Keratitis is one of the most common ophthalmologic diseases affecting the anterior eye.
Pathology is characterized by the development of the inflammatory process in the cornea of the optic organ. The cornea performs a light refractive function, and the visual perception of the eye depends on its homogeneity, transparency and sphericity.
With the development of the inflammatory process, corneal clouding and ulceration occurs. Quite often, such changes are irreversible, which can lead to a decrease in visual acuity, up to its complete loss.
Keratitis may develop under the influence of external and internal factors. Pathology can occur in mild, moderate or severe form.
The classification of the disease depends on the degree of corneal damage. According to this, keratitis is:
Superficial keratitis is characterized by damage to the upper layer of the cornea. In this situation, there are no irreversible processes that can lead to loss of vision.
The following classification of keratitis depends on the reasons for its development. By this criterion, the disease is divided into:
- bacterial form, in which the infection penetrates into the anterior part of the optic organ due to injuries or wearing contact lenses;
- viral form (often keratitis causes abnormal activity of herpes viruses);
- fungal form, which is one of the most dangerous, because it can cause the appearance of a cataract. This type of keratitis leads to the fact that all layers of the cornea are affected, even the blood vessels that feed the eye.
In addition, there is another gradation of keratitis:
- The so-called "creeping corneal ulcer", which can be triggered by the ingress of small foreign objects that traumatize the top layer of the cornea.
- Onchocerciasis keratitis, developing due to the presence of allergic reactions. Such a pathological process can affect both the front and back of the eye. Severe allergies can lead to the development of so-called. spring keratoconjunctivitis.
- Photokeratitis is a form of the disease caused by corneal and conjunctival burns caused by exposure to ultraviolet radiation.
- Non-ulcerative keratitis is a pathological process caused by the attack of gram-negative microorganisms that have penetrated eye tissues.
- Superficial marginal keratitis - develops as a complication of inflammations of the eyelid and mucous membranes of the eye, as well as with untreated meybomite.
- Neurogenic keratitis.
- Acanthus keratitis caused by irrational use of contact lenses.
With deep keratitis, the inflammatory process affects the inner layers of the cornea, which in the future may lead to the appearance of scars, as well as to a decrease in visual acuity.
In most cases, the development of keratitis contributes to the penetration of viruses in the tissue of the eye. In 70% of cases, the cause of the pathology becomes herpes virus type 3 - Varicella-Zoster, which is the causative agent of chickenpox and shingles.
External causes of keratitis include:
- mechanical impairment of the integrity of the cornea;
- chemical exposure to the eye mucosa;
- bacterial infections;
- fungal infections;
- wearing contact lenses;
- working conditions with a high degree of danger.
Internal factors predisposing to the development of keratitis include corneal pathologies caused by:
- severe infectious lesions of the cornea from the inside;
- acute reaction of the body to neuroparalytic effects;
- vitamin deficiency.
Modern ophthalmology has therapeutic techniques that help quite successfully fight keratitis. However, in severe cases, they do not always help prevent a decrease in visual acuity or its complete loss.
Keratitis Symptoms and Photos
A common symptom of all forms of keratitis is the development of the so-called corneal syndrome. It is characterized by the appearance of:
- sharp pain in the eye;
- increased tearing;
- reflex blepharospasm, characterized by involuntary closing of the eyelid of the diseased eye;
- reduced visual acuity;
- feelings of "sand" or a foreign object in the eye;
- pericorneal injection of the eyeball.
When keratitis is the formation of infiltration, which subsequently begins to put pressure on the nerve endings of the cornea. The development of the corneal syndrome is associated with this.
In addition, with keratitis, the cornea loses its transparency and luster. It becomes turbid, its sphericity and photosensitivity changes. Neurogenic keratitis, on the contrary, is characterized by a decrease in the sensitivity of the cornea, and a decrease in the intensity of the manifestation of the corneal syndrome.
The accumulation of lymphoid cells gives a gray tinge infiltration. If the number of leukocytes dominates, it becomes yellow, which indicates the presence of pus. With superficial keratitis, the infiltrate can resolve itself, but with a deeper lesion, corneal opacities of varying severity occur at the site of the infiltration. Depending on it, the visual function of the patient suffers.
The formation of corneal ulcerations is considered the most unfavorable variant of the progression of keratitis. Further, exfoliation and desquamation of the epithelium begins to occur, which leads to the formation of erosions on the surface of the cornea. The progression of the pathological process and the death of tissue causes the appearance of ulcers.
Keratitis, accompanied by corneal ulcers, often ends with the formation of a catcher. In severe cases of the disease, deep ulcerative defects reach the anterior chamber of the eye, leading to the development of a hernia of the Descemet's membrane. In some cases, ulcer perforation, development of endophthalmitis, secondary glaucoma and other complications occur.
Keratitis often occurs in a complex with other eye diseases, for example, conjunctivitis (keratoconjunctivitis), scleritis (keratoscleritis), uveitis (keratouveuity). When all the membranes of the eye are involved in the pathological process, the death of its tissues and loss of visual function occur.
The diagnosis is a relatively easy process, based on the examination of the patient's complaints about the presence of the previously considered symptoms. To identify the effects of exogenous factors, tissue is scraped from the surface of the infiltrate. Usually, the presence of pathogens is determined during the study.
With endogenous keratitis, a number of studies are carried out aimed at determining the etiology of an ophthalmologic disease. In this case, the oculist necessarily examines the patient’s history in detail, since keratitis often occurs against a background of another pathology. A mandatory event is to conduct biomicroscopy using a special slit lamp.
It is very important to differentiate keratitis from various degenerative processes in the cornea. During the primary degeneration of the cornea, both visual organs are affected. In addition, the disease is characterized by a chronic course and very slow progression.
How to treat keratitis?
After a thorough diagnosis, the doctor develops a treatment regimen. If the inflammatory process proceeds without complications and associated diseases, the patient is treated on an outpatient basis. With a deep eye lesion, the presence of abnormal discharge, or a high risk of complications, the patient is placed in the hospital.
The keratitis treatment regimen often includes the use of:
- Local anesthetics (in the form of eye drops) to relieve pain;
- Restorative and moisturizing eye gels (if the cause of keratitis was the prolonged wearing or improper use of contact lenses);
- Moisturizing drops (if there are irregularities in the work of the eye glands);
- Antihistamine drugs (drops, tablets or injections) for allergic keratitis;
- Antimicrobial drugs - with a bacterial origin of keratitis (antibacterial ointments can be used, but in severe cases, parabulbar or subconjunctival injections are used. If the therapy does not give the expected results, the antibiotic can be administered intramuscularly or intravenously.);
- Antiviral drugs, if keratitis was the result of a viral infection;
- Intramuscular injections and instillation of eyes with antibiotic drugs for syphilitic lesions of the cornea (in this case, therapy is carried out by an ophthalmologist and venereologist).
If keratitis was caused by a foreign object in the eye, it is first withdrawn, and only then, after assessing the degree of corneal damage, they begin treatment. Sometimes it may even require surgical intervention.
Treatment of tuberculous keratitis is carried out in conjunction with a TB doctor. The course of therapy is quite complicated and long.
In some situations, in addition to pharmacotherapy, laser coagulation, cryotherapy, and diathermocoagulation are used. Using these methods, only the affected eye areas are treated. Along with these techniques, vitamin and diet therapy is carried out.
An integrated approach to treatment gives maximum results and helps to avoid complications of the pathology. If there is no positive dynamics with such therapy, or the patient begins to rapidly lose his sight, corneal transplantation may be performed.
The duration of the course of therapy and the recovery period depends on the professionalism of the doctor and the quality of the medical services provided.
Performing an operation
Severe keratitis requires the operation to be performed, especially when a purulent ulcer of the stratum corneum is formed. Laser coagulation methods can be used for different types of keratitis, and for fungal etiology of the disease - laser coagulation or microsurgical intervention.
Endothelial dystrophy of the cornea is treated exclusively by surgery. In this case, we are talking about the transplantation of the stratum corneum, although after such an operation the risk of complications is quite high.
The operation can also be performed to prevent the spread of keratitis. So, for the beginning, the epithelial envelope of the eye is scraped, followed by electrocoagulation, neurotomy, layered keratoplasty. The ophthalmologist may resort to laser coagulation.
If infiltration is formed during inflammation of the cornea, then after it there may be clouded areas. With the formation of an eyesore, an operation is performed on transplantation of the stratum corneum.
Complications and prognosis
The outcome of the treatment and the consequences of a disease such as keratitis mostly depend on the etiology of the pathological process, the degree of lesion of the visual organ, the location of the infiltrate and the presence of concomitant diseases. If the therapy is started in time and completed, then the outcome is very favorable - up to complete and complete resorption of the infiltrate. In some cases, there may be a slight turbidity on the surface of the cornea, similar to a cloud.
With the defeat of the pathological process of the deeper layers of the eye, or with paracentral or central localization of the infiltrate, there is a significant clouding of the cornea.
The result of keratitis may be the formation of a cataract, the development of secondary glaucoma, optic nerve atrophy or an eyeball. As a result, complete loss of vision occurs. Septic complications such as thrombosis of the cavernous sinus, cellulitis of the orbit, or even sepsis are dangerous to life.
Particular attention should be paid to the prevention of keratitis. To avoid disease, it is necessary, if possible, to avoid any damage to the mucous membrane of the eyes. This warning is especially relevant for people working in traumatic facilities.
It is also important not to start any ophthalmologic disease, but to cure it in time and completely. In addition, the following rules are of great importance in the prevention of keratitis:
- do not neglect hygiene;
- properly store and use contact lenses, if any;
- carefully protect the eyes from the effects of external irritants, and avoid foreign objects on their mucosa;
- avoid (if possible) diseases that may lead to the development of keratitis (see above);
- include in the diet as much as possible proteins, vitamins, minerals. If necessary, you can resort to receiving multivitamin complexes.
Of great importance is the prevention of keratitis in those people who have previously encountered this disease.