Basic methods of treating viral and bacterial keratitis

Bacterial keratitis is an eye disease. It causes inflammation of the cornea. This is a transparent shell that is part of the light refractive system. Keratitis is a common cause of decreased visual acuity. In the absence of proper treatment, a creeping ulcer forms.

Development of infectious keratitis

Bacterial keratitis is an acute inflammatory eye disease that affects the cornea. This is a very common pathology in children and adults. Keratitis is a serious problem. It can cause disability, decreased vision and blindness. The following types of keratitis are known:

• primary;
• secondary;
• superficial;
• deep;
• endogenous;
• exogenous.

This disease mainly affects adults. The endogenous form of the disease is caused by internal factors (acute and chronic infections).

Main etiological factors

The causative agents of the disease are the following bacteria:

• staphylococci;
• streptococci;
• Pseudomonas aeruginosa;
• pneumococci;
• proteas;
• coli;
• gonococci.

Etymology of bacterial keratitis

These microbes are introduced into the eye in different ways. Endogenous keratitis develops against the background of other diseases. This can be sinusitis, otitis media, rhinitis, tuberculosis, bronchitis, herpes, syphilis. Many people pick up germs from dirty hands or while swimming. The cause may be foreign objects getting into the eye. For some people, contact lenses are a factor in transmitting bacteria.

Predisposing factors are:

• decreased immunity;
• improper treatment of infectious diseases;
• hypothermia;
• lack of thiamine and riboflavin;
• disruption of the innervation of the eye;
• allergic reactions;
• incomplete closure of the eyelids;
• disruption of tear fluid production;
• abnormal eyelash growth;
• dystrophic changes in the cornea;
• inflammation of the ciliary edge of the veins;
• conjunctivitis;
• endocrine diseases (diabetes mellitus).

The development of keratitis is caused by damage to the corneal epithelium and active proliferation of bacteria. This problem is more often encountered by people who rarely wash themselves and neglect the rules of personal hygiene.

Clinical manifestations of the disease

Keratitis occurs in an acute form. The main manifestation is corneal syndrome. It includes watery eyes, involuntary closing of the eyelids, and fear of bright light. The cornea area contains many nerves and pain receptors. With the bacterial form of keratitis, the following symptoms are possible:

• the presence of yellowish infiltrates;
• mucopurulent discharge;
• dullness of the eyes;
• decreased transparency;
• blurred vision;
• the presence of small ulcers;
• pain.

  What is filamentous keratitis and how to treat it

This pathology progresses rapidly. When examining the cornea, precipitates are detected on the posterior surface. They contain lymphocytes, plasma cells and macrophages. A cloudy area forms in the optical zone of the eye. As the disease progresses, complaints become more pronounced.

Often such people cannot open their eyes. The feeling of the presence of a foreign object is disturbing. Deep keratitis is the most severe. Ulcers form on the cornea. Against the background of keratitis, the ciliary body and iris become inflamed. Iridocyclitis develops. With keratitis of bacterial origin, a hypopyon is formed.

With it, pus accumulates in the lower part of the anterior chamber of the eye. Inflammation caused by Pseudomonas aeruginosa is very severe. Keratitis can occur against the background of diphtheria. In this case, ulcerative defects of a dirty yellow color are revealed. There is a film on the outside. The surface may bleed.

Patient examination plan

Diagnosis of the disease is not difficult. The following studies are needed:

• ophthalmoscopy of both eyes;
• biometrics;
• assessment of visual acuity;
• biomicroscopy;
• determination of corneal parameters;
• pachymetry;
• confocal microscopy.

The sensitivity of the cornea must be determined. An additional research method is keratotopography. During this process, corneal distortion is determined. The results of eye biometrics are of great value. This is a set of studies during which the structure of the eye, its size and other anatomical features are determined.

During biometrics, the following changes are possible:

• presence of ulcers;
• infiltrates;
• edema;
• the presence of purulent exudate.

To isolate the pathogen, a bacteriological study is carried out. A smear is made from the conjunctiva and a microscopic examination is performed. The results of sowing are of great value. Differential diagnosis is carried out with other forms of keratitis.

How to cure the sick

The disease progresses rapidly and can lead to blindness. Because of this, hospitalization is required. The basis of therapy is the use of antibacterial drugs. The main treatment methods are:

• use of disinfectant and antimicrobial drops;
• detoxification of the body;
• use of systemic antibiotics in the form of tablets, solutions or capsules;
• instillation of glucocorticoids.

A remedy such as Sulfacyl Sodium Bufus is often prescribed. It is effective for purulent corneal ulcers and eye damage with gonococci. Possible side effects include itchy and red eyes. Antibacterial drops based on fluoroquinolones and aminoglycosides are often used.

  Symptoms and treatment of parenchymal keratitis

These include Floxal, Uniflox, Dancil, Tobrex, Tobropt, Dilaterol, Tobrosopt. When keratitis is combined with blepharitis or iridocyclitis in the absence of defects in the corneal epithelium, local agents based on glucocorticoids (Maxidex, Dexamethasone Bufus, Oftan Dexamethasone) can be used.

This group includes Dekson and Mezaton. An auxiliary treatment for bacterial keratitis is Korneregel. This medicine speeds up the healing of ulcers. The main active ingredient is dexpanthenol. If necessary, antihistamines are prescribed. The treatment regimen for patients with keratitis includes vitamins and immunocorrectors.

In advanced cases, the following manipulations may be required:

• scraping the upper layers of the cornea;
• keratoplasty;
• extinguishing the ulcer;
• electrocoagulation.

The prognosis for this disease is relatively favorable. Keratitis often leads to the formation of a cataract. In this case, surgery is required. If not treated in a timely manner, other structures of the eye may be damaged. Dangerous complications are endophthalmitis and corneal perforation.

Nonspecific prevention of keratitis

Despite the fact that keratitis is an infectious disease, there is no specific prevention. To reduce the risk of developing this pathology, you must adhere to the following rules:

• properly disinfect lenses;
• prevent foreign objects (dust, debris, eyelashes) from getting into the eye;
• promptly and correctly treat existing chronic diseases;
• use safety glasses while working;
• avoid any injury.

To prevent complications such as watery eyes, pain, or photophobia, you should consult an ophthalmologist. Self-medication can lead to negative consequences. An important aspect of prevention is compliance with personal hygiene rules. You need to wash your hands and face more often. Thus, the bacterial form of keratitis can lead to decreased vision and other negative consequences.

Video

Source: https://o-glazah.ru/keratit/bakterialnyj-keratit.html

Viral keratitis: symptoms and treatment features

Viral keratitis is an inflammatory process of viral origin that affects the cornea of ​​the eye. The progression of this pathology and the lack of adequate treatment provokes damage to the deep structures of the eye and the development of blindness.

Types of pathology

The most common causes of pathology are:

1. Herpes simplex virus.
2. Herpes zoster virus.

Keratitis caused by herpes can be primary or post-primary:

• Primary – affects children under 5 years of age. The disease develops due to the introduction of a virus into the body. This type of pathology is characterized by an acute course, severe photophobia, and increased tear production. The child's cornea becomes cloudy and swollen. Inflammation of the iris is also observed.
• Post-primary – develops due to the activation of a virus that is in a latent form in the body. More often, the pathology spreads to the trigeminal ganglion and conjunctival epithelium. The cause of activation of the latent virus can be hypothermia, menstruation or abortion in a woman, or consumption of large amounts of alcohol.

Each subsequent activation of the virus is characterized by a more severe course, an increase in the duration of the disease, deeper damage to the cornea and an increasing decrease in vision.

Depending on the location and degree of damage to the organs of vision, viral keratitis is divided into the following types:

• Superficial - in most cases develops after conjunctivitis or some other inflammatory eye disease. This form does not yet cause scar tissue changes and darkening of the cornea.
• Deep – affects the deeper layers of the eyeball. After treatment, scars and extensive ulcers often form on the cornea, which have a negative impact on vision.

In addition to the listed types, keratitis can be:

• Point – characterized by the appearance of point opacities.
• Vesicular - accompanied by the formation of small bubbles on the cornea, which subsequently burst and form ulcers.
• Tree-like - formed as a result of the connection of burst bubbles, transformed into abscesses.
• Metaherpetic - characterized by damage to the corneal stroma. With this form, the resulting opacities and erosions cause acute pain, swelling, and lacrimation. The pathology takes a long time and is difficult to treat.
• Discoid - accompanied by the formation of a gray-white disc on the surface of the cornea, severe swelling and inflammation, increased IOP, loss of sensitivity of the cornea.
• Adenoviral – occurs due to damage to the lymph nodes by adenoviral infection. The disease first affects one eye, and after 5 days it spreads to the second.

Reasons for development

In most cases, the cause of viral keratitis is a herpes virus. Other reasons for its development may be:

• Chickenpox.
• Parotitis.
• Measles.

If there are viruses in the body that are in latent form, the following factors can trigger their activation:

• Eye irritation caused by contact lenses.
• Constant dry eyes, which can occur both due to the incorrect anatomical structure of the visual organs, and long-term work at the computer or exposure to other unfavorable factors on the eyes.
• Hypothermia, vitamin deficiency, decreased immunity.
• The presence of certain systemic diseases, such as gout or diabetes.

In some cases, the cause of keratitis formation is frequent emotional stress.

Manifestations of the disease

The peculiarity of viral keratitis is its chronic course and the periodic occurrence of exacerbations. A long-term inflammatory process leads to the formation of various morphological changes in the structures of the visual organs.

In patients suffering from the primary form, the symptoms are very pronounced. More often, the primary form occurs in children who have had chickenpox, measles, herpes infection or mumps. Viral keratitis in such cases is manifested by the following symptoms:

• Pain in the eyes when trying to look at bright light sources.
• Watery eyes, redness, swelling of the cornea and eyelids.
• The appearance of opacities on the surface of the cornea in the form of dots, discs, bubbles, and tree-like formations.
• The presence of a rash in the form of blisters on the mucous membranes of the mouth and facial skin.
• Temperature increase.

In the secondary form, the clinical manifestations are not so pronounced. The disease is characterized by a long course, its duration can be 2 or 3 weeks.

The secondary form is manifested by the following symptoms:

• Discharge of a small amount of serous-mucous fluid from the eyes.
• With the vesicular form, small, transparent blisters appear, which eventually open, forming small ulcers.
• In the tree-like form, gray lines appear along the superficial nerves on the cornea, which are formed from fused and ulcerated herpetic vesicles.
• In the metaherpetic form of the disease, the patient is bothered by blepharospasm, severe pain, and severe lacrimation. The eyes are affected by large inflammatory infiltrates and erosive defects. The cornea is edematous, painted in a rich gray color.
• With discoid keratitis, the eyelids and eyeballs become red and swollen, eye pressure increases, and a gray-white disc-shaped lesion forms in the center of the cornea.

Diagnostics

With most forms of viral keratitis, symptoms occur that force the patient to see a doctor. However, with punctate keratitis there are no obvious symptoms. The presence of pinpoint opacities in the initial stages is detected only during a diagnostic examination.

During the study, the doctor, first of all, conducts an external examination and establishes a connection between the appearance of keratitis and a previous viral disease.

The following diagnostic methods are used to assess the condition of the cornea:

• Biomicroscopy of the eye.
• Confocal and endothelial microscopy of the cornea.
• Keratometry.
• Pachymetry.

To detect erosions and ulcers on the cornea, a fluorescein instillation test is used. To identify and identify the pathogen, a culture test and PCR smear from the cornea and conjunctiva are used. Determination of the titer of virus-specific antibodies in the patient’s blood is carried out by ELISA.

When making a diagnosis, it is necessary to differentiate viral keratitis from other forms of keratitis, for example, bacterial or fungal.

Treatment of viral keratitis

Symptoms and treatment of keratitis are closely interrelated - the method of therapy is selected depending on the type of disease and accompanying symptoms. So, in the presence of severe pain, patients are prescribed painkillers (Analgin, Novocain).

Antihistamines (Diphenhydramine, Chloropyramine), mydriatic drugs (Cyclopentolate, Atropine), NSAIDs (Indomethacin, Phenylbutazone), antioxidant drugs (Methylethylpyridonyl, vitamin E), vitamins A, B, C, PP are also used.

Treatment of herpetic ulcers is carried out using laser coagulation and cryoapplications. In order to improve blood circulation and trophism of the cornea, diathermy and electrophoresis are performed. A helium-neon laser is used to stimulate regenerative processes.

If drug treatment does not give a positive result, progressive ulcerations are treated surgically. Superficial forms are eliminated by scraping the affected epithelial layer, and layer-by-layer or penetrating keratoplasty is used to treat deep lesions.

Drops for keratitis

The main active ingredient on the basis of which most modern antiviral eye drops are made is interferon. The action of some drops can be aimed at activating the processes responsible for the production of the body's own interferon. There are also medications that prevent viral cells from producing DNA.

The selection of the drug should be handled by an experienced ophthalmologist. Only he can correctly determine which drops are suitable for the patient in a particular case.

The most common and effective antiviral eye drops include:

• Poludan - prescribed for herpes and adenoviruses. Helps increase local immunity and suppress the activity of pathogens.
• Oftan Idu – disrupts the DNA structure of pathogens. The drug is effective for the tree-like form of the disease caused by herpesvirus.
• Ophthalmoferon - has a pronounced analgesic effect, prescribed for herpes viruses and adenoviruses.
• Adgelon is an immunostimulating drug that allows you to block the activity of viruses.
• Actipol - activates the process of producing natural interferon, which suppresses the vital activity of pathogens.

Treatment of acute viral keratitis

For severe viral infections that occur in an acute form, large doses of oral antiviral medications, for example, Acyclovir, are prescribed. To enhance immunity, nonspecific gamma globulin can be prescribed in the form of intramuscular injections. Also, the immune status is corrected with the help of extracts of the thymus gland, Levamisole.

Prognosis and prevention

If eye irritation or the first signs of keratitis appear, you should stop wearing contact lenses. If the patient is concerned about frequent exacerbations of the disease, a special antiherpetic vaccine is used.

In order to prevent the development of the disease, you should avoid stress, injury to the cornea, hypothermia and other factors that can activate the virus, which is in a latent state.

With timely detection and treatment of the disease, the prognosis is favorable. Lack of or unprofessional treatment can lead to scars on the cornea and its clouding, the development of myopia or farsightedness, partial or complete loss of vision.

In order to prevent the development of severe consequences and loss of vision, when the first signs of keratitis appear, you must immediately seek medical help. Successful treatment largely depends on how timely measures were taken to combat the disease.

Source: https://oculistic.ru/bolezni/drugie-zabolevaniya/priznaki-i-metody-terapii-virusnogo-keratita

Keratitis: causes of the disease, main symptoms, treatment and prevention

An inflammatory eye pathology characterized by damage to the cornea of ​​the eye, which leads to clouding of the cornea and decreased vision.

Causes of keratitis

In more than a third of cases, the cause of the disease is herpesvirus infections (herpes virus, chickenpox, measles).

The development of the disease can also be caused by infections of a bacterial nature - staphylococci, streptococci, diplococci, pneumococci, Proteus, Escherichia coli Klebsiella.

Amoebic keratitis is most common in patients who wear contact lenses. In the case of fungal etiology of the disease, the causative agents are usually candida or aspergillus.

Symptoms of keratitis

The main clinical manifestations of the disease are: redness of the eyes, severe photophobia, spasm of the eyelids, profuse lacrimation, pain, clouding of the cornea, deformation of its shape and impaired sensitivity. Corneal ulceration is also possible, which is an unfavorable course of keratitis. Also, the characteristics of the course of the disease depend on the nature of the infection.

Diagnosis of keratitis

During the diagnosis, a number of studies are performed: eye biomicroscopy, ultrasound pachymetry, keratotopography, corneal microscopy, computer keratometry, esthesiometry, fluorescein instillation test. In order to determine the nature of the lesion, a bacteriological examination of a smear taken from the affected area is carried out.

Treatment of keratitis

Features of therapy depend on the etiology of the disease. Patients who use contact lenses to correct their vision should stop wearing them until complete recovery.

In the case of a bacterial nature, antibiotic therapy is prescribed (aminoglycosides, penicillins, cephalosporins); therapy for viral keratitis is carried out using antiviral agents. For the treatment of keratomycosis, antifungal agents are used.

Possible complications of the disease include: keratouveitis, secondary glaucoma, keratoscleritis, optic neuritis, cataracts, keratoconjunctivitis.

Prevention of keratitis

In order to prevent keratitis, mechanical damage to the eyes, vitamin deficiencies, inflammatory eye diseases, and immunodeficiency conditions should be avoided. It is also necessary to follow the rules of wearing contact lenses and the rules of personal hygiene, and regularly perform exercises to relax the eye muscles.

Keratitis: causes, symptoms, treatment

Causes and risk factors

There are 2 main types of causes of keratitis: infectious and non-infectious. Non-infectious causes include:

• wearing contact lenses for too long;
• dry eyes;
• allergies, for example to cosmetics;
• presence of foreign objects in the eye;
• corneal damage;
• exposure to intense sunlight, for example due to reflection from water or snow;
• vitamin A deficiency.

Infectious causes of keratitis:

• bacterial, usually due to contaminated contact lenses;
• fungal, most often due to eye damage from a tree branch or plant;
• viral, due to infection with the herpes simplex or herpes zoster virus;
• parasitic, caused by microorganisms often found in lakes and rivers.

Complications

Keratitis can lead to vision loss if not treated promptly. Complications may include scarring, corneal ulcers, or less commonly, glaucoma. You should consult an ophthalmologist if the patient notices symptoms of keratitis.

Treatment

Treatment for keratitis will depend on the cause of the disease. To determine the cause, you must consult a doctor for qualified help.

If a person develops keratitis and wears contact lenses, they should immediately remove them and consult a doctor. Your current lenses should be thrown away and new ones should be used only after treatment.

People with fungal keratitis need to use antifungal medications for several months. If this does not solve the problem, surgery may be required.

Based on materials from www.medicalnewstoday.com

Source: https://rmc05.ru/lechenie/keratit-prichiny-simptomy-diagnostika-lechenie-profilaktika.html

Infectious keratitis

Inflammation of the cornea (that is, the front transparent part of the eye that covers the iris and pupil) is called keratitis. One of the common types of the disease is infectious keratitis ; this inflammation can be bacterial, viral, fungal or protozoal. Treatment of infectious keratitis is determined by the cause of the inflammation.

Symptoms of infectious keratitis

There are common symptoms that occur with various infectious keratitis:

• red eyes;
• lacrimation and other discharge from the eyes;
• irritation and pain, difficulty opening the eyelids;
• photophobia;
• blurred vision;
• sensation of the presence of a foreign body in the sore eye.

If you experience these symptoms, you should immediately see an ophthalmologist (for example, at our OkoMed clinic). Late diagnosis and treatment of this disease increases the likelihood of developing severe complications, including loss of vision. Next, we will look at the types of infectious keratitis and the features of their treatment.

Bacterial keratitis

This disease develops under the influence of pathogenic microbial flora. In the vast majority of cases, bacterial keratitis develops due to damage by staphylococci, streptococci, pneumococci and Pseudomonas aeruginosa. The risk of developing keratitis increases if the following factors are present:

• corneal injury (foreign body, burn, etc.);
• wearing and improper storage of contact lenses;
• irrational use of certain medications;
• the presence of certain eye pathologies (corneal dystrophy, dry eye syndrome, conjunctivitis, etc.);
• chronic infections (such as tooth decay or sinusitis);
• diabetes;
• immunodeficiency.

As a rule, the bacterial variety of infectious keratitis has an acute onset with sharp pain, lacrimation, increased light sensitivity and spasm of the eyelids, and the disease progresses rapidly.

In the corneal area there are yellow or brown infiltrates, varying in size, shape and depth of location. Purulent discharge from the eyes is usually present.

The cornea takes on a matte tint and vision deteriorates.

Depending on what pathogen causes inflammation of the cornea, the symptoms of the disease vary.

Thus, with keratitis associated with the proliferation of Pseudomonas aeruginosa, inflammation quickly spreads to the inner membranes of the eyeball and is very difficult.

With gonococcal lesions of the cornea, a purulent whitish ulcer forms on it, which spreads both over the surface of the cornea and deep into it.

Purulent infectious keratitis requires professional treatment in an eye clinic. If the cause of purulent keratitis is not identified and specific treatment for such a disease is not carried out in a timely manner, perforation of the cornea and infection may enter the cavity of the eyeball with the most severe consequences.

Viral keratitis

As the name implies, viral keratitis is a consequence of viruses entering the gas. The development of the disease is accompanied by redness and swelling of the tissues, as well as small rashes in the form of blisters.

A common form of pathology is herpetic keratitis.

As is known, approximately 95% of the world's population are carriers of the herpes virus; in some cases, the balance between the host and the virus is disturbed, and a specific inflammation of the cornea develops.

Another type of viral inflammation of the cornea is adenoviral keratitis. This disease usually occurs in the cold season, is accompanied by conjunctivitis and affects both eyes. This type of keratitis is contagious to others; the infection is transmitted by airborne droplets, as well as through household objects.

Fungal keratitis

The development of the fungal variety of keratitis is caused by filamentous fungi and yeast. This disease occurs after an eye injury; Fungal infectious keratitis is often diagnosed in rural residents.

An object that injures the cornea (for example, a tree branch) introduces a fungus into the eye, which then slowly multiplies and penetrates into the deep layers of the cornea.

In some cases, the fungus breaks into the anterior chamber of the eye.

Despite the fact that this type of keratitis is less painful than bacterial keratitis, fungal keratitis also requires accurate diagnosis and timely professional treatment in an ophthalmology clinic.

Protozoal keratitis

Such pathologies are caused by protozoan parasites - amoebas (Acanthamoeba and Hartmanelta), which live in the soil, standing reservoirs, swimming pools, tap water and sewer pipes.

Normally, the human body does not allow the amoeba cyst to penetrate the tissue, but in case of injury to the cornea (for example, when wearing contact lenses), infection can occur.

People who do not follow the rules for cleaning and storing lenses, as well as those who suffer from dry eye syndrome and diabetes, are at risk of developing protozoal (acanthamoeba) keratitis.

The likelihood of infection increases after undergoing ophthalmic surgery.

This form of infectious keratitis is characterized by severe pain in the eye, redness of the affected eye and photophobia. The disease occurs in a chronic form.

Endogenous infectious keratitis

In some cases, keratitis is endogenous, developing against the background of pathologies such as tuberculosis, syphilis, malaria, etc. In this case, the infection is introduced into the eye tissue with blood or lymph.

There are many types of endogenous keratitis. Thus, parenchymal keratitis becomes a complication of congenital syphilis.

This disease is protracted, recurs, and is often accompanied by iridocyclitis.

When the eyes are affected by Koch's wand, phlyctenulous keratitis develops; this disease occurs mainly in children and is characterized by a pronounced corneal syndrome (pain, lacrimation, photophobia, blephrospasm) and the presence of characteristic nodules in the layers of the cornea. The onset of the disease is acute, the course is long, and relapses are likely.

Treatment of infectious keratitis

The OkoMed clinic offers professional services for the treatment of inflammatory eye diseases, including keratitis. Treatment of infectious keratitis depends on the cause of the inflammatory process. To establish the causes of the disease, the doctor examines the patient, questions him about the circumstances of the manifestation of keratitis, and prescribes additional laboratory tests.

Treatment of bacterial keratitis involves drug therapy with broad-spectrum antibiotics.

Antibiotics are prescribed in the form of drops; in severe cases, injections of drugs are possible - under the conjunctiva or under the eyeball.

If keratitis is of viral origin, drugs are used that suppress specific viruses, as well as increase the body's defenses.

In addition, medications are used to help restore damaged tissue. Medicines are used in the form of drops and ointments, but if the disease is severe, the drugs are prescribed orally.

Ulcers resulting from herpetic keratitis require coagulation (for example, laser).

Fungal keratitis involves the use of antifungal drugs topically (drops) and orally.

Protozoal keratitis requires long-term treatment with eye drops; antibacterial drugs and corticosteroids can be prescribed at the same time. For severe pain, analgesics are prescribed.

If drug treatment for keratitis does not produce significant results and leads to irreversible damage to the cornea, accompanied by significant deterioration of vision, the doctor may recommend a corneal transplant surgery.

Source: https://okomed.ru/infekcionnyj-keratit.html

Features of bacterial keratitis

• 25
• Lecture No. 3
• Today's
  lecture is devoted to inflammatory
  diseases of the eyeball and optic
  nerve.
• Relevance of
  the problem

Inflammatory
eye diseases remain a serious
problem in ophthalmology.

In 80% of cases,
it is inflammation that causes
temporary disability, in 10–20
% of cases it leads to blindness, and in 8% to
anatomical death of the eye.
Patients with inflammatory diseases occupy
first place in the number of
outpatient visits.

Among
inflammatory eye diseases
, the largest group consists of conjunctivitis
- 66.7% and blepharitis
(23.3%).
Keratitis occurs in only 4.2%, but it is this form of eye disease
that is fraught with persistent vision loss and
blindness. Every year,

million cases of monocular blindness
caused by corneal ulcers are registered worldwide

1. Classification
   of keratitis
2. -
   bacterial (staphylo-, pneumo-, diplo-,
   streptococcal; tuberculosis;
   syphilitic; malaria, brucellosis,
   etc.);
3. — viral: adenoviral, herpetic,
   measles, smallpox, etc.;
4. —
   fungal;

1. Infectious (toxic)-allergic : phlyctenulosis (scrofulous), allergic (various allergens).

2. Exchange keratitis:

—
amino acid (protein);

—
avitaminous.

1. Other: neuroparalytic, post-traumatic, caused by dry eye syndrome, etc.

In
recent decades, the structure
of keratitis has changed.
If previously tuberculosis-allergic diseases predominated,
now the first place is occupied by keratitis
of viral etiology.

• Clinical
  picture .
  Regardless of the etiology, keratitis
  is characterized by a number of typical signs:
• —
  corneal
  
  syndrome (pain of varying severity, often
  in combination with reduced sensitivity
  of the cornea!; lacrimation, photophobia,
  blepharospasm);
• -
  deterioration
  
  of vision with central localization of the process
  (which distinguishes keratitis from conjunctivitis!);
• —
  violation
  
  of the epithelial layer (roughness, “weariness” of the epithelium,
  its desquamation with the formation of erosion);
• —
  infiltrates
  or ulcers;
• —
  vascularization
  of the cornea.
• Depending
  on the clinical form
  
  the listed symptoms or some
  may be observed .
• The main
  symptom of keratitis is a violation
  of the transparency of the cornea, caused by
  its swelling and infiltration of cellular
  elements.
• Inflammatory
  
  infiltrates can have different shapes, sizes
  and depths of location: pinpoint,
  round, in the form of a branch, streaks or
  diffusely covering the entire cornea.

With
purulent keratitis, the infiltrate becomes
yellowish, and with significant
vascularization it acquires a rusty
tint.
The boundaries of the infiltrate are unclear, which is determined by pronounced swelling
of the surrounding areas of the corneal stroma.

In the presence of an inflammatory infiltrate,
the cornea loses its shine and specularity,
it becomes rough,
and areas of ulceration and thinning
of the stroma may appear.

Purulent bacterial infiltrates
are usually accompanied by significant
tissue necrosis and, as a rule, disintegrate
and ulcerate.

They are bright red in color and
have tree-like branches.
Deep vessels are darker in color and usually have the appearance of
short, straight branches
resembling “brushes” or “brooms.”

They develop from deep episcleral
vessels.

When
the inflammatory process moves to
the deeper layers of the eye - the iris,
ciliary body,
keratoiritis, keratoiridocyclitis, and keratouveitis develop

. In this case, the disease is accompanied by
the deposition
of precipitates on the endothelium, the appearance of
fibrin in the humor of the anterior chamber, and
hypopyon .

In
case of perforation of a purulent corneal ulcer,
severe complications may occur:
endophthalmitis, secondary glaucoma,
subatrophy of the eyeball.

Diagnosis of
keratitis and corneal ulcers. It is based
on anamnesis data, a typical clinical
picture, as well as on the results
of microbiological examination
of patients.

Treatment
is often carried out in a hospital setting,
especially for acute and purulent
keratitis.
When determining the etiology, the disease that caused the keratitis is first treated
.

Outcome
of the disease. Superficial
infiltrates that do not violate Bowman’s
membrane can resolve without a trace.

Infiltrates
located under Bowman's membrane
in the superficial layers are partially
resolved, partially organized
without disintegration, leaving a delicate scar in
the form of a cloud-like

opacification (nubecula).

Widespread infiltration of the
corneal stroma in the middle and deep layers
is usually not prone to disintegration and forms
a more or less pronounced scar
opacification ( spot
- macula ,
thorn - leucoma ).

factors
for bacterial keratitis are presented
on the slide.

with
trauma
.

The role of contact correction as a risk factor for this pathology has increased
significantly (up to 19–42%!!!) .
Moreover, leaving lenses overnight increases the risk of
a purulent corneal ulcer by
5 times .
The role
dry eye
syndrome as a risk factor for corneal ulcers has increased

Causative agents of bacterial keratitis

The most
common (more than 80% of all cases) causative agents
of bacterial corneal ulcers are:
Staphylococcus ,
Streptococcus ,
Pneumococcus, Pseudomonas
aeruginosa Escherichia
coli , Neisseria ,
Proteus vulgaris ,
Moraxella less
common .
In isolated cases
, keratitis caused by Nocardia .
The most severe and urgent is
Pseudomonas aeruginosa infection.

Antibacterial agents

1. Current
   trends in antibacterial therapy:
2. • introduction
   of new antibiotics, for example, the quinolone
   series;
3. • intensification
   of the use of drugs, ensuring
   maximum activity at the site of infection:
4. 1)
   forced administration methods;
5. 2)
   concentration increased by 3–5 times
   ;
6. 3)
   ophthalmic dosage forms
   (ocular
   medicinal films, corneal
   caps);
7. • complex
   drugs, for example Colbiocin, which includes
   3 antibiotics: tetracycline, chloramphenicol,
   colistin;
8. • drugs
   of combined action: Dexa-Gentamicin
   (dexamethasone + gentamicin).
9. Let's look at
   some drugs that are of
   greatest practical interest.
10. Picloxidine
    
    0.05% eye drops (Vitabact) is an antiseptic with a broad antibacterial
    spectrum of action and very good
    tolerability.

Lomefloxacin
0.3% (Okacini)
belongs to the group of difluoroquinols from
the quinolone class.

bacteria ( Staphylococcus
epidermidis ,
saprophyticus )
highly sensitive to the antibiotic gram-negative ( Pseudomonas
aeruginosa ,
Neisseria spp. ,
Enterobacter
cloaca, Escherichia
coli , Haemophilus
Influenzae ,
Klebsiella
pneumoniae ,
Moraxella
catarrhalis ,
Proteus
mirabilis)
and other microorganisms ( Clamydia
trachomatis ).
Of the second generation quinolone antibiotics,
lomefloxacin entered
ophthalmological practice
several years later, so the number
of pathogens resistant to it
is approximately 2 times less than to the first
quinolone antibiotics - ofloxacin,
ciprofloxacin and norfloxacin .

Levofloxacin

(Tavanic) is a third-generation quinolone antibiotic
that has a wide spectrum
of antimicrobial action.
Compared to ofloxacin, it exhibits higher
activity against S.

aureus , S.
pneumoniae , Streptococcus
,
active against Pseudomonas
aeruginоsa , Chlamydia .

Used in tablets (250 mg, 500 mg) in
the treatment of bacterial and chlamydial
eye infections.

Of
the fourth generation quinolone antibiotics,
eye drops being studied are
0.5% moxifloxacin (Viganax), 0.3% gatifloxacin
(Zimar), 0.5% trovafloxacin.

Colbiocin
is an antibacterial drug containing
chloramphenicol, colistin, and roletetracycline.
Possesses, perhaps, the widest spectrum
of antibacterial activity against
gram-positive and gram-negative
bacteria (including Pseudomonas
aeruginosa ),
spirochetes, chlamydia, mycoplasmas, rickettsia, and
some fungi.

Source: https://studfile.net/preview/6137918/

Acute keratitis - causes, symptoms and effective treatments

Often the initial form of keratitis occurs in an acute form. The disease lasts up to six weeks or more, but there are documented cases of recurrent processes. For comparison, superficial traumatic keratitis lasts about a week. It is the nutritional characteristics of the cornea that influence the long-term development of keratitis.

Metabolic processes occur very slowly in these cells, and all due to the fact that they do not have their own blood vessels. It is very sad, but keratitis can cause some complications.

These include the influence of the inflammatory process on the anterior part of the uveal tract, which occurs due to a single source and close location for the processes of innervation and blood supply.

Keratitis as a cause of scar formation

At the end of the disease, keratitis necessarily forms a scar turbidity in the area of ​​inflammatory infiltrate. The area of ​​this scar depends on the nature of the resorption process. This means that the resulting inflammatory infiltrate is greater than the resulting clouding of the cornea.

These signs help determine the possible outcomes of the disease.

The subtle cloudiness is called a cloud (nubecula). It is not easy to detect, so methods of objective examination of the visual organs that are damaged are used for this purpose. The threat of decreased visual acuity occurs if the clouding is located in the center. Intense and significant turbidity is considered to be a cataract (leycoma).

A total cataract is a cataract that occupies the entire cornea. The fused category includes a cataract in the area of ​​which the surface of the iris is soldered, and the anterior chamber has an uneven depth. If the cataract is penetrated by vessels, then it is considered vascularized.

To determine treatment methods and indications for keratoplasty surgery, a special classification is used.

V.P. Filatov developed a special technique, thanks to which blindness due to a cataract can be classified as a treatable form. Filatov was the first to master the transplantation of a corneal graft from a cadaveric eye, rather than from a living organism. This has made keratoplasty acceptable in almost all cases.

Individual forms of keratitis differ in quite noticeable frequency parameters. These are not only temporary, but also territorial differences. Many etiological factors influence these indicators. Tuberculous keratitis is being recorded more and more often due to the increasing incidence of tuberculosis. The statistics of herpetic keratitis is also changing upward.

Treatment of bacterial keratitis

When treating bacterial keratitis, it is recommended to start taking antibiotics (tetracycline, erythromycin, oletethrin) as early as possible, and also give the patient intramuscular benzylpenicillin sodium salt 3-4 times a day or streptomycin sulfate 2 times a day in age-appropriate dosages.

Locally: first thoroughly rinse the eyes with any of the following disinfectant solutions of antibiotics: neomycin, gentamicin, monomycin, kanamycin or chloramphenicol, you can also use the sodium salt of benzylpenicillin in the form of an installation of 0.25–0.5–1 percent solutions of 6–8 once a day, plus add 0.5 percent ointment to this.

The doctor may recommend using 1 percent dibiomycin, tetracycline, erythromycin ointment.

Treatment with antibiotics should be combined with the administration of oral sulfonamide drugs (sulfadimezin, etazol or sulfapyridazine), a 30% solution of sulfacyl sodium or a 10–20% solution of sulfapyridazine sodium is prescribed locally.

In addition, it is necessary to instill vitamin drops and a solution of atropine sulfate or a 1 percent solution of pilocarpine into the sore eye; the prescription of atropine or pilocarpine depends on the depth and location of the ulcer.

If the course of the process is rapid, cryo- and diathermocoagulation of the progressive edge is performed, it is necessary to perform paracentesis and rinse the anterior chamber with broad-spectrum antibiotics. It is necessary to prescribe periorbital and retrobulbar novocaine blockades. To relieve pain, it is recommended to take analgesics and desensitizers internally.

• During the recovery period, it is necessary to carry out therapy aimed at resolving the infiltrate; lidase and ethylmorphine hydrochloride are used for these purposes; other drugs can be used in the form of drops or electrophoresis
• Corticosteroid preparations with enzymatic treatment in the active phase of the disease are strictly contraindicated.
• Expert editor:

Education: Moscow Medical Institute named after. I.M. Sechenov, specialty - “General Medicine” in 1991, in 1993 “Occupational Diseases”, in 1996 “Therapy”.

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Treatment of keratitis

Having determined the source of infection, identifying which pathogen provoked the inflammation, medical prescriptions are carried out.

The viral etiology of keratitis involves taking therapeutic measures to eliminate the identified infectious pathogen. In this case, medical prescriptions include drip administration of the following medications:

• acyclovir
• interferon
• pyrogenal

In addition, ointment is placed behind the eyelid:

• Floraleva
• bonaftone
• tebrofen

• Inside, the use of immunomodulators is indicated: levamisole, thymalin
• When the bacterial nature of keratitis is proven, it is treated with antibiotics, taking into account the sensitivity of the pathogen to them.
• List of medical prescriptions:

• eye drops
• injections directly under the conjunctiva - the drugs are administered with a thin insulin syringe, in the area of ​​the transitional fold of the conjunctiva
• aminoglycosides
• fluoroquinolones
• cephalosporins

1. The tuberculosis form of pathology is fought jointly by an ophthalmologist and a phthisiatrician, using anti-tuberculosis chemotherapy drugs.
2. An allergic type of inflammation of the cornea requires the use of antihistamines and drip administration of hormonal solutions.
3. For the gonorrheal form of the disease, treatment is controlled by a venereologist.
4. To stimulate the epithelial layer and eliminate corneal defects, Taufon and Vitasik are prescribed.

The ulcerative form of keratitis is a strong argument in favor of intervention by an ophthalmologist. The problem is dealt with by:

• cryoapplications
• keratoplasty
• removal of superficial scars
• trabeculotomy
• removal of the eyeball - enucleation is resorted to in severe cases, in a negative scenario for the development of the disease

Traditional ways to combat keratitis

As for home therapy, such treatment is considered as an auxiliary measure that complements drug therapy. Before use, consultation with an ophthalmologist is required.

1. Centrifugal honey is a folk remedy that can help heal the eyes with keratitis. Make a 30% solution in distilled water. Drip three drops twice a day. If the disease is advanced, the course of treatment lasts for a month.
2. It is acceptable to place undiluted honey behind the eyelid. There is a possibility of a slight burning sensation.
3. Squeeze the juice from Kalanchoe, dilute with water 1/1. Apply compresses to the eye for ten minutes.
4. Brew blue cornflower (1 tbsp) with boiling water, strain and apply lotions.

Prevention of keratitis

• eye hygiene
• proper care of lenses, wearing according to the rules
• protection against foreign bodies
• neutralization of infectious foci

Take care of your eyes, get systematically checked by an ophthalmologist, then you will not be in danger of getting acquainted with keratitis. Remember that good vision is an invaluable wealth given to man by nature, which is easy to lose and extremely difficult to restore.

Take an interest in health, goodbye.

Alternative medicine

Treatment of keratitis can be carried out at home using special folk remedies:

1. Sea buckthorn oil. Over the course of a week, two drops of herbal medicine are instilled into the sore eye at intervals of one hour. After the specified period, the interval between procedures can be increased to three hours.
2. The use of celandine juice and propolis water extract. The substances are mixed in a ratio of 1:3. The resulting medicine is instilled 2 drops into both eyes daily before bedtime.
3. Aloe juice and mumiyo. Six large leaves are plucked from a houseplant and kept in the refrigerator for ten days. After this, the aloe is crushed using a meat grinder, and the juice is squeezed out of the resulting pulp. 2 g of mumiyo are dissolved in the liquid. The resulting mixture must be instilled into the sore eye every day until complete recovery. Dosage - 1 drop for each eye.
4. Aloe juice. You can get rid of the inflammatory process on the cornea with the help of special compresses. A sterile bandage is moistened in fresh aloe juice and applied to the sore eye for 15 minutes. The procedure can be performed daily.
5. Rye bread. Use fresh baked goods, on which you need to place a glass upside down. Condensation will collect on its walls. In the future, this liquid can be used as anti-inflammatory eye drops.
6. Plantain infusion. You need to take a half-liter jar, fill it 1/10 with dried leaves of the medicinal plant, and add water. The mixture should stand for 3 hours, after which it should be filtered and used to wash the sore eye.
7. Clay lotions are used to relieve pain. White, blue or red clay is suitable for the procedure. It is mixed with a small amount of water and then applied to sterile napkins. They are recommended to be applied to the area of ​​the eyes, forehead and back of the head. The duration of the procedure is 1.5 hours. Compresses can be done several times a day until the pain disappears.
8. Contrasting lotions. Use a regular cotton swab, which is moistened in cold (almost ice-cold) water and applied to the sore eye for 1 minute. After this, it is dipped in hot water. A warm cotton swab is applied to the eye and held for 2 minutes. The procedure is repeated ten times.
9. Woodlice infusion. A handful of crushed plant material is poured with a liter of boiling water. The medicine must infuse for 6 hours, after which it must be strained. The resulting liquid is used to wash the sore eye.
10. Application of garlic. This treatment method is effective in combating viral keratitis. To carry out the procedure, you need to take a clove of garlic, cut it in half and apply it to the closed eye, securing it with a bandage. Keep the compress for 5-10 minutes. During the day, you can carry out 5-6 such treatment procedures.

To get rid of keratitis, you can use any of the following remedies. But self-treatment is unacceptable; it is better to consult a doctor. He will not only help eliminate the pathology, but also prescribe preventive therapy to prevent relapse of the disease.

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Source: https://medic-help.ru/zabolevanija-glaz/keratit-glaza/