Syphilitic keratitis is a late manifestation of congenital syphilis. The disease usually occurs in childhood and adolescence, less often in middle-aged and elderly people. Both eyes are usually affected. Keratitis occurs cyclically. At first it hurts: photophobia, mild redness of the eye wallpaper. When examining the cornea in the limbus, diffuse infiltration is visible, which spreads throughout the cornea.
The period of infiltration lasts 3-4 weeks . Following infiltration into the cornea, deep vessels begin to grow – this is a period of vascularization . It lasts 6-8 weeks. Visual acuity decreases, eye pain intensifies. Then comes the resorption period (regression period). Within 1-2 years, the transparency of the cornea is restored to varying degrees.
The diagnosis is made on the basis of the clinic and the data of specific serological tests ( Wasserman reaction ).
Treatment of syphilitic keratitis is carried out jointly by oculists and venereologists.
- Apply general treatment (iodine preparations, bioquinol , penicillins).
- Locally prescribed mydriatics , solutions of ethylmorphine hydrochloride in increasing concentrations, 1%, 2% yellow mercury ointment, corticosteroids.
- Paraffin baths, ultra-high-frequency therapy, treatment with a solux lamp, electrophoresis with 1% ethylmorphine hydrochloride (dionine) solution and 3% potassium iodide solution are useful.
- The treatment is supplemented with the use of vitamins B ,, C, D.
- If after treatment there are persistent corneal opacities that reduce visual acuity, keratoplasty is indicated.
Tuberculous keratitis.
Tuberculous keratitis occurs when a tuberculosis pathogen enters (metastasizes) in the cornea. This is deep keratitis, occurs in the form of various forms.
Deep diffuse keratitis is characterized by the appearance Niemi tearing, photophobia, pericorneal injecting tion. The cornea diffusely becomes turbid, in the deep and middle layers yellowish-gray large non-merging foci stand out . Superficial and deep vessels grow into it. One eye is usually affected. Remissions alternate with exacerbations. The outcome is unfavorable. Dense scars remain.
Deep infiltration of the cornea – nai more common form of metastatic corneal tuberculosis. The focus is located in the posterior layers of the cornea. Such keratitis develops on the basis of tuberculosis-allergic keratitis suffered in childhood.
Sclerosing keratitis develops in the presence of deep scleritis in the form of infiltration deep into the FIR layers at the rim of the cornea, propagating toward the center in the shape of a half moon . The epithelium over the affected portion thereof: but pitting nikoga so arises. The vessels in the cornea, usually absence exist. The disease proceeds for a long time, with remissions and exacerbations. The prognosis is unfavorable, since the infiltrated tissue is replaced by a scar. Very often, the iris and ciliary body are involved in the process.
Treatment of tuberculous keratitis is carried out jointly by an optometrist and a TB specialist.
- Apply streptomi ching sulfate, sodium paraaminosalitsilat , ftivazid , metazid , salyuzid , isoniazid ( tubazid ) antituberculosis chemotherapy and other actions. Streptomitsi to sulfate is typically used daily Ltd. 500 IU intramuscularly (at the rate of up to 50 IU LLC) subkonyunk – tivalno (100 000 units) and in the form of electrophoresis. Ftiva Zid designate 0.5 g of 2 times a day (at the rate of 40 g), sodium paraaminosalitsilata 0.2 g per 1 kg body weight of the patient (at the rate of 250-400 mg).
- In severe cases, tuberculin therapy is also recommended .
- At the same time, intravenous infusions of 10% calcium chloride solution of 5-10 ml daily for 20-25 days are recommended.
- Inside, diphenhydramine is prescribed at 0.05 g 2 times a day, multivitamins.
- To prevent adhesions of the iris rear shows the assignment mydriatics , solljuks lamps, dry of heat.
- For desensitization, subcutaneous injections of a 0.25% calcium chloride solution, corticosteroids are useful.
Caring for patients with tuberculous keratitis includes monitoring the implementation of doctor’s prescriptions, patient diet (restriction of carbohydrates, high levels of fat, protein), organization of the daily regimen (prolonged exposure to air).
Prevention is the timely detection and treatment of tuberculosis patients.
Outcomes of corneal diseases.
After inflammation of the corneal lesions, cicatricial opacities remain.
According to the degree of prevalence and intensity of clouding of the cornea, they distinguish:
- a cloud
- spot and
- thorn.
A cloud is a limited clouding of gray that is hardly perceptible upon examination.
A spot is a persistently limited clouding, which can be detected during a general examination. A corneal spot significantly reduces vision.
Belmo – persistent opacification of the cornea, light gray or white. Many diseases, especially corneal ulcers, ending with perforation, heal by rough scarring with the formation of fusion with the iris. Such wallets are called spliced. They, as a rule, are accompanied by secondary glaucoma, under the influence of which the cataracts stretch, become thinner and acquire the character of staphyloma. Often the thorn grows in vessels. It significantly reduces visual acuity.
Treatment.
The main method for eliminating persistent clouding of the cornea is its keratoplasty (transplantation) or keratoprosthetics (replacing a clouded cornea with artificial prostheses), so that patients who are previously doomed to blindness are able to see again.