Creeping corneal ulcer - etiology, clinical signs, methods of early diagnosis, treatment, outcomes. Creeping corneal ulcer Corneal ulceration

Good day, dear readers! One of the most serious ophthalmic problems is damage to the tissues of the cornea, as a result of which the lens becomes cloudy, crater-like defects are formed and vision is significantly reduced.

These symptoms are characterized by an ulcer of the cornea of \u200b\u200bthe eye, due to which there are uncomfortable and pain... This disease requires emergency treatment - this is the only way to prevent the development of complications and preserve vision.

An ulcer or ulcerative keratitis is an inflammation of the cornea that is infectious. With this pathology, the epithelial layer of the cornea is damaged. The insidiousness and danger of this disease lies in the fact that its development can begin even after minor injury to the organ of vision, and the consequences can be very sad, up to blindness in both eyes.

One of the main factors provoking the development of corneal ulcers is a lack of vitamin A. This ailment is characterized by the formation of a large number of cracks at the site of injury. After receiving a microtrauma, the cornea is inhabited by bacteria that "move" from neighboring parts of the organ of vision or get inside from the external environment.

In most cases, ulcerative keratitis occurs in a person suffering from these inflammatory diseases eyes, like uveitis, etc. The disease can have both acute and chronic course.

One of the most dangerous forms pathology is a purulent corneal ulcer resulting from getting into the injured area pneumococcal infection... A purulent ulcer can be recognized by the formation of a small yellow-gray infiltrate in the central part of the cornea, which is clearly visible in the photo. Corneal opacity and edema occurs within 24 hours.

Can a corneal ulcer be cured with medication?

Medical treatment of corneal ulcers is carried out strictly under the supervision of a qualified ophthalmologist. For this purpose, the following medicines are used:

• strengthening antibiotics;
• cycloplegic drops (provide eyes with rest);
• pain relievers.

Cycloplegic drops help dilate the pupil and relieve painful muscle spasms... To achieve good result ointments and injections help, which are often supplemented with physiotherapy (magnetotherapy, electrophoresis and phonophoresis) to achieve the desired effect as soon as possible.

Thanks to properly selected drug therapy, a superficial corneal ulcer heals in just a week, and a stubborn one - within a few weeks or months. In especially severe cases, surgery is required - sometimes this is the only way to preserve the organ of vision.

Treatment regimen for corneal ulcers

There is a specific treatment regimen for corneal ulcers, which is followed by most ophthalmologists. When selecting it, the patient's medical history and the severity of the disease are taken into account.

The traditional treatment regimen for corneal keratitis is based on the following groups drugs:

1. Drops to moisten the surface eyeball... This is necessary if there is a lack of tear fluid.
2. Antibiotic eye drops (Vigamox, Signicef,). They need to be buried up to 7-8 times a day.
3. Ointment, which contains a broad spectrum antibiotic (, gentamicin, detetracycline).
4. Non-steroidal anti-inflammatory drugs (Diclo-F, Indocollir).
5. Reparative drugs (, Oftolik). They stimulate the regenerative processes in the cornea.
6. Vitamins. Patients diagnosed with a corneal ulcer should eat properly and take daily vitamins of groups A (up to 50,000 units), B (0.5 g) and C (10-20 mg).

Besides drug therapy subcutaneous injections are prescribed and osmotherapy is a type of treatment during which osmotic intraocular pressure is exerted. At the stage of corneal regeneration, corticosteroids are prescribed to help scar the healing tissues.

In parallel with traditional therapy, treatment can be carried out folk methods... Plantain is considered an excellent natural remedy. To cure ulcerative keratitis, try to bury your eyes with plantain juice, 1-2 drops three times a day.

Surgical treatments for ulcerative keratitis

If the trophic ulcer of the cornea progresses rapidly, keratoplasty is prescribed - an operation during which corneal transplantation is performed. More precisely, its damaged area is replaced with donor material or a special corneal graft. Operative intervention performed under both general and local anesthesia.

Duration rehabilitation period depends on the characteristics of the patient's cornea. Typically, the recovery process lasts 6-12 months. During this period, constant supervision by the attending eye doctor is necessary.

It is very important that the treatment of this pathology is started immediately after its diagnosis, when only the upper layers of the cornea are damaged. If the ulcer penetrates deep into the tissues of the cornea, there is a high probability that after its healing, a scar will remain.

But this is not the worst thing. Lack of timely treatment can lead to the development of more serious pathologies of the organ of vision. We are talking about iridocyclitis, endophthalmitis and panuveitis - these diseases often cause complete blindness, so you can't joke with them.

Video: Why does corneal keratitis occur and how to fix it?

I recommend that you watch a video about the causes and treatment of corneal keratitis. Keratitis is a fairly complex eye disease with a difficult predictable outcome, often, it ends in a significant decrease in vision, due to (leucorrhoea). Why this happens and how to fix it is described in the video. Enjoy watching!

How is corneal ulcer treated in animals?

It's no secret that ulcerative keratitis is common not only in humans, but also in animals. Conservative therapy of eye pathology in cats and dogs is based on the use of anti-inflammatory drugs - ointments and drops. An animal needs to bury its eyes up to 6 times a day. The optimal dosage is prescribed by the attending veterinarian.

For the treatment of corneal ulcers in animals, the following are also prescribed medicines:

• antibacterial drops (Tsiprolet, Iris, Levomycetin);
• antiviral drops (Tobrex, Trifluridin, Idoxuridin);
• ointments (tetracycline, streptomycin);
• immunomodulators (Roncoleukin, Anandin, Fosprenil, Gamavit).

When conservative methods of therapy do not bring the desired result, veterinarian prescribes an operation to remove necrotic corneal tissue.

findings

A corneal ulcer is a serious ophthalmic disease that requires urgent treatment. This is the only way to slow the progression of the inflammatory process and prevent loss of vision. Take care of yourself and be healthy, friends!

I would be glad to receive your comments and questions! Best regards, Olga Morozova.

Corneal ulcer is a common and dangerous complication of inflammatory eye diseases... At the same time, deep purulent infiltration of the cornea, its necrosis, followed by the formation of an ulcer defect develops.

The outcome of the disease is the formation of a cicatricial ulcer at the site of a healed ulcer. connective tissue... As a result, the cornea loses its transparency, and the person may lose sight. To avoid this, rapid diagnosis and effective treatment are required.

What causes ulcers to form?

The main reasons why a corneal ulcer occurs:

• eye injury, including with improper use contact lenses;
• infection.

When a microtrauma is received, the cornea becomes infected with microbes introduced from the outside. Also, if the membranes of the eye are damaged, it is possible to activate conditionally pathogenic microflora and exacerbate chronic eye diseases, which are caused by the following pathogens:

• pneumococci, streptococci, staphylococci - the most common causative agents of ulcerative keratitis, they contribute to the formation of a creeping corneal ulcer;
• diplococci - an ulcerative process with a more favorable outcome;
• pseudomonas aeruginosa - a rare cause of ulcers, more often against the background of immunodeficiency;
• fungi (when plant elements get into the eye);
• viruses (adenovirus, herpes simplex);
• protozoa (amoeba, chlamydia).

Diabetics and people with reduced immunity are more likely to get sick.

Pathogenesis

The ingress of microbes into the eye or their activation leads to the development of keratitis. An inflammatory gray-yellow infiltrate with blurred edges is formed. Later, it transforms into a corneal ulcer, which rapidly increases in size and deepens. The pathological process can go to other parts of the eye.

Then scarring of the ulcer occurs with the formation of leukoma (leukoma), which threatens blindness.

Clinic features:

• one-way process;
• a history of chronic eye diseases (conjunctivitis, dacryocystitis, dry eye syndrome);
• acute onset (after a microtrauma, after 12 hours there may be a bright clinic of inflammation).

Ulcerative keratitis has some differences depending on the pathogen.

So, with pneumococcal, staphylococcal or streptococcal etiology, a creeping ulcer of the cornea of \u200b\u200bthe eye in humans is formed. The bottom and one of the edges of the ulcer are loosened, soaked in pus. The ulcer "creeps" along the cornea, increasing in size and deepening, up to the complete destruction of the membranes of the eye. Fungal keratitis can cause the same consequences.

With diplococcal etiology, the process is more local and superficial, giving fewer complications.

Diagnostics

Anamnesis data - chronic eye diseases, recent eye microtrauma.

• severe pain in the eye, especially at night;
• swelling and redness of the eye;
• mucopurulent discharge;
• lacrimation;
• photophobia, pronounced blepharospasm;
• a sharp deterioration in vision.

Examination by an ophthalmologist for pain and blepharospasm is performed after local anesthesia.

This reveals:

• inflammatory infiltration or erosive and ulcerative corneal defect;
• change in the color of the iris;
• miosis and decreased pupillary reflexes;
• sharp soreness of the eye on palpation.

Instrumental examination - visometry, perimetry, biomicroscopy (sometimes using dyes), as well as the determination of intraocular pressure. In addition, a scraping is taken from the surface of the cornea and a conjunctival smear to determine the pathogen and its sensitivity to drugs.

Complications

In advanced cases, a corneal ulcer can lead to the following unpleasant consequences:

• the ingress of pus into the anterior chamber of the eye;
• rupture of the cornea in the area of \u200b\u200bthe bottom of the ulcer;
• development of iridocyclitis;
• prolapse of the iris;
• the formation of extensive thorns;
• blindness.

Late complications are:

• abscess of the eyeball;
• secondary glaucoma;
• atrophy of the eyeball;
• osteomyelitis of the bones of the orbit;
• sepsis.

With timely referral to an optometrist, these complications can be prevented.

Treatment

Purpose: relieve inflammation, achieve scarring. Usually carried out in a hospital.

Urgent measures:

• hospitalize the patient in a supine position with the threat of corneal perforation;
• stop the increase in ulcerative defect (diathermocoagulation, laser therapy);
• use mydriatics (atropine eye drops) for the prevention of pupil congestion;
• sanitize foci of chronic eye infection, in particular the lacrimal canals, the lacrimal sac.

Antibiotics are used in the form of ointments, eye drops... With diplobacillary etiology, zinc solutions are also used, with fungal keratitis - antifungal agents.

Oral or parenteral antibiotics are also prescribed.

After the inflammation subsides and the formation of a thorn, the patient should tune in to surgical treatment: keratoplasty or corneal transplant.

A corneal ulcer leads to the formation of a leucorrhoea, which brings a lot of experience due to a cosmetic defect. But much more terrible is a sharp decrease in vision up to blindness. Therefore, it is necessary to consult an ophthalmologist in time and complete the prescribed course of treatment. This will help preserve vision and restore health to the eyes.

Learn also about another disease that is also dangerous and can lead to blindness. Read

For a more complete acquaintance with eye diseases and their treatment - use the convenient search on the site or ask a question to a specialist.

A corneal ulcer is a disease that, most often, is provoked by the activity of bacteria such as staphylococci, streptococci, pneumococci, Pseudomonas aeruginosa, etc., which leads to a defect in the cornea and, as a consequence, visual impairment up to blindness. Severity clinical picture and the subsequent prognosis will directly depend on the depth of ulcer formation. Treatment is prescribed only by the attending physician, self-medication is unacceptable.

Etiology

A corneal ulcer in a person can be triggered by the following etiological factors:

• mechanical damage to the cornea;
• eye burn;
• dry eye due to peripheral paralysis facial nerve, deficit nutrients or chronic blepharitis, etc .;
• hit chemical substances on the cornea;
• pathogenic bacteria, fungi, viruses.

Separately, it is necessary to highlight the factors that may be predisposing for the development of this disease:

• prolonged rubbing of the eye with a contact lens;
• unauthorized use of eye drops, ointments and the like medications for the organs of vision;
• lack of personal hygiene;
• excessive exposure of the cornea to ultraviolet rays.

Regardless of the etiological factor, treatment should be prescribed only by a doctor, after carrying out the necessary diagnostic procedures.

Classification

Based on the etiology of the inflammatory process, the following forms of this disease are distinguished:

Taking into account the degree of spread of the pathological process, the following forms of ophthalmic disease are distinguished:

• creeping corneal ulcer - destruction spreads along the membrane and is directed to one edge of the eye. In addition, at the same time, the cornea is damaged deeply, which can provoke the development of a purulent process;
• corrosive ulcer - several ulcerative defects are formed at once, which leads to the development of destruction of the lunar form. The etiology of this form of the disease is unknown.

They also distinguish forms of pathology based on the localization of the inflammatory process:

• paracentral;
• central;
• peripheral.

By the nature of the course, the ulcer can be acute or chronic.

Symptoms

Usually, initial symptoms manifest themselves within the first day after injury to the organ of vision or exposure to a certain etiological factor. The clinical picture can manifest itself as follows:

• severe pain, which can be intermittent, cutting;
• increased tearing;
• photophobia;
• severe redness of the eye and skin around it;
• sensation foreign body in the eye;
• decreased visual acuity;
• difficulty opening and closing the eye;
• discharge of purulent exudate.

In the presence of such a clinical picture, you should urgently contact an ophthalmologist; it is strictly forbidden to use any eye drops, as this can only aggravate the course of the inflammatory process. The formation of a scar is possible, which will lead to an irreversible pathological process and the formation of a thorn.

Diagnostics

First of all, a thorough physical examination of the patient is carried out using a slit lamp with the collection of a general anamnesis. To clarify the diagnosis, the following procedures are carried out:

• instillation into the eye with fluorescein and examination with a slit lamp;
• diaphanoscopy;
• ophthalmoscopy;
• diagnosis of the process of lacrimation;
• Ultrasound of the organ of vision.

If external discharge is observed, then a bacteriological analysis of the exudate is carried out.

Based on the results of the examination, examination of the organ of vision and the collected anamnesis, the doctor makes a final diagnosis and chooses the most effective treatment tactics.

Treatment

The treatment program will depend on the stage, form and localization of the development of the inflammatory process. Drug therapy may include taking such drugs:

• antibiotics;
• anti-inflammatory;
• cycloplegics;
• vitamin and mineral complexes.

Applying a bandage to the affected organ of vision is prohibited, as this can lead to the development of a bacterial environment and aggravation of the pathological process.

Besides drug treatment, the doctor may prescribe the passage of such physiotherapeutic procedures:

• magnetotherapy;
• ultraphonophoresis;
• electrophoresis.

The duration and mode of these procedures are determined only by the optometrist. Even if significant improvement is noticeable, it is impossible to stop treatment of corneal ulcers without a doctor's recommendation.

Possible complications

If treatment is not started in a timely manner, the following complications are likely to develop:

• corneal thorns;
• melting of the structures of the eyeball;
• secondary nature;
• perforation of ulcerative lesions;
• endo- and panophthalmitis;
• complete loss of vision;
• eye sockets;

Therefore, at the first manifestations of the above-described clinical picture, you should immediately apply for medical care... Timely started therapy allows you to completely get rid of the disease.

Is everything correct in the article with medical point vision?

Only answer if you have proven medical knowledge

Diseases with similar symptoms:

Scleritis is a serious disease of the visual apparatus, in which the inflammatory process affects the albuminous membrane of the eye (sclera). The disease can be expressed as small reddish nodules, and occupy the entire sclera. Almost always, only one eye is affected, but depending on the type, it can spread to two at once, or alternately occur in both eyes. It occurs in women several times more often than in men. IN childhood it is expressed quite rarely, most often it appears due to another inflammatory process in the body. It is complicated by the fact that it is very painful and can lead to visual impairment.

Deep ulceration leads to significant thinning of the cornea, which contributes to its local protrusion under the influence of intraocular pressure. With the formation of a dense scar, the protrusion may disappear, but sometimes it remains in the form of an ectazed scar.

Some ulcers, especially pneumococcal ulcers, quickly spread in depth, reaching the Descemet's membrane. Descemet's membrane, like other elastic membranes, has great resistance inflammatory process... But, nevertheless, she is unable to maintain intraocular pressure alone. As a result, a hernia-like bulge forms in the area of \u200b\u200bthe ulcer in the form of a bubble, called a keratocele or descemetocele. The protrusion can persist for a rather long time surrounded by a white scar ring, but more often it perforates.

Ulcer perforation and its consequences

Perforation of the ulcer is usually caused by such reasons as spasm of the circular muscle of the eye, cough, sneezing, etc. Any of these conditions causes an increase blood pressure, which in turn provokes an increase in intraocular pressure, which leads to perforation of the ulcer. With perforation, aqueous humor is poured out and the intraocular pressure is equal to atmospheric. As a result, the iris and lens move forward, contacting the back of the cornea. This gives some positive effect, since due to a decrease in intraocular pressure, diffusion of fluid through the cornea is facilitated, its nutrition improves, the progression of ulceration stops, pain subsides, epithelialization and scarring accelerate. At the same time, complications that accompany perforation pose a threat to vision and even to the preservation of the eye. These complications depend on the location and size of the perforation.

The perforation can be located opposite any part of the iris, which rushes to the perforation with a current of aqueous humor.

If the perforation is small, the iris sticks to it, forming anterior synechia. Blocking perforation by the iris helps to restore the anterior chamber due to the secreted aqueous humor. If the perforation is large, then a portion of the iris falls out through it and iris prolapse occurs. If the dropped out part does not include the pupillary edge, then the prolapse has a hemispherical shape; if it does, then the pupillary edge of the iris lies on the cornea. In some cases, the color of the iris soon changes due to the deposition of gray or yellow exudate on its surface. The stroma gradually becomes thinner and the black retinal pigment is concentrated in the area of \u200b\u200bprolapse.

Sometimes the entire cornea melts, with the exception of a small rim along the periphery, and total iris prolapse occurs. The pupil is blocked by exudate and a false cornea is formed, consisting of an iris covered with exudate. With a sudden perforation of the cornea, the ligaments of the lens are pulled, torn, causing a subluxation or complete dislocation of the lens with its loss into the perforation.

With prolapse of the iris, scarring of the cornea may continue. The exudate covering the prolapse is organized and a thin layer of connective tissue is formed, along which the corneal and conjunctival epithelium rapidly grows. Reduction of fibrous tissue fibers leads to flattening of the prolapse and pseudo-cornea. This is very rare. Often, the iris and scar tissue are too weak to support intraocular pressure, which usually rises, and secondary glaucoma develops. As a result, an ectazed scar with an iris embedded in it is formed, the so-called anterior staphyloma, which, depending on its length, can be partial or total. The fibers of the scar tissue in the staphiloma are different in width and thickness, therefore, a lobular structure of the surface is formed, covered with dark pigment.

If perforation occurs opposite the pupil, then the pupillary edge of the iris is glued to the edges, and the hole itself is filled with exudate. The anterior chamber recovers very slowly, resulting in the lens long time contacts with the ulcer and opacities form in it - anterior capsular cataract. When the anterior chamber is restored, the exudate filling the opening breaks out under the influence of intraocular pressure, especially in restless patients. This process can be repeated, which contributes to the formation of a permanent opening - a corneal fistula.

A sudden decrease in IOP during perforation leads to the expansion of the intraocular vessels, their rupture and the occurrence of intraocular hemorrhage. Rupture of the retinal vessels leads to hemorrhages in vitreous; rupture of the vessels of the choroid - to subretinal or subchoroidal hemorrhages. The bleeding can be so profuse that the contents of the eyeball flow out with gushing blood.

When the cornea is perforated, the microorganisms that caused the ulcer penetrate into the eye. Ultimately, purulent iridocyclitis and even panophthalmitis develop. Such complications are more often observed with gonorrheal ophthalitis and an ulcer with hypopyon.

T. Birich, L. Marchenko, A. Chekina

"Complications of purulent keratitis (corneal ulcer)" - article from the section

As a result of infection or under the influence of other factors, an ulcer of the cornea of \u200b\u200bthe eye occurs in a person. The disease is accompanied by pain, involuntary blinking, photophobia, and the appearance of pus. There are several types of pathology, which is dangerous with consequences in the form of thorns, glaucoma, atrophy optic nerve, the spread of infection to other organs. It is recommended to consult a doctor in a timely manner, who will diagnose and prescribe effective treatment.

Why does pathology arise?

Improper nutrition leads to a lack of trace elements and vitamins, which negatively affects the cornea.

An ulcer on the cornea occurs as a result of destructive processes in which a defect in the form of a crater forms on the Bowman's membrane. There are several types of pathology, but the most severe is the marginal creeping ulcer of the cornea. It is characterized by a deepening in one of its borders and the capture of tissues of the iris. The disease is provoked by the following factors:

• burns and eye injuries;
• infection with pathogenic microorganisms (streptococci, staphylococci, Pseudomonas aeruginosa, herpes viruses, flexible, acanthamoeba);
• improper use of contact lenses and improper care of them;
• uncontrolled intake of medicines;
• the development of dry eye syndrome;
• unnatural direction of eyelash growth;
• chronic ENT diseases;
• infectious diseases of the organs of vision (conjunctivitis, keratitis, trachoma);
• diabetes;
• arthritis;
• decreased immunity;
• the use of non-sterile equipment for ophthalmic or aesthetic manipulations in beauty salons.

Symptoms: how does the disease manifest itself?

Growth bacterial infection provokes the appearance of purulent discharge.

Most often, a purulent corneal ulcer appears at stage 2 of keratitis due to tissue death. The disease is accompanied by the following symptoms:

• photophobia;
• pain and pain in the eye;
• feeling of a foreign body;
• lacrimation;
• involuntary blinking of the eyelids;
• swelling of the eyelids and conjunctiva;
• the formation of an infiltrate from particles of cells, lymph and blood;
• the appearance of purulent discharge;
• clouding of the cornea;
• deterioration of vision;
• redness of the sclera.

Diagnostic measures

Keratitis and corneal ulcers are determined and treated by an ophthalmologist. The doctor performs the following diagnostic procedures:

• slit lamp examination of the cornea;
• instillation test using fluorescein solution;
• gonioscopy to visualize the anterior chamber;
• measurement of intraocular pressure;
• diaphanoscopy;
• ophthalmoscopy;
• examination of eye structures with ultrasound;
• bacterial culture of purulent secreted from the eyes;
• microscopy;
• blood chemistry.

How is the treatment carried out?

Drug therapy

Medicines should be prescribed by a doctor, self-medication is dangerous. Comprehensive treatment creeping corneal ulcer includes drops and ointments shown in the table:

Changes in the structures lead to the formation of scars, therefore the treatment of corneal ulcers includes physiotherapy methods, such as:

• magnetotherapy;
• electrophoresis;
• UHF therapy;
• diadynamic therapy;
• exposure to ultrasound;
• ultraviolet irradiation;
• diathermocoagulation.

The initial stage of an eye ulcer is successfully treated, since the methods have the following effect:

• relieve pain and inflammation;
• promote tissue regeneration;
• normalizes blood circulation;
• eliminates the consequences of the inflammatory process;
• stops the decrease in vision.