Symptoms of the development of ocular tuberculosis and methods of treating the pathology

Tuberculosis is an infectious disease caused by the tuberculosis bacillus. It does not depend on age, gender or heredity. The most common is the pulmonary form of the disease. However, it can spread to other human organs.

Thus, a complication of the disease can result in ocular tuberculosis. However, this type of illness can appear for other reasons.

What signs could be a warning sign? Under what conditions can infection begin? What diagnostic methods are used to establish an accurate diagnosis? How can you stop or cure the disease? And what can be done to avoid infection or complications of tuberculosis in the eyes?

Causes

In recent years, people of middle age and younger have been suffering from this disease. Therefore, in order not to catch tuberculosis anywhere, it is necessary to monitor the eyes of children and young people. In addition, it is worth understanding where exactly you can encounter the disease in order to take timely measures.

Since tuberculosis is caused by the activity of a microorganism, it is most often transmitted through the air. If a person already suffers from one of the forms of this disease, then infection of the eyes can occur through the sinuses, skin or blood vessels.

In order for the tuberculosis bacillus to enter a healthy body, physical contact or being in a closed room is necessary. It could be a poorly lit hospital corridor or a crowded bus during rush hour. Not many people know how far the infection spreads from a sick person.

So, in the process of sneezing, even people who are at a distance of 9 meters find themselves in the affected area.

If there is someone coughing in the room, it is enough to be no further than 4 meters to become infected. And particles of sputum scatter about a meter.

Often this microorganism can enter through air or dust. But there are other ways of infection. Thus, using the same devices with an infected person can cause the appearance of symptoms of the disease. Or the entry of microorganisms through food and water will lead to the same effect.

People working in agriculture can become infected from animals with tuberculosis. However, it is worth remembering that simple remedies are destructive for tuberculosis bacilli: fresh air and sunlight.

In addition, the body's defenses can resist the virus if maintained.

To do this, you need to eat right, fight bad habits, devote enough time to rest, sleep and exercise, and, if possible, avoid situations that will cause stress.

All this will help strengthen the immune system. And then, even if the tuberculosis bacillus enters the body, it will not multiply there.

Classification of types of disease development

Experts studying the disease and searching for more effective treatment methods note that when tuberculosis affects the eye, there are several options for the development of the disease. They differ in severity and treatment methods chosen.

First , if this is the result of a primary infection, symptoms will be found in the mucous membrane of the eye. Also, if the disease began its development in the visual organ, inflamed eyelids, conjunctiva, eyelashes, muscles or lacrimal apparatus are usually observed.

Secondly , if inflammation of the eye is a complication of the underlying disease, infectious and allergic manifestations can be expected against the background of pulmonary tuberculosis or central nervous system.

For a sick person, this is the most severe variant of the pathology, since against the background of signs of the underlying disease, ophthalmological disorders may be left unattended.

And then the disease in its advanced form can cause new side effects leading to blindness.

Symptoms of eye tuberculosis

When ocular tuberculosis is suspected, the healthcare professional understands that symptoms often depend on the severity or form of the disease. Some signs of the disease may be similar to other ophthalmic diseases. That is why a person is often in no hurry to go to an ophthalmologist, which can lead to serious consequences in the future.

Pathology of the posterior wall of the eye leads to a sharp decline in visual acuity. Damage to the iris leads to a feeling of a veil with subsequent weakening of vision. Pain, redness, and increased intraocular pressure may indicate corneal disease.

The last sign is considered the most severe manifestation of ocular tuberculosis. The disease often manifests itself on both visual organs at once, but sometimes symptoms will first appear on only one of them, moving to the other.

First signs

When the disease manifests itself in the eyes, the symptoms are often similar to those of conjunctivitis or an allergic reaction: swelling of the eyelid, tearing and redness of the blood vessels. Along with this, lymphatic compaction may appear, causing an abscess.

In addition, causes of anxiety may include the appearance of fog in the eyes, decreased visual acuity, increased sensitivity to light, and pain in the orbit. All these disorders are accompanied by severe pain.

With inflammation due to allergies, all these signs are clearly visible for a few days, and then disappear for a while. In other cases, symptoms may persist for several months.

Eye tuberculosis in children

At a young age, the risk of primary ocular tuberculosis is unlikely due to strong immunity.

However, this disease can arise as a complication against the background of other disorders. Thus, tuberculosis in this case can occur as a consequence of a pulmonary disease or allergy.

Since children cannot control their condition, and sometimes clearly explain what exactly is happening to them, parents need to check their visual acuity in an ophthalmology office. You should not lose sight of it if your son or daughter has noticeable swelling of the eyelids, redness of the eye, or increased tearing.

Parental attentiveness will help identify the disease at earlier stages. And timely treatment will make it possible to protect the child’s vision.

Diagnosis of the disease

If the attending physician suspects tuberculosis, an eye examination will help identify ways of spreading the disease and prevent the onset of complications. The first thing the ophthalmologist will do is determine the visual acuity and field of vision. A decrease in these parameters will be a reason for him to conduct additional research to determine the causes of the violation.

The doctor will measure the eye pressure and examine the fundus. For a more detailed study of the cause of the disease, an ultrasound of the eye may be required.

The examination may reveal grayish nodules on the conjunctiva. Within a month, they turn into small ulcers that can cause sharp pain in the eyes. This sign helps doctors determine the development of tuberculosis.

In addition to special tests, procedures are carried out to determine the general condition of the body. Thus, when undergoing diagnostics, a fluorographic examination is mandatory. Taking urine and blood tests will reveal the presence of chronic or other infectious diseases. The doctor may use topographic or bronchoscopic examination.

A separate method is culture for bacteria that cause tuberculosis. This is a rather lengthy and labor-intensive procedure, since these organisms reproduce rather slowly. However, if the tuberculosis bacillus was detected during an examination of the lungs or gastrointestinal tract, then there is a high probability of complications occurring in the eyes.

Methods of treating the disease

Treatment of tuberculosis can be carried out either with the help of medications or surgery. Depending on the severity of the disease, treatment methods of varying degrees of intensity will be prescribed. In most cases, the doctor will prescribe treatment in a hospital setting.

Treatment with drugs has several directions:

1. medicines that kill germs;
2. taking vitamins to strengthen the immune system;
3. if the above methods do not bring the expected result, pathogenetic therapy is included in the complex;
4. if detected late, the doctor uses hormonal therapy;
5. Often advanced tuberculosis is treated with chemotherapy.

Surgical intervention for eye tuberculosis is prescribed if the above remedies do not bring results. Such operations are usually carried out by a clinic with modern equipment, qualified specialists and a good reputation.

The main goal of intervention for ocular tuberculosis is to preserve the person’s vision.

Disease prevention

Knowing what eye tuberculosis is and how it develops, you can take measures to protect yourself from it. Firstly, in order to prevent the disease, vaccination is carried out. It is done to a newborn in the first weeks of life, and then at 7 and 14 years of age. This allows the body to develop immunity against the tuberculosis bacillus.

An annual fluorographic examination will help identify the main form of the disease in the early stages. And important is compliance with hygiene standards, regular cleaning and ventilation of the home.

It is important to wash fruits and vegetables before eating. It is worth paying attention to common items, since it is through them that there is a high risk of introducing bacteria into your body. And on farms, livestock are regularly inspected for tuberculosis infection.

If you are already suffering from tuberculosis, in addition to undergoing treatment, you should take measures so as not to pass the disease on to your loved ones and people around you. Firstly, it is undesirable to appear in crowded places without a serious reason. When coughing and sneezing, you should cover your mouth to prevent bacteria from spreading over a long distance.

It is important to maintain personal hygiene, wash your hands and disinfect objects that may be touched by other people. Avoid touching your eyes and sinuses with your hands. This way you can avoid complications of tuberculosis on other organs.

Let's summarize: ocular tuberculosis can manifest itself as a primary infection or a complication of an existing disease. Infection can occur through contact with a sick person, animal, through household objects or food.

When the first signs of the disease appear, you should not postpone your visit to the doctor, since delay may result in loss of vision. To establish an accurate diagnosis, it is necessary to undergo a complex of general and special examinations. And then one of the types of complex treatment will be prescribed depending on the stage and speed of spread of the disease.

As with any disease, prevention is the main means of protection. To do this, you need to be vaccinated against tuberculosis in a timely manner, regularly have fluorography, lead a healthy lifestyle and monitor the hygiene of your body and home.

Source: https://MedTub.ru/vidy-tuberkulyoza/tuberkulez-glaz

What is eye tuberculosis and how to cure it

Tuberculosis is a very dangerous infectious disease caused by mycobacteria, which can affect any organ or tissue if it becomes generalized. Ocular tuberculosis is a pathology that affects the visual organs, disrupting or reducing visual function.

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Classification

Metastatic (hematogenously disseminated):

• uveitis;
• keratitis;
• scleritis;
• tuberculosis damage to the protective apparatus.

Tuberculosis-allergic lesion:

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Exogenous:

• primary tuberculosis of the conjunctiva;
• tuberculosis infection of the skin of the eyelids.

Conjunctivitis is a type of eye tuberculosis

Etiology

The organ of vision can be affected independently (for example: droplets of saliva that contain the causative agent of tuberculosis may enter), there is also a second way for the pathogen to enter the organs of vision - hematogenous. Primary infection of a person is possible in various ways:

• airborne;
• nutritional;
• contact;
• intrauterine;

The airborne route is the main route of infection; it is caused by the high content (especially in stuffy, poorly ventilated rooms) of the pathogen in the air, which enters the air when a patient infected with an active form of tuberculosis coughs and sneezes. Direct infection occurs by inhalation of mycobacteria.

If the contamination is high, infection can occur through nutritional intake of food contaminated with Mycobacterium tuberculosis. Scientists have also proven that self-infection is possible by ingesting coughed up pulmonary sputum that contains the pathogen.

Possible contact infection. The pathogen cannot penetrate the skin, but through the mucous membrane it can easily enter the body and cause illness.

Quite rare, but intrauterine infection does occur. It has its own characteristics. For example:

• The mother's tuberculosis occurs in a generalized form.
• Infection occurs during childbirth, when the placenta is damaged.

Risk factors:

• low immunity;
• alcoholism, drug addiction and smoking;
• autoimmune pathologies;
• diseases that have a chronic course.

Symptoms of eye tuberculosis

The rate at which the disease progresses varies from patient to patient. Thus, the manifestations of symptoms can be of varying intensity and over different time frames. During the prodromal period, ocular tuberculosis is extremely difficult to notice; serious diagnostic tests are required to make a diagnosis. Main signs:

• incomplete loss of vision, which manifests itself extremely sharply;
• feeling of pain in the area of ​​the orbits and eyeballs;
• pronounced hyperemia of the tissues of the organs of vision;
• flies, stars, fog before the eyes;
• glaucomatous changes;
• pronounced inflammatory reaction of eye tissues;
• drop in visual acuity;
• excessive secretion of tears;
• severe swelling;
• enlargement and softening of regional lymph nodes;
• the appearance of whitish scars;
• pus.

Swelling is one of the symptoms of eye tuberculosis

A sharp exacerbation of the process occurs against the background of a decrease in immunity over several days. If the disease is chronic, symptoms may appear over several months.

If the slightest symptoms appear, you should definitely contact a specialist so as not to waste precious time.

Diagnostics

Diagnosis of this disease is difficult due to the asymptomatic or blurred clinical picture, as well as the location and anatomical structure of the eyeball. Thus, it becomes difficult to collect material for microbiological and histological examination.

Allergic form

This form of the disease manifests itself with extremely severe primary symptoms. The process tends to worsen and then subside sharply even during treatment. It is caused by a generalized process (i.e.

the pathogen is in the bloodstream and spreads throughout the body). Such patients undergo mandatory detailed examination by a phthisiologist, phthisiourologist and phthisiogynecologist.

It is necessary to conduct radiography and tomography of the chest, studies excluding specific processes occurring in the genitourinary system.

Tuberculin diagnostics is an additional, but not the main method for making a diagnosis. If the process occurs not only in the eyeball, then an allergy to tuberculin should be excluded.

Patients with this form of tuberculosis are registered in anti-tuberculosis dispensaries. If they experience acute inflammatory changes, they are immediately taken to an ophthalmologist for examination.

Metastatic form

A full examination is carried out, which includes:

• collecting anamnesis (presence of contacts with infected people, past infectious diseases, etc.);
• visit to the ophthalmologist;
• chest x-ray (if necessary, abdominal cavity);
• bronchoscopic examination;
• bacteriological examination of sputum, blood and urine;
• mandatory examination by a phthisiologist (if necessary, a phthisiurologist and a phthisigenecologist);
• tuberculin and immunodiagnostics.

• 
• It is imperative to exclude syphilis, rheumatism, toxoplasmosis, brucellosis, sarcoidosis, and various viral diseases.
• The method of trial specific treatment is used.

Treatment

The course and tactics of treatment will depend entirely on the form of tuberculosis and the severity of the process. Therapy is always carried out comprehensively and acts in several directions. There are several ways to treat this eye disease:

Type of therapy	Short description
Antibiotic therapy	Considering that mycobacteria are resistant to many antibiotics, there is a need to determine by laboratory methods which antibiotics these microorganisms are sensitive to. Parabulbar or subconjunctival injections are recommended. For greater availability of antibiotics to the pathological area. The most effective combinations used for treatment: Riboflavin+Tubazid+Ethionamide, Riboflavin+Tubazid, Riboflavin+Tubazid+Rifadin.
Vitamin therapy	The issue of treatment is approached comprehensively and it is very important to maintain immunity at a high level. Used: Retinol, Alpha tocopherol, vitamin C, Thiamine, Rutin and other vitamins.
Pathogenetic	At the first signs of decompensation of internal organs, hepatoprotectors, nephroprotectors and gastroprotectors are prescribed. This is done to maintain high body resistance.
Hormonal	The most commonly used are corticosteroids. However, drugs are used with extreme caution because they reduce local immunity. Used: Hydrocortisone, Dexamethasone.
Corticosteroid	Anti-inflammatory - to alleviate the condition. Dexamethasone, Dexazone, Kenalog-40 are used. This is a very important part of therapy for damage to the visual organs.
Antiglaucomatous surgery	These operations are performed to reduce the pressure inside the eyeball. They can be of different nature and execution techniques, but they pursue only one goal. Iridectomy, corneal paracentesis, etc. can be performed.
Cornea transplant	It is used when drug treatment is ineffective.
Chemotherapy	This type of treatment occupies a leading place in the treatment of ocular tuberculosis.

Prognosis and prevention

Active prevention of ocular tuberculosis is based on vaccination and revaccination. The first vaccination is carried out at the age of 1-5 days of a newborn’s life, provided that the child is fully term and there are no signs of disease. Revaccination is carried out at the age of 7 years.

To prevent tuberculosis in healthy individuals at risk, the method of chemoprophylaxis is used.

If during the diagnostic process a positive diagnosis for ocular tuberculosis is made, then the patient must be registered with an ophthalmologist. Afterwards, it is necessary to adhere to sanitary preventive measures to break the mechanism of transmission of mycobacteria to others.

Be sure to follow hygiene rules, ventilate thoroughly, use ultraviolet irradiation, use masks and respirators. With timely consultation with a specialist and proper treatment, the prognosis for life and preservation of visual function is favorable.

Source: https://glazexpert.ru/bolezni/drugie/tuberkulez-glaz.html

Tuberculosis of the eye

Ocular tuberculosis is an extrapulmonary form of tuberculosis that affects the choroid, conjunctiva, or adnexa of the organ of vision. Clinically, the pathology is manifested by “spots” or “black spots” before the eyes, decreased visual acuity, and pain. Diagnosis of ocular tuberculosis includes biomicroscopy, ophthalmoscopy, visometry, and microscopic examination of biopsy material. The treatment regimen consists of drugs from the ansamycin group, aminoglycosides and synthetic antibacterial agents. Surgical tactics are reduced to laser coagulation of large chorioretinal lesions and revascularization of the choroid.

Ocular tuberculosis is a disease of the organ of vision of a specific etiology, which is characterized by frequent relapses and long-term persistence of the pathogen in the patient’s body. German pathologist Yu.

Conheim in 1879 experimentally proved the possibility of developing tuberculosis in the eyes. The scientist transplanted small biopsies from other organs (lungs, kidneys) of patients with this pathology into the anterior chamber of the eye.

At the same time, the progression of ocular tuberculosis led to the formation of specific tubercles in the structures of the eyeball.

Damage to the organ of vision ranks 4th in the structure of the prevalence of extrapulmonary forms of tuberculosis. According to statistics, the incidence rate increased 2.7 times from 1991 to 2000.

Mostly young and middle-aged people are affected. The female sex is more predisposed to the development of this pathology.

There is a tendency to increase the incidence of ocular tuberculosis among children and socially advantaged classes of the population.

Tuberculosis of the eye

The specific causative agent of ocular tuberculosis is Mycobacterium tuberculosis. Damage to the organ of vision may be caused by hematogenous dissemination of the pathogen from a tuberculous granuloma or the reaction of the membranes of the eyeball to the course of the pathological process in the body.

The metastatic variant of the development of the disease occurs when a focus of infection forms in the choroid, an exudative reaction of surrounding tissues, or the penetration of mycobacteria into the choroid by hematogenous route. Damage to the organ of vision can occur during any period of the disease.

In this case, the choroidal vessels of medium diameter are the first to be affected. The course of eye tuberculosis becomes abortive and asymptomatic. Next, a specific inflammatory process spreads to the choriocapillaris and retina, which provokes the development of the clinical picture of ocular tuberculosis.

The involvement of other structures of the eyeball is due to the perifocal tissue reaction to inflammation.

The basis of the tuberculosis-allergic reaction is the increased sensitivity of eye tissue to the causative agent of the disease. This etiological variant develops with previous sensitization to mycobacterial antigens. The antigen penetrates into the choroid of the eye.

The source of pathological agents are foci of tuberculosis (lymph nodes, pulmonary granulomas). Secondary damage to the organ of vision is possible when a specific tubercle is localized in the central nervous system.

In this case, the clinical picture of ocular tuberculosis occurs against the background of intracranial hypertension and is caused by mechanical compression of the optic nerve by the tuberculous tubercle.

At the secondary stage of the pathology, proliferation increases, which is manifested by the formation of specific granulomas with caseous necrosis in the central part.

The tuberculosis-allergic form is characterized by swelling of the surrounding tissues, their lymphoplasmic infiltration in combination with a histiocytic reaction. With this form of ocular tuberculosis, an increased number of eosinophils is observed in the infiltrate.

Ocular tuberculosis with hematogenous dissemination of the pathogen is characterized by a slowly progressive onset, while the course of the disease becomes torpid. Nonspecific anti-inflammatory therapy does not bring relief.

An acute course is observed in the tuberculosis-allergic form of the pathology, while the clinical symptoms of the disease quickly subside. This option is characterized by the greatest tendency to recur, which is due to the action of nonspecific allergens.

The clinical picture of ocular tuberculosis is determined by the localization of the pathological process.

In ophthalmology, the following types of ocular tuberculosis are distinguished: anterior and peripheral tuberculous uveitis, chorioretinitis, panuveitis. The disease is characterized by an asymptomatic course for a long time.

When the anterior parts of the choroid are affected, patients complain of the appearance of “fog” before the eyes, a feeling of heaviness in the projection area of ​​the orbit, a progressive decrease in visual acuity, photophobia, and lacrimation.

With eye tuberculosis, accompanied by combined inflammation of the choroid and retina, patients notice the appearance of “black spots” or “fog” before the eyes, pain in the orbit, increased sensitivity to light, and lacrimation.

Panuveitis is manifested by severe pain, decreased visual acuity up to its complete loss. Tuberculosis of the conjunctiva is predominantly unilateral.

There are no symptoms of the disease until secondary complications or ulceration of tuberculous nodules occur.

Diagnosis of ocular tuberculosis is based on biomicroscopy, ophthalmoscopy, visometry, tonometry, histomorphological and cytological examination of the biopsy specimen. Using slit-lamp biomicroscopy, it is possible to visualize large precipitates on the cornea, as well as posterior synechiae. Ophthalmoscopically, round chorioretinal lesions are detected.

Biopsy is most accessible when the eyelids are affected by the tuberculosis process; chorioretinal endobiopsy is performed less frequently. Biopsies are subject to histomorphological examination to identify mycobacteria. A cytological examination is carried out when obtaining materials during aspiration of the contents of the anterior chamber of the eye or vitreous body after iridectomy.

With conjunctival tuberculosis, a group of gray nodules prone to fusion is visualized using biomicroscopy. After 21-28 days from the moment of formation, they undergo ulceration with the formation of a deep ulcerative surface. The visometry method for conjunctival lesions determines normal visual acuity.

In turn, with ocular tuberculosis of other localizations, visual acuity varies from a slight decrease to complete loss with panuveitis. The etiology of the disease can be confirmed after assessing the local tissue response to tuberculin administration. In this case, for a short time, an increase in the clinical manifestations of ocular tuberculosis is observed.

Treatment tactics for ocular tuberculosis depend on the form of the pathology. After confirmation of the tuberculous etiology of the disease in the hematogenously disseminated variant, a long course of etiotropic therapy is recommended.

The treatment regimen includes drugs from the pharmacological group of ansamycins, aminoglycosides and other synthetic antibacterial agents active against mycobacteria. Throughout the entire period of treatment for ocular tuberculosis, taking multivitamin complexes and immunomodulators is indicated.

Gastroprotective drugs and hepatoprotectors are prescribed for primary manifestations of decompensation in these organs. The duration of the intensive phase of the course of treatment for ocular tuberculosis ranges from 2 to 5 months.

Antibacterial agents for ocular tuberculosis must be administered in the form of parabulbar injections or using electrophoresis. In the presence of large chorioretinal lesions, laser coagulation or choroidal revascularization is performed.

For conjunctival tuberculosis, subconjunctival administration of drugs or their instillation is indicated.

For the tuberculous-allergic form of ocular tuberculosis, it is necessary to include desensitizing agents and non-steroidal anti-inflammatory drugs in the standard treatment regimen.

Active specific prevention of ocular tuberculosis involves vaccination and revaccination with BCG. The first injection of the vaccine is carried out in healthy full-term newborns on days 1-4 of life. Revaccination is carried out only for healthy children at the age of seven. The goal of chemoprophylaxis is to prevent the development of regional forms of tuberculosis in healthy individuals at risk.

Sanitary preventive measures are aimed at breaking the mechanism of transmission of the disease in the outbreak and include compliance with hygiene rules, regular ventilation, bactericidal ultraviolet irradiation, the use of masks and respirators. The prognosis for life and ability to work with eye tuberculosis with timely diagnosis and treatment is favorable.

Source: https://www.KrasotaiMedicina.ru/diseases/ophthalmology/ocular-tuberculosis

Ocular tuberculosis (tuberculous keratitis)

Ocular tuberculosis is an extrapulmonary type of disease. In the early stages, it is difficult to detect such a pathology, and it takes a long time to treat. In an advanced state, visual function decreases so much that it leads to disability.

Causes

Tuberculous keratitis occurs as a result of the penetration of mycobacteria into the structure and choroid of the eyeball.

The main sources of infection include:

1. A source of infection in the body that is localized in other organs. From there, Koch's bacillus is carried into the ocular vascular tract.
2. Mucous membranes of the sinuses, skin. From these areas, mycobacteria enter the eyes.
3. Tuberculosis patients. Infection occurs through prolonged contact with them through airborne droplets.

The likelihood of developing the disease increases with weakened immunity and autoimmune pathological conditions. Risk groups for developing ocular tuberculosis include:

• migrants;
• refugees;
• homeless people;
• prisoners or released from prison;
• patients in psychiatric and drug treatment hospitals;
• residents of nursing homes, shelters, shelters.

There is a medical risk factor presented by patients with diseases that lead to a weakened immune system. These are patients suffering from:

• HIV infection;
• alcoholism;
• diseases of the genitourinary system;
• diabetes mellitus;
• thyroid dysfunction;
• hematological diseases;
• oncology.

This group also includes pregnant women, the elderly, and children under 3 years of age. They are more susceptible to disease due to changes in the endocrine system. In addition, there is a high risk of infection among people who are in close contact with tuberculosis patients. This:

• workers of transport, trade, medical institutions;
• patients who were removed from the dispensary register;
• persons living with the patient in the same room.

Contagious or not

Many people are interested in the question of whether ocular tuberculosis is contagious or not. This disease is extremely rarely associated with the production of mycobacteria in the body, and therefore is not considered contagious. However, it is possible to find out whether the patient is dangerous to others and whether he can become infected from him after a bacterial culture test.

Symptoms

With ocular tuberculosis, symptoms may resemble clinical manifestations of an allergic reaction or conjunctivitis. The first signs of ocular tuberculosis in adults are as follows:

• redness of blood vessels;
• tearfulness;
• foreign body sensation;
• itching, pain;
• swelling of the eyelid.

As the disease progresses, the following is observed:

• damage to the back wall of the eye, resulting in a sharp decrease in visual function;
• infection of the iris, which leads to deterioration of vision due to a constant veil before the eyes;
• deterioration of the cornea, which contributes to the appearance of pain, redness, and increased intraocular pressure.

Such symptoms indicate that the disease is acute, which can cause the person to go blind.

In children, tuberculous keratitis occurs as a result of allergies or pulmonary disease. A small child cannot always explain what is happening to him, so parents should take him to the doctor if there is increased tearing, redness of the eye or swelling of the eyelids.

Diagnostics

If the doctor suspects an eye infection with Koch's wand, then, thanks to the examination, he will be able to find out the cause of the disease and prevent the development of complications.

The specialist measures eye pressure and examines the fundus. But it is quite difficult to diagnose such a disease, since there are many vision pathologies that have similar symptoms.

Therefore, differential diagnosis of tuberculosis is carried out.

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In this case, the doctor refers the patient to the following diagnostic measures:

• biomicroscopy;
• tonometry;
• ophthalmoscopy;
• viziometry;
• cytological and histomorphological examination.

In addition, the patient must undergo fluorography, urine and blood tests, which makes it possible to detect chronic and other infectious diseases. The doctor may refer the patient for a bronchoscopic or topographic examination.

Treatment

Treatment of ocular tuberculosis is carried out using 3 main medicinal groups of medications, which have varying effectiveness:

• potent: Rifampicin, Isoniazid;
• having an average level of impact: Ethambutol, Streptomycin, Ethionamide;
• moderate action: PASK, Tibon.

If the disease is severe, then 2 courses are given. Over the course of 3 months, the patient is administered drugs from the first group and one from the second. Subsequently, 2 medications are used - one from the first two groups (course of treatment - 3 months).

In the event that the disease is of moderate severity, 2 potent drugs are taken for 1-2 months. Then Streptomycin and Isoniazid are taken for six months.

Instead of the latter medication, it is allowed to use Prothionamide or PAS.

To increase immunity, immunomodulatory agents are used:

• Dibazol;
• Dekaris;
• Adrenaline solution;
• Pentoxyl.

You can use vitamins: Rutin, Thiamine, vitamin C, Alpha tocopherol, Retinol. If exudation occurs, the doctor prescribes Metipred intravenously.

Corticosteroids are often used: Dexamethasone, Hydrocortisone. But they should be used with caution, because they reduce local immunity.

To alleviate the condition, it is recommended to take anti-inflammatory drugs: Kenalog-40, Dexazone, Dexamethasone.

Surgery is performed if the disease has caused complications that are dangerous to the patient’s health. The following surgical treatment methods exist:

• cornea transplant;
• cataract removal;
• laser coagulation.

They are carried out in a hospital setting. Nursing care is important. It involves distributing medications, monitoring compliance with doctor’s orders and hygiene rules, performing manipulations (injections, applying a bandage, etc.), ensuring a safe (in terms of epidemic) environment in the ward.

Complications and prognosis

Common complications of ocular tuberculosis include:

• glaucoma;
• retinal detachment;
• corneal clouding.

When glaucoma appears, eye drops are used to reduce intraocular pressure. In case of retinal detachment, laser coagulation is performed. Patients with corneal clouding undergo corrective surgery.

Phthisiology provides for a favorable outcome of the disease if it was detected in a timely manner and competent treatment was carried out. In advanced cases, the pathology can lead to blindness.

Source: https://ProTuberkulez.info/vidy/glaz.html

Symptoms and treatment of eye tuberculosis. Ocular tuberculosis is a rare but very dangerous disease of the organ of vision.

Eye infection with mycobacteria occurs through contact with a patient with tuberculosis. The main routes of transmission of infection are airborne droplets (sneezing, coughing). Infection can occur through food and contact with cows.

Mycobacterium tuberculosis can enter the eyes through the bloodstream (hematogenous-lymphoid infection) from an inflammatory focus in the body, as a reaction of the eye structures to tuberculous intoxication (allergic form of tuberculosis), infection from adjacent tissues (nasal cavity, facial skin). A common combination is cutaneous-ocular tuberculosis.

• The video shows a description of the disease:
• The ocular pathological process begins from the choroid, in places of slow blood flow, or from the conjunctiva.
• Uevitis is a choroid of three parts: the iris, the choroid (choroid), and the ciliary body.
• The metastatic and allergic form affects:

• conjunctiva. But this information will help you understand how to wash your eyes with conjunctivitis.
• cornea;
• iris. But this information will help you understand what iris coloboma is.
• choroid;
• choroid and retina simultaneously.

Symptoms of primary infection of the conjunctiva (what a conjunctival cyst is and how it is treated is indicated here). The pathogen creates a lesion under the upper or lower eyelid.

The inflammatory process is characteristic of conjunctivitis: lacrimation, swelling, redness. It infects and forms a lesion in the facial lymph node near the ear.

From here, dissemination of mycobacterium tuberculosis (MBT) occurs to other organs and tissues.

Tuberculous iridocyclitis most often has a diffuse form: serous inflammation with the formation of accumulations of leukocytes and pigment along the edge of the pupil, sometimes a border of gray nodules is observed within 2 weeks. Rough adhesions of connective tissues form.

Tuberculous iridocyclitis

Serous uevitis is the most common form of infectious uevitis. Symptoms: soreness of the eyeball, redness of the sclera, lacrimation, intolerance to light, the appearance of spots before the eyes. But what the symptoms are and what disease photophobia is, is detailed here.

Retinal tuberculosis is determined by examining the fundus. Yellow, rounded spots (tubercles) with a diameter of up to 3 mm with blurred boundaries are found on the retina. In mature tubercles, the edges are clearly defined, the center is discolored.

Tuberculosis intoxication is manifested by phlyctenulous conjunctivitis. At the border of the sclera and cornea, gray-yellow nodules with thread-like branches appear, forming a blood network to the conjunctival sac.

After some time, the nodules burst, ulcerate, leaving scars on the cornea (but what are the symptoms of inflammation of the cornea of ​​the eye are described in detail here). The pathological process continues, new formations appear.

But how inflammation of the cornea in a child is treated is described in detail here.

Acute tuberculous pantophthalmitis means purulent inflammation of the entire eyeball.

Diagnostics

It is difficult to determine the tuberculous nature of the inflammatory process, since it is impossible to culture the MBT. A comprehensive study is required to identify an extraocular pathogenic focus.

1. The symptoms of tuberculous inflammation of the eyes are in many ways similar to those due to other pathogenic causes.
2. The examination is carried out in a hospital setting to monitor the patient's condition.
3. List of diagnostic measures:

• anamnesis;
• fluorography;
• blood tests;
• tomography;
• bronchoscopy;
• urine culture;
• tuberculin skin tests (Mantoux, Pirquet).

The lymph nodes and abdominal cavity are examined. Additionally, the doctor may request information about what the fundus shows. X-ray examinations and immunological studies may also be performed. An important aspect is the exclusion of other pathogens: syphilis, brucellosis, toxoplasmosis.

Studying the reaction in the ocular tissues to the tuberculin skin test allows us to make a final diagnosis. Four possible options are being considered:

• positive skin reaction and increased inflammatory phenomena in the eye (increased scotoma, swelling, exudate, increased turbidity, hemorrhage, increased intraocular pressure). But what are the symptoms of fundus pressure, this information will help you understand.
• negative skin reaction and positive focal reaction;
• positive skin reaction with paradoxical focal reaction;
• positive skin reaction in the absence of visible changes in pathology.

Observation begins before the tuberculin test. The patient's temperature is measured every 6 hours. For 3 days, the functional state of the eyes is assessed daily. IOP is measured, ophthalmic and microscopy is performed. Blood tests determine the reactivity of the immune system.

The diagnosis is considered established in the first and second cases of skin testing. The attenuation of pathological symptoms after the administration of tuberculin is called a paradoxical (therapeutic) reaction of the body. In case of a positive skin test without changes in the eye, the examination continues. Another tuberculin diagnostic method is selected and the dose is increased.

Tuberculin tests are contraindicated in cases of bleeding, oncology, infectious diseases, and pregnancy.

Symptoms of eye tuberculosis

With eye tuberculosis, the symptoms manifest clearly. Standard anti-inflammatory therapy practically does not produce positive results and only occasionally improves the condition of the visual apparatus. Signs of tuberculosis can be confused with the clinical picture of other diseases. Therefore, you cannot do without a medical diagnosis.

The first signs in adults are blurred vision. In this case, increased lacrimation and poor tolerance of bright light appear. A person feels pressure in the area of ​​the diseased eye, the conjunctiva becomes inflamed and red. A characteristic symptom is a floating cloudiness in the eye, which can change position and seem to slip out of sight.

Signs of tuberculosis are often characterized by the appearance of dark spots that interfere with visualization of objects.

In advanced cases, vision may completely disappear, which is typical for such a form of eye damage as tuberculous keratitis. When immunity decreases to critical levels, symptoms may increase. Primary lesions ulcerate.

Treatment methods for eye tuberculosis

If the disease is detected in the early stages or during exacerbation, antibacterial therapy is resorted to. If the disease has become chronic, or in severe cases, treatment is added with immunomodulators, tuberculin serum, and symptomatic drugs. Other general strengthening agents are prescribed.

Chemotherapy

The main therapeutic measures are aimed at destroying pathogens present in the body. For this purpose chemotherapy is prescribed.

According to their strength, drugs are divided into 3 groups:

• Powerful - isoniazid, rifampicin.
• Medium - kanamycin, prothionamide, pyrizinamide, streptomycin, florimycin, cycloserine, ethionamide, ethambutol.
• Weak – T-Bone, PASK.

The daily dose is administered once a day (single dose). In case of poor tolerance, the drug is replaced or the dose is divided into 2-3 injections.

If eye tuberculosis has severe symptoms, then treatment is carried out in 3 stages

1. For 2-3 months, the patient is administered rifampicin and isoniazid, and any agent of moderate action is added.
2. The patient is administered isoniazid and ethionamide for 3 months.
3. Next, any drugs are used based on the patient’s condition, the last stage lasts an indefinite amount of time (1-2 years) until complete recovery.

If eye tuberculosis symptoms and first signs are moderate or mild, then treatment is carried out in two stages:

1. Isoniazid and rifampicin are administered for 1-2 months.
2. Isoniazid and streptomycin are used for 6-8 months.

If chemotherapy has already been carried out, then it is advisable to use a drug that has not been used before. In order not to provoke addiction in the pathogen.

Photo 9. If the chosen treatment regimen does not help, it is necessary to apply another one.

Immunomodulators

Since ocular tuberculosis symptoms manifest with reduced immunity, it is advisable to prescribe immunomodulators for severe forms.

Corticosteroids

Treatment of ocular tuberculosis with corticosteroids is necessary for severe inflammatory reactions with abundant exudate.

Stages of treatment of the disease	The most severe forms	Less severe forms
Start	2 months: isoniazid rifampicin pyrazinamide streptomycin	2 months: isoniazid rifampicin pyrazinamide
Continuation	4 months: isoniazid and rifampicin OR isoaniside and pyrazinamide	4 months: isoniazid – 3 times a week, rifampicin – 3 times a week	4 months: isoniazid – 3 times a week, pyrazinamide – 3 times a week	4 months: metazide – 3 times a week pyrazinamide – 3 times a week

The table presents recommended treatment regimens for ocular tuberculosis.

All drugs are administered intravenously through a dropper over 10-15 minutes. The drugs are used 3 times a week, usually three times is enough. If the result is insufficient, you can repeat the procedure, but now the dose is halved.

How to identify the disease?

Diagnosis of ocular tuberculosis is complicated by the lack of specific symptoms, since its manifestations are similar to other ophthalmological diseases.

The inability to obtain a tissue sample to test for the presence of mycobacteria also makes diagnosis difficult.

If there are complaints indicating possible tuberculosis, it is advisable for the patient, as prescribed by a doctor, to undergo a number of the following examinations:

• determination of visual acuity and fields;
• measurement of intraocular pressure;
• fundus examination;
• Ultrasound of the eye;
• retinal angiography;
• tuberculin test;
• diagnostic treatment with anti-tuberculosis drugs.

In addition, the patient must undergo an x-ray of the chest cavity and tomography of the mediastinum, since it is here that inflamed foci are often found in allergic eye tuberculosis. To understand the general condition of the body, the patient may also be prescribed clinical blood and urine tests.

Risk factors

These include:

• non-compliance with the correct diet;
• lack of vitamins;
• frequent stressful situations;
• non-compliance with the daily routine;
• insufficient rest;
• chronic untreated diseases;
• other forms of tuberculosis;
• poor living and working conditions;
• lack of sun and fresh air;
• contact with an infected person, including when using the same hygiene items, etc. In rare cases, infection occurs through food and water.

Infection with the tuberculosis bacillus can be avoided if you have a strong immune system. If for some reason it is weakened, then the percentage of risk of contracting infectious, allergic or primary tuberculosis increases many times. The tuberculosis bacillus penetrates along with dust into the human eye.

The source of infection is a person with tuberculosis who is a carrier of MBT. A person has an open form of tuberculosis, so he can be contagious and dangerous to others.

Prevention

Eye tuberculosis is a very dangerous disease, which is why it is important to follow the recommendations regarding its prevention.

The main preventive measure is BCG vaccination (a vaccine against tuberculosis prepared from a strain of weakened live bovine tuberculosis bacilli).

Typically, the vaccine is first administered in the first weeks of a child's life. The next intramuscular injection of the vaccine is given at the ages of 7 and 14 years.

Doctors strongly recommend that the population undergo annual fluorography for timely detection of tuberculosis. Be sure to strictly maintain cleanliness in the house, ventilate the room, and do wet cleaning.

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