These keratitis usually you is called diplococci, streptococcus, staphylococcus and other bacteria, trapped in the cornea through kakuyu- or scratch on the surface. They can occur in the vie de superficial keratitis or corneal ulcers creeping.
Superficial keratitis often occurs as a complication of conjunctivitis, blepharitis, dacryocystitis . When joining keratitis, a patient with these diseases has a feeling of a foreign body behind the eyelids, eye pain, corneal syndrome. When viewed from the eyes cha slit on the edge of the cornea appear small grayish infiltrates; often they merge, ulcerate.
Emergency First aid Zack becomes active in the following events:
- instill in a conjunctival sac of a 30% solution of sulfacyl sodium and
- in laying 1% tetra cyclin or 5% levomycetin ointment;
- Salo can live off the lower eyelid eye drug film with sulfa drugs or antibiotics.
Treatment .
- First of all, it is necessary to eliminate the causes of the disease – conjunctivitis, blepharitis, dacryocystitis .
- The local use of antibiotics and sulfonamides is prescribed after the microbial flora of the conjunctival sac is detected and its sensitivity to antibiotics is determined.
- Tools that extend zra choke ( midriatiki ), such patients are not assigned.
- After decrease of inflammation in the cornea are used resorbable conductive agent [3% potassium iodide solution, a solution ethylmorphine hydrochloride (dionin) in increasing concentrations tion, 1% yellow mercury ointment.
Care for patients with superficial keratitis is carried out in a hospital or at home. It includes frequent instillation of drops according to the doctor’s prescription, and medication. Due to photophobia patients can Nadya Vat glasses with tinted windows. A blindfold should not be applied. It is necessary to monitor the diet (limit carbohydrates, spicy foods, sweets, eggs, oranges, strawberries, chocolate). Prevention is camping in the early detection and treatment of conjunctivitis, blepharitis, dacryocystitis.
Crawling corneal ulcer occurs when about penetration of infection through abrasion or erosion of the cornea. Almost always, when a patient is questioned with a corneal ulcer, it is revealed that she was preceded by eye microtrauma. A creeping ulcer begins with a sensation of a foreign body in the eye; soon joined photophobia and slezoteche set, swelling and redness of the eyelids, pyorrhea starts from conjunctival sac, which is very abundant.
Copious pyorrhea is one of the most characterized Terni creeping signs corneal ulcers. Another characterized lattice constant a symptom of the disease – the presence of purulent infiltration of the cornea yellow. Infiltrate Stano vitsya purulent and opened. An ulcer forms. The iris is involved in the process. The moisture in the anterior chamber becomes cloudy due to the appearance of exudate in it. Exudate becomes Xia purulent, settles on the bottom of the front chamber. The accumulation of pus at the bottom of the chamber is called hypopyon .
Creeping corneal ulcer is prone to rapid progression, has characteristic features. One edge of the ulcer is smooth, the other is sap. The ulcer moves – “creeps” along the cornea towards the sap. The bottom of the ulcer may deeper until complete perforation (perforating radio) cornea. This can lead to purulent melting of the vitreous body – endophthalmitis or purulent inflammation of all the membranes of the eye – panophthalmitis , i.e., death of the eye.
Emergency first aid for creeping corneal ulcer is:
- The rinse thoroughly Vania conjunctival sac solution furatsilina 1: 5000,
- A solution of rivanol 1: 1000 or potassium permanganate 1: 5000.
- It is necessary to instill in the eye a 30% solution of sulfacyl sodium and 0.25% solution of chloramphenicol, 1% solution of atropine sulfate.
- Required are inside 1g sulfadimethoxine or sulfapiridazina and tetracyclo on, oletetrin ;
- Intramuscularly, a single dose of a broad-spectrum antibiotic is prescribed (streptomycin, monomycin , etc. or penicillin).
- The patient is immediately sent to a hospital. Medication in the eye should be installed all the time on the way to the hospital. You can’t apply a bandage.
Treatment.
- Assign installation 30% solution sulfatsil -sodium or 0.25% solution of chloramphenicol kazh Dyje 2-3 hours.
- At the same time you must enter a conjunctive tivu antibiotics (streptomycin, monomitsin et al.), Selected depending on the results of bacteriological one study.
- Useful tushirovanie sores% 1 Spear striation solution of brilliant green, 5% alcoholic solution of iodine.
- 5-6 hours after subconjunctival injection of an antibiotic, the ulcer should be powdered with sulfacyl sodium powder .
- To enhance the activity of epithelialization prescribed drops of 1% solution of quinine gidrohlori yes 5-6 times per day.
- It is necessary to apply mydriatics (1% atropine sulfate solution, a combination of solutions Atro pin sulfate and epinephrine hydrochloride 1: 1000 et al.).
- Without fail we treat vitamin B ,, B b , by intramuscular injection of 1 ml of 15-20 injections on course.
- In severe cases, resort to diathermocoagulation of the progressing edge of the ulcer or cryoapplication .
- With hypopyone , paracentesis can be applied – opening the anterior chamber, followed by washing it with a weak antibiotic solution.
- With the threat of perforation, therapeutic layered keratoplasty is indicated.
Care of patients with crawling corneal ulcer is carried out in the hospital care similar pain nym with superficial keratitis. However – instillation into the eye, laying the ointment should be carried out very PICs goad, in any case do not press on the eye, not a break shat patient greatly compress the eyelids due to the threat of breakdown Denia corneal thinning.
Prevention crawling corneal ulcers conclude chaetsya in preventing micro-traumas in the eyes of the home and in the workplace, health and educational work with the population Niemi (appeal to the medical staff at any microtrauma eye, timely and complete their treatment). It is necessary to identify and treat all patients with Dacre cystitis (their frequent complication is creeping corneal ulcer).