Lecturer: Maksymuk O.Ju.

Transcription

1 Diagnosis of inflammation of the conjunctiva and eye membranes ("red eye" - conjunctivitis, keratitis, iridocyclitis, uveitis, retinitis, endophtalmitis, panophtalmitis). Diagnostics, treatment, prophylaxis Lecturer: Maksymuk O.Ju.

2 Of all patients with ocular pathology over 30% of patients treated to an occasion conjunctivitis and other diseases of the connective membranes. Diseases of connective membranes are divided into three groups: 1) inflammations; 2) dystrophies; 3) tumors of the conjunctiva;

3 In its turn inflammations of the conjunctiva are divided into: 1. Conjunctivitis of exogenous origin; 1) acute and chronic conjunctivitis of infectious nature (viral, bacterial, fungal, etc.); 2) conjunctivitis caused by physical and chemical harmfulness; 3) allergic exogenous conjunctivitis; 2. Conjunctivitis of endogenous origin: 1) conjunctivitis at common diseases; 2) autoimmune conjunctivitis

4 The main symptoms of acute conjunctivitis: 1) lacrimation; 2) "The feeling of sand" in the eyes; 3) redness of the eye; The patient had difficulty opening his eyes because of the presence of purulent discharge, which in its turn is a cardinal symptom of bacterial conjunctivitis.

5 Treatment Frequent washing with 2% boric acid, 30% albucid, 1:5000 furazilin or potassium permanganate. 1) Valavir 2tab 2 days 2t/d; 1tab 1 day 2t; 2) Ocoferon 6t/d; 3) Vigren (gel)

6 Conjunctivitis Koch-Weeks Causes of Koch-Weeks bacillus. The disease is extremely contact. Affects both eyes. The disease begins suddenly. Symptoms: Redness of the conjunctiva; Lacrimation; Photophobia; The presence of purulent discharge; Characteristic sign of acute epidemic conjunctivitis is the involvement in the process conjunctiva of the eyeball. Noted its redness, presence of petechial hemorrhages.

7 Bacterial conjunctivitis Pathogen Neisser gonococcus. Clinically distinguish gonoblennorrhea of infants, children and adults. Gonoblennorrhea of newborn develops in 2-3 days after birth. Symptoms: 1) swelling of the eyelids, with marked cyanotic-purple edema; 2) availability of secretions with color of meat slops; Objectively: Conjunctiva is sharply hyperemic, infiltrated, friable, bleeding. After 3-4 days, the secretions from the eyes is copious, purulent.

8 Vascular tract Medium membrane of the eye is called vascular or uveal tract. It is divided into 3 parts: 1) iris; 2) ciliary body; 3) choroidal membrane (choroid)

9 Iris The iris is the front, visible part of the vascular tract. It does not direct contact with the outer shell. Iris is located in the front of the cavity so that between it and the cornea stays free space - anterior chamber of eyeball filled with liquid contents - aqueous humor. In the connective tissue stroma of the iris are located branches of the anterior and posterior ciliary arteries, that anastomosing with each other, in the thickness of the iris lies two muscles, innervation is carried by branches of sympathetic and parasympathetic nerves.

10 Pupil The average value of it is 3mm, largest - 8mm and the lowest - 1 mm. The width of the pupil in the newborn is 2mm, it is natural reaction to light is not significant. Presence at the child a wide pupil (3 mm or more) and the absence of his reaction to light shows or on the blindness, or on the pathology of muscular and nervous system.

11 The iris has two muscles: 1) sphincter (constriction of the pupil); 2) dilator (expansion of the pupil); Sphincter is located in the pupillary zone of the iris stroma, receives innervation from the oculomotor nerve, is the most powerful muscle. Dilatator located as part of the inner leaf pigment, in the outer zone, receives innervation from sympathetic nerve. Sensitive innervation of the iris provides the trigeminal nerve.

12 Iris function: 1)participates in nutrition of avascular structures of the eye by ultrafiltration of blood in intraocular fluid; 2)promotes intraocular thermoregulation, accommodation; 3) promotes the outflow of intraocular fluid; 4) with it help formed the anterior chamber angle, which is a major collector of intraocular fluid.

13 Ciliary body Appear intermediate link between the iris and choroid. It is inaccessible to immediate inspected by the naked eye. Only a small portion, which goes to the root of the iris can be seen by the special inspection by goniolens.

14 Ciliary body is a closed ring width of about 8 mm. The fore is narrower than temporal lobe posterior border of the ciliary body goes by the so-called, a toothed edge, and corresponds on the sclera of the site of attachment of direct eye muscles. Front part with appendages on the inside is called ciliary crown. The rear section deprived appendages and is called - ciliary circle or flat part of the ciliary body.

15 The ciliary body carries out production of intraocular fluid, is involved in almost continuous act of accommodation, in the regulation of ophthalmotonus, in thermoregulation, in the outflow of intraocular fluid and is very subtle indicator of the pathology of the eye or other organs and systems.

16 Choroid Constitute the rear, the most extensive part of the vascular section from the toothed edge to the optic nerve. It is tightly connected with the sclera only around the optic nerve exit site. Thickness ranges from 0.2 to 0.4 mm, has a complex multi-layer structure, caused by the development of the vascular network and a large number of pigments. Choroid contains 5 layers: 1)suprachoroidal; 2)large vessels; 3)layer of medium and small vessels 4)choriocapillary; 5)glassy plate that separates the choroid from the pigmented layer of the retina;

17 The main function of the choroid - is nutrition of the neuroepithelium of the retina, carried out thanks to that choriocapillary layer is open and firmly connected to the pigment layer of the retina. The presence in choroid of a large number of pigments contributes to the fact that it is absorbed by the "excess" of light entering the bottom of the retina.

18 Diseases: The structure of the vascular tract, its extensive vascular network, create favorable conditions for the spread of various pathogens, that circulating in the blood and allergization of tissues, so the primary diseases of the vascular tract, most often endogenous pathology it is rheumatism, rheumatoid arthritis, viral infections, toxoplasmosis, tuberculosis, brucellosis, etc. and metabolic diseases - diabetes, gout. In recent years, defined great importance allergy in the etiology of these diseases is influenced by many factors, particularly streptococcal infections (tonsillitis, etc.). Provoke disease injury, cooling the body, frequent exogenous disease of vascular tract, penetrating injuries, keratitis.

19 Inflammatory diseases of the vascular tract constitute about 5% of all cases of ocular pathology. Independently or combine may flow iritis, iridocyclitis, horioidity, chorioretinitis. Moreover inflammation can have total character that leads to panuveitis

20 Uveitis Uveitis irrespective on their localization, can be: 1) congenital or acquired; 2) exogenous and endogenous; 3) toxic allergic and metastatic; 4) granulomatous and nongranulomatous; 5) single and relapsing; 6) acute, subacute and chronic, concomitant to general pathology and without it, with reversible development and with complications. By the nature of exudation: serous, fibrinous, purulent, hemorrhagic, mixed.

21 Iridocyclitis (anterior uveitis) The first sign of inflammation of the choroid - is slightly pronounced corneal syndrome (photophobia, lacrimation, blepharospasm, redness, decreased vision). The cardinal symptoms of inflammation are: smearing of image, iris color changing, pupil constriction, iris tissue swells due to the expressed edema. Blue color of the iris becomes dirty green, brown iris gets rusty hue. You can find the tarnish of the corneal endothelium and the presence of precipitates. Because of the abundant of exudation appears turbidity in moisture of anterior chamber, is not rare in the bottom of the chamber in the form of a strip settles pus (hypopyon), at hemorrhagic iritis found blood in the anterior chamber (hyphema).

22 Posterior synechia Posterior synechiae - is the adhesions of iris to the anterior capsule of crystalline lens, frequent companions of iritis. They are particularly well appreciable with drug expansion of pupil (by atropine). With involvement in process of ciliary body, is developing such disease as iridocyclitis, which is accompanied by a sharp pain increase in in the eye, especially at night.

23 Choroiditis (posterior uveitis) At posterior uveitis there is no corneal syndrome, as choroid have not sensory innervation. Clinical manifestations depend on localization the lesion focus. If the choroid affected closer to the posterior pole of the eyeball, in particular in the area of yellow spot, the patient pays attention to the sharp decline of central vision photopsias. These complaints are characterized the presence in the patient of process, which not only affects the vascular tract, but also the retina (chorioretinitis).

24 During the propagation of the inflammatory of infiltration on the retina, it becomes edematous, accompanied by a opacification of the vitreous. In the area of inflammatory site, subsequently begins to penetrate the retinal pigment epithelium that results in the formation of pigmented lesions on it. On the fundus become visible connective tissue scars and sclerotic vessels. Can shine through white scleral tissue. The cause of the chorioretinitis and choroiditis can be diseases such as tuberculosis, syphilis, toxoplasmosis, a common infectious disease.

25 Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous and/or vitreous humor) usually caused by infection. Noninfectious (sterile) endophthalmitis may result from various causes such as retained native lens material after an operation or from toxic agents. Panophthalmitis is inflammation of all coats of the eye including intraocular structures. The 2 types of endophthalmitis are endogenous (ie, metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation of an organism from the outside as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma.

26 Thank you for your attention!!!