Keratitis - Causes, symptoms and treatment. MF.

Keratitis - inflammation of the cornea of ​​the eye, resulting from injuries, infections or allergies, manifested by its turbidity and decreased visual acuity.

Causes of keratitis:

- infections( viral, bacterial, fungal, protozoa)
- contact lens wear
- corneal injuries
- allergy
- photokeratitis( in welders)
- hypotension and beriberi
- nerve damage in case of damage to 1 branchtrigeminal nerve.

Symptoms of keratitis

Keratitis is characterized by the so-called corneal syndrome , which includes a triad of symptoms: lacrimation, photophobia, blepharospasm ( involuntary closing of the eyelids).Due to good innervation of the cornea of ​​the eye, there are constant pain in the eye and sensation of the foreign body, the patient can not open the eye. There is a pericorneal( around the cornea) or a mixed injection. In the anterior chamber there may be pus( hypopion).Precipitates appear on the posterior epithelium( they consist of lymphocytes, macrophages, plasma cells, pigmentary "dust" floating freely in the chamber moisture, all these elements stick together and settle on the posterior surface of the cornea).Reduces visual acuity in the formation of

turbidity in the optical zone.

The keratites can be superficial( the epithelium and the Bowman membrane are damaged) and deep( the following corneal layers-the stroma and descemet's membrane-are involved in the inflammatory process).

Depending on the localization of the inflammatory process, central and peripheral, limited and diffuse keratitis are isolated. According to the morphology of opacification distinguish point, coin-like, tree-like. They are distinguished externally in shape, size and location of the inflammation of the cornea.

Asiologically( depending on the cause of keratitis),

- exogenous ( viral, bacterial, fungal, caused by protozoa, traumatic, with eyelid and conjunctival diseases, lacrimal passages)

Traumatic keratitis

- endogenous ( chronic infections, such as herpes, syphilis, tuberculosis, metabolic disorders, autoimmune and rheumatic diseases, allergies).

Endogenous keratitis

The causative agent of keratitis is often the herpes virus .Thus on a cornea there is a tree-like opacity, the corneal syndrome is sharply expressed. Characterized by severe pain. The sensitivity of the cornea is reduced in unaffected areas.

When wearing contact, acanthamoebic keratitis may occur. Its causes: washing containers with tap water, bathing in dirty water, violation of hygiene rules. Characteristically lingering flow with severe pain.

Acanthamoeic keratitis

Traumatic keratitis occurs due to the attachment of a secondary infection, more often bacterial. Characteristic of all signs of inflammation. On the cornea, an infiltrate is formed, and then an ulcer that spreads not only over the area but also deep inside, often reaches the Descemet's membrane and possibly perforation.

With allergic keratitis , long-term inflammation results in corneal opacification. Often this diagnosis has to be differentiated from allergic conjunctivitis.

In case of damage( more than trauma) 1 of the trigeminal nerve of , the innervation of the cornea( loss of sensitivity until complete loss of it) can occur and neuroparalytic keratitis may occur. The same pathology is possible with lagophthalmus( complete or incomplete unlocking of the eye gap).The only symptoms are pain and decreased visual acuity. The infiltrate turns into an ulcer, which spreads very quickly and is difficult to treat.

With hypo- and avitaminosis B1, B2, PP , it is possible to develop keratitis, which often has bilateral localization.

Symptoms may be mild;some keratitis have a slow course. When flaccid and chronic inflammation in the cornea appear vessels.

If you notice any of the following, seek medical attention immediately:

- pain in the eye
- lacrimation
- foreign body sensation
- inability to open the eye
- redness of the eye

Self-diagnosis is not permissible becauseonly an expert can make the correct diagnosis.

Diagnosis of keratitis

The doctor performs the following diagnostic methods:

- external examination,
- visual acuity check,
- eyelid rotation is necessary to eliminate foreign body,
- biomicroscopy( examination of eye media with a microscope),
- corneal staining with fluorescin( forbetter visualization of the degree of damage to the cornea),
- analgesimetry( definition of pain sensitivity).

Microscopy and seeding of fingerprints from the cornea, detection of antibodies to the herpes virus( ELISA, PCR), blood on RW, rheumatological tests, fluorography, intradermal allergic tests are of great importance in diagnosis.

It is mandatory to investigate the lacrimal pathways and to sanitize them if necessary.

To exclude foci of focal infection, the patient is advised by an ENT, a dentist. In the presence of endogenous causes it is necessary to visit a therapist, rheumatologist, gynecologist or urologist, allergist, venereologist, phthisiatrist.

Treatment of keratitis

Treatment of keratitis should be local and general, most often it is carried out in a hospital. Perhaps outpatient treatment under the supervision of a doctor and with all the recommendations, but only if the inflammation is superficial. Self-medication leads to complications.

General for all keratitis:

- detoxification therapy( rheosorbylact 200.0 intravenously drip),
- inside or parenterally antibiotics, antiviral and antifungal drugs depending on the type and sensitivity,
- desensitizing therapy( calcium gluconate 10% added to dropper),
- multivitamins 1 tablet 1-2 times a day.

Local keratitis treatment:

- Instill disinfectants( sulfacil sodium 20%, miramistin) and antibacterial drops( Floxal, Tobrex, Oftakwix) first every 2 hours, then 4 times a day.
- If the epithelium is not damaged, drops containing hormones( Oftan-Dexamethasone, Maxix) 2 times a day are instilled.
- With viral keratitis, drops containing interferon( Okoferon) 5 times a day or Oftan-go( first every hour, lowering the dose up to 3 times a day).
- Anti-inflammatory drops( Naklof, Indocollir) every 4-6 hours.
- Mideatics( dilate the pupil to prevent the formation of adhesions) - tropicamide, mezaton, atropine.
Between the instillation of different drops should be a gap of at least 5-10 minutes.
Good effect from subconjunctival( mydriatica - mezaton) and parabulbar( antibiotics - gentamicin, cefazolin, and hormones - dexon) injections.
- Korneregel 2-3 times a day helps accelerate the epithelialization of the cornea.
- Ointment Zovirax 5 times a day with herpetic keratitis. With herpetic keratitis still take acyclovir orally 200 mg 5 times a day for 7-10 days.

If infected with tear ducts, they are daily washed with 0.25% solution of levomycetin, 0.01% miramistin or furatsilinom 1: 5000

In keratitis with a violation of innervation, frequent ointment( erythromycin 1%, tetracycline 1%, floxal) and eliminationcauses the development of neuroparalytic inflammation of the cornea.

For acceleration of epithelialization and resorption of scars, physiotherapy is prescribed: electrophonophoresis, magnetotherapy.

With prolonged course of herpetic keratitis, it is possible to use such treatment methods as cryotherapy, laser coagulation or diathermocoagulation of damaged areas.

Recommended diet with increased content of proteins, vitamins and trace elements, restriction of fats and carbohydrates.

Complications of keratitis

Treatment of keratitis should be comprehensive and timely in order to prevent the development of such formidable complications as corneal perforation, iridocyclitis( inflammation of the choroid), scleritis, endophthalmitis( purulent vitreous damage), secondary glaucoma that can lead to eye loss,and opacity of the cornea, in which the visual acuity is irreversibly reduced.

Prevention of keratitis

Prophylaxis is hygiene, rules of wearing and care of contact lenses, protection of the eyes from ingress of foreign bodies, sanation of foci of infection and treatment of diseases that can be the cause of keratitis.

Doctor ophthalmologist Letyuk T.Z.