Most often, viral keratitis occur in the form of herpetic keratitis, that the frequency and severity ranks first among the inflamed Nij cornea. Herpetic keratitis occur in de paths at the age of 5 years in the form of primary eye syndrome in adults – as poslepervichnogo keratitis. The impetus for the disease may be hypothermia, overwork, general illness; Often, damage to the eyes is preceded by a rash of herpes on the lips, wings of the nose, etc.
For all forms of herpetic keratitis characterized precipitates absence of conjunctival cavity unsharp redness eyeball gray infiltrates, decreased corneal sensitivity and the abutment Noe, long duration.
Herpetic keratitis is:
- superficial and
Of the superficial, tree keratitis is more common , of the deep – metaherpetic and disk-shaped.
Arboreal keratitis is one of the most common forms of post-primary herpes. He accompanied nied by moderate subjective oschu scheniyami, photophobia, lacrimation, pericorneal injection. When examining the cornea, groups of small vesicles in the epithelium and surface gray infiltrates are revealed, which, when combined, form bizarre shapes in the form of tree branches. Sloughing of the epithelium leads to the formation of an ulcer surrounded by swollen elevated epithelium. As a rule, the tree prominent keratitis stale and hard, complicated by inflammation of the iris.
Metaherpetic keratitis is, as it were, a transitional form of a tree-like lesion of the cornea. This form of keratitis is characterized by infiltration You are located deep in the cornea, and Fade are fifth form with indistinct contours. Vision is sharply reduced. Sensitivity of the cornea is almost absent. There is a slight pain, photophobia, blepharospasm, slezote chenie.
Discoid keratitis is a deep form of keratitis caused by herpes viruses, and characterized ized by the formation of the deep infiltration in the form of a disk, which is located more frequently in the center of the cornea. Rogo Vitsa in the area of thickened, there are folds the rear border of the plate. Around the infiltrate there is a swelling zone. Infiltrate usually do not ulcerate, but replaces camping connective tissue. As a result, vision is sharply reduced.
Emergency First aid with herpetic keratitis is to protect the patient’s eyes from the introduction of the affected cornea herpes secondary infection and the direction of the patient on the stationary Narnia treatment in the eye department of the hospital.
- A 30% solution of sulfacyl sodium is instilled into the eye ,
- 0.2% solution of chloramphenicol and lay 0.25% oxolinic ointment. In the absence of this ointment, 3% tetracycline ointment can be placed in the eye. A blindfold cannot be worn.
Treatment of herpetic keratitis is a long, complex integrated polices.
- They use painkillers to relieve corneal syndrome – forced installations of 2% novocaine solution.
- Mydriatic agents ispol’uet form a as prevention of iridocyclitis: installation of 0.25% solution of scopolamine hydro bromide in conjunction with applications 0.01% epinephrine hydrochloride solution.
- Means apply anti viral chemotherapy: installation solutions idoxuridine ( keretsida ), deoxyribonuclease 0.1% florenal 0.1% 6-8 times a day; the laying of ointments – florenal 0.25%, 0.5%, tebrofen 0.5%, oxolin 0.25% 3-4 times a day.
Treatment listed pre Paraty is carried out not more than 10 days due to their local toxic effects.
- In the absence of a pronounced therapeutic effect, interferon is additionally prescribed in the form of hourly instillations for 5-7 days, immunomodulators in the form of intramuscular injections of pyrogenal in increasing doses – from 50 to 350 MTD.
- For the treatment of herpetic keratitis are used, vitamin A, vitamin B, C, autologous blood from 2% tensile thief ascorbic acid in a ratio of 2: 1 under the conjunctiva, means to facilitate epithelization of the cornea: installation oily solution of vitamin A, sea buckthorn oil, honey 40% vitamin ointments ( thiamine 5%, etc.),
- Use the method of physical exposure (diathermocoagulation, cryocoagulation , cryoblowing , laser therapy).
- Suckable clouded neny corneal installation solution used ethylmorphine hydrochloride (dionin) rising in a concentration of from 1% to 8% by 1-2 drops 3 times a day;
- Forced installations and electrophoresis with enzymes: lidase , trypsin, lycozyme (papain).
- With deep keratitis treatment painkillers added as novocaine blockade nonspecific and spe graphical instruments antiinflammatories general dei Corollary [ phenylbutazone , indrmetatsin , hexamethylenetetramine (urotropin) with glucose intravenously]; corticosteroids in the form of installations, subconjunctival and retrobulbar injections of dexazone , cortisone, hydrocortisone, dexamethasone strictly after the end of corneal epithelization under the cover of antiviral drugs; desensitizing agents (diphenhydramine, tavegil, suprastin , diazolin ); Surgical treatments (Kera toplastika).
Care of patients with herpetic keratitis performed in hospital and at home as a physician performing assignments (drops, ointments, pre Paratov inside injection). You can’t blindfold these patients. Since the sensitivity of the cornea is reduced, while walking, protect the sore eye with glasses or a gauze curtain.
Prevention of herpes ke ratita = is improving the body’s defenses (general restorative treatment) prevention of re cooling, overheating, especially against dashing Radka, protivoretsidiv – term treatment of persons re bare the herpetic keratitis.