, an ulceration of an adjacent conjunctiva. In dynamics expansion of a zone of a necrosis is found. By a tonometriya method at patients with sklerity increase in intraocular pressure (more than 20 mm Hg) often comes to light.
Treatment of a sklerit
The scheme of treatment of a sklerit includes local use of glucocorticoid and antibacterial drops for instillation. If the disease is followed by the increased intraocular pressure, then the complex of therapy needs to be added with topichesky hypotensive means. The course of treatment includes reception of nonsteroid anti-inflammatory medicines. At their intolerance purpose of medicines from group of glucocorticosteroids is recommended. At a sklerita without necrotic defeat it is necessary to inject glucocorticoids and antibacterial drugs in the form of subconjunctival injections. An alternative to this method of introduction is reception of the prolonged forms of glucocorticoids.
At development of a necrosis skler the combined therapy is shown by glucocorticosteroids and immunodepressants. In cases of emergence of allergic reaction in parallel with these medicines the antiallergic and desensibilizing medicines are applied. At a purulent form of a sklerit tactics of treatment comes down to performing massive antibacterial therapy. At the same time oral and subconjunctival ways of introduction of medicines from group of ftorkhinolon, aminoglycosides and semi-synthetic penicillin are used. An additional way of introduction – an electrophoresis. In the absence of effect of medicamentous therapy surgical opening of abscess is shown. Also it is necessary to include medicines for treatment of the main pathology against the background of which developed in the scheme of treatment sklerit. If an etiologichesky factor are tuberculosis mikobakteriya, antitubercular means for local application are considered as auxiliary.
Forecast and prevention of a sklerit
Specific prevention of a sklerit it is not developed. Nonspecific preventive measures come down to timely treatment of the main pathology, prevention of an inflammation of additional bosoms of a nose (sinusitis), observance of rules of an asepsis and antiseptics during performing surgeries. To patients with system diseases in the anamnesis it is necessary to have 2 times a year examination at the ophthalmologist. The forecast for life and working capacity depends on timeliness of diagnosis, adequacy of treatment, a type of the activator at infectious defeat and disease forms. Optimum option are diffusion forms of a disease. The adverse forecast is characteristic of the sklerit caused by a sinegnoyny stick more often.