Despite the advances of modern medicine, tuberculosis kills about 3 million people on the planet every year. This disease can affect not only the lungs of a person, but also many other organs and systems. Eye tuberculosis refers to infectious diseases that are difficult to diagnose and completely cure. The development of this disease in children is especially dangerous, because in the absence of adequate and timely therapy, it can lead to meningitis, sepsis and other serious complications.
Causes of disease
If a person's immunity works normally, then the ingestion of mycobacteria does not necessarily cause the development of tuberculosis. With the help of protective forces, foreign microbes can be defeated by special cells that prevent the infection from spreading. But with a weak immune system, a large number of pathogenic bacteria and the presence of adverse indirect factors, the likelihood that eye tuberculosis will still develop is very high.
Factors that contribute to the development of the disease:
- unbalanced diet and beriberi;
- unfavorable living and working conditions;
- insufficienthuman exposure to fresh air and sun;
- psycho-emotional tension, stress;
- lack of sleep and rest;
- bad habits;
- presence of chronic foci of inflammation in the body;
- severe diseases of the immune system.
Classification
Eye damage in tuberculosis can be of varying severity depending on the form of the disease. Treatment options and the prognosis of the disease depend on this. In total, there are 4 options for the development of the disease:
- mucosal tuberculosis;
- pathological changes in the eye muscles, eyelashes, lacrimal apparatus, conjunctiva or eyelids;
- secondary painful changes in the eyes with tuberculosis of the central nervous system or lungs;
- infectious-allergic lesions of the eye apparatus.
In the first two cases, we are talking about primary infection with mycobacteria and their reproduction directly in the tissues of the eye. These types of pathologies are less common than the forms of the disease associated with allergies or the primary focus of tuberculosis in other organs. In these cases, ophthalmic signs can sometimes be ignored because of the pronounced underlying symptoms. But this can be fraught with loss of vision in the future, so it is important to recognize them in time and start treatment.
Symptoms of primary tuberculosis of the eye and adnexa
Some diseases are difficult to recognize at an early stage due to the lack of specific signs. One of these ailments is eye tuberculosis, the symptoms of which are similar to many ophthalmic diseases. They may differ depending on the location of the infection.
With primary infection with tuberculosis and its development in the organs of vision, the patient first has symptoms characteristic of ordinary conjunctivitis: redness of the vessels, swelling of the eyelids, lacrimation. But along with this, lymphatic seals form inside the eye, which increase in size and over time, without treatment, can lead to an abscess.
Tuberculosis of the adnexa of the eye (such as the eyelids or lacrimal ducts) is rare. At the same time, inflamed tubercles appear on the skin and mucous membrane, the tissues of which eventually die and suppurate. This can lead to drooping of the upper and lower eyelids, as well as scarring of the skin.
Eye tuberculosis: symptoms, first signs of the allergic nature of the disease and secondary damage
In infectious-allergic tuberculosis, the symptoms are acute, and they practically do not have an incubation period. Both eyes are usually involved in the pathological process, although manifestations may be more pronounced on one side. The duration of the acute period ranges from several days to 2 months. This form of the disease is characterized by such signs of eye tuberculosis:
- lacrimation;
- inflammation of the mucous membrane;
- itching and burning;
- photophobia;
- soreness.
If unpleasant symptoms in the eye area are caused by primary tuberculosis of the brain or spinal cord, then they are usuallyonly an addition to the general neurological symptoms. In such patients, the posterior part of the choroid is most often affected, where foci of inflammation (granulomas) with lymphoid tissue occur. Clinically, this is manifested by a decrease in visual acuity and clouding in the eyes. The disease can develop acutely or progress gradually.
How to identify the disease?
Diagnosis of ocular tuberculosis is complicated by the absence of specific symptoms, since its manifestations are similar to other ophthalmic diseases. The inability to take a tissue sample for analysis for the presence of mycobacteria also makes it difficult to make a diagnosis. If there are complaints indicating possible tuberculosis, it is advisable for the patient, as prescribed by the doctor, to undergo a number of such examinations:
- determination of acuity and visual fields;
- intraocular pressure measurement;
- fundus examination;
- Eye ultrasound;
- retinal angiography;
- tuberculin test;
- diagnostic treatment with TB drugs.
Besides this, the patient must definitely have an X-ray of the chest cavity organs and a tomography of the mediastinum, since it is in it that inflamed foci are often found in allergic eye tuberculosis. To understand the general condition of the body, the patient may also be prescribed clinical blood and urine tests.
Routes of infection
Tuberculosis of the eyes can occur due to the spread of infection through the blood or direct contact with the pathogen from the external environment. The hematogenous route of transmission is possible if there is a primary focus of this disease in the body. The options for getting mycobacteria from the outside world to a he althy person are as follows:
- airborne droplets (when talking, coughing or staying in the same room with the patient for a long time);
- contact-household method (when using contaminated household items);
- fecal-oral mechanism (when bacteria enter with food or water).
Mycobacteria can remain pathogenic for years in dark, dusty rooms, so when such air is inhaled, a person with a weakened immune system is at high risk of infection. Sometimes the disease is transmitted through the blood when the integrity of the skin is damaged or vertically (from mother to child). But most often the transmission of infection is associated with the presence of mycobacteria in the air.
Features of the course of the disease in childhood
Since a child's immunity does not function as actively as an adult's, any serious illness poses a serious danger to him. Tuberculosis of the eyes in children is most often allergic in nature or is a secondary manifestation of an active pulmonary process. In itself, the primary manifestation of this infection exclusively in the organs of vision is extremely rare in them.
Given the tendency to generalize the pathological process, the treatment of tuberculosis should always include inpatient treatment until complete recovery. At the same time, the ability to regenerate in the affectedtissues in childhood is higher, so the child always has a chance of a successful cure without subsequent relapses and complications.
Surgical treatment
Effective therapy should include general antibacterial drugs, even if it is an extrapulmonary form of the disease that affects one organ. So, for example, eye tuberculosis, the symptoms of which are most often concentrated in this area, should still be treated using a comprehensive scheme.
When surgical pathologies appear, in some cases, emergency surgery is possible in order to preserve a person's vision. In this case, it should be carried out in parallel with antibiotic therapy. But if there is no urgent need, in order to avoid complications, it is better to carry it out after the full completion of the course of therapeutic treatment.
Eye tuberculosis: treatment without surgery
Complex treatment of the disease involves the use of antibiotics, chemotherapy and immunomodulators. In addition, drugs are prescribed for symptomatic relief of the patient's condition, depending on the clinical picture. All anti-tuberculosis drugs according to the severity of action can be divided into 3 classes:
- strong drugs ("Isoniazid", "Rifampicin");
- medium-strength drugs ("Kanamycin", "Streptomycin", "Prothionamide");
- drugs with a moderately pronounced therapeutic effect ("Para-aminosalicylicacid", "Thioacetazone").
The regimen of their intake and dosage should be selected by a phthisiatrician, taking into account the peculiarities of the course of the pathological process in each individual case. With severe retinal hemorrhages, before using these drugs, it is necessary to conduct a therapy that normalizes the state of the blood vessels of the eye. Until the patient's condition stabilizes, he is shown inpatient treatment.
Prevention
Preventing eye tuberculosis is much easier than treating it. For specific prevention, there is a BCG vaccine that protects the human body from all forms of this insidious disease. It is recommended to administer it to children after birth in order to form active immunity.
For non-specific prevention of tuberculosis, it is important to follow these rules:
- lead a he althy lifestyle;
- eat rationally;
- regularly carry out wet cleaning in the apartment and carefully wipe the dust;
- spend enough time outdoors;
- do gymnastics or any simple sport to improve the body;
- it's okay to rest and get enough sleep;
- to undergo x-ray once a year (from the age of 15).
If you have any strange symptoms, you should immediately consult a doctor, because in the case of tuberculosis, this can help maintain he alth, normal vision and a fulfilling life.
