Corneal diseases are widespread in the ophthalmological field and account for 30% of all eye diseases. This can be explained by the fact that the cornea forms the outer chamber of the eye and is more exposed to pathogenic factors. The conjunctiva always forms its own microflora, so even a minimal impact from the outside and injury to the outer layer of the cornea can provoke the onset of pathology.
Functions of the cornea
The cornea is located just behind the conjunctiva and looks like a colorless shell that allows free penetration of light to the deep parts of the eye. The shape of the cornea resembles a convex-concave lens, the radius of curvature of which reaches 8 millimeters. In men, the curvature is greater by 1.4%. Violation of the work of this part of the visual organ may be caused by the presence of a disease.
Main functions of the layers of the cornea of the eye:
- Refractive. The cornea is part of the optical system of the eye. Due to its transparency and unusual shape, it helps to conduct and refract light rays.
- Protectivefunction. Such a shell is distinguished by its strength, as well as the ability to quickly recover when damaged.
- Supporting the overall shape of the eye.
Corneal diseases go away against the background of a rapid deterioration in visual acuity, in some cases a person even becomes blind. Since there are no vessels in the cornea, and most of the tissue has a homogeneous structure, diseases can occur when exposed to various pathological processes. Before starting treatment, you should familiarize yourself with the list of diseases of the cornea of the eye.
All eye diseases have similar symptoms, making it difficult for a doctor to make a diagnosis. In addition, since the cornea does not contain blood vessels, and in its anatomy it is similar to the conjunctiva, the inflammatory process begins in it very quickly and just as quickly ends. In the cornea, all metabolic processes proceed at a slow pace.
Main types of diseases
List of human eye diseases:
- hereditary problems with shell development;
- inflammatory processes - keratitis;
- keratectasia - anatomical abnormalities in the size and shape of the cornea;
- beginning of dystrophic or degenerative processes;
- benign and malignant tumors;
- getting various injuries.
Anomalies due to heredity
Hereditary problems in the development of the shell are a change in the shape and size of the cornea. Megalocornea - determineda disease of the cornea of a human eye, in which it acquires a huge size, more than 10 mm. As a rule, the doctor does not reveal other violations during the diagnosis. The patient may experience a secondary nature of the pathology as a result of glaucoma.
Microcornea - the cornea is too small, its diameter does not exceed 5 mm. The disease may be accompanied by a decrease in the size of the eyeball. As a result, complications such as corneal opacity and glaucoma may occur.
Keratoconus is a hereditary disease of the cornea of the eye. With such a lesion, the shape of the cornea changes greatly, it becomes conical. The shells in the center of the eye become significantly thinner and its entire chamber loses its natural elasticity. The disease begins to appear in children between the ages of 11 and 12 and leads to astigmatism that cannot be cured. The patient has to change lenses all the time due to the fact that the axis and shape of astigmatism often change.
In the early stages of development, keratoconus can be corrected with lenses. But when pathology appears, the lens is no longer held on the enlarged eye and simply falls off. In this case, the doctor may prescribe a surgical intervention to remove part of the cornea - penetrating subtotal keratoplasty.
Keratoconus may appear in a patient as a complication after LASIL surgery. In this case, the disease develops for a long time and is poorly detected. It can make itself felt only 20 years aftersurgery.
Appearance of keratitis
Keratitis is a disease of the cornea of the eye, characterized by its wide prevalence in patients. The infection enters the membrane through adjacent tissues. The complexity of the development of the disease will directly depend on the microorganisms and the resistance of the shell.
Keratitis can be:
- Endogenous. They appear in humans against the background of an infectious lesion, a systemic disease, an allergic reaction, beriberi, or leprosy. Often this problem is provoked by neuroparalytic and neurotrophic disorders. These include allergic, infectious, tuberculous, syphilitic and neuroparalytic keratitis.
- Exogenous. They appear when the cornea is exposed to factors from the external environment - infectious lesions, burns, injuries, diseases of the meibomian glands, eyelids and conjunctiva. Infections can be parasitic, viral or bacterial in nature. This group includes the following forms of keratitis: infectious (bacterial flora of the cornea), traumatic, and also fungal.
Main symptoms of keratitis lesions
Symptoms of inflammation of the cornea in diseases occur due to irritation of sensitive nerve fibers. It all starts with mild discomfort. Also, the patient may show the following symptoms of corneal disease: intolerance to bright light, severe lacrimation, blepharospasm. With keratitis of a neurotrophic nature, such symptoms are not diagnosed. Also for keratitisdue to inflammation of the nerves, the vessels of the marginal looped network form a red corolla with a bluish tint along the circumference of the cornea.
Specific signs of inflammation of the cornea of the eye are called corneal syndrome. In addition to the symptoms described above, the patient has clouding of the cornea (a thorn appears) and an inflammatory form of infiltrate is formed - a dense accumulation of inflammatory products (leukocytes, lymphocytes and other cells) that penetrate into the shell of the eye from the vessels of the marginal looped network.
The color of inclusions will directly depend on the composition and number of cells forming it. With a purulent lesion, the color will be yellow, with severe neovascularization - a rusty-brown color, with an insufficient number of leukocytes - a shade of gray. The border of the infiltrate becomes blurry, and nearby tissues swell strongly and change to white.
The cornea of the eye ceases to shine, loses its transparency, in the place of clouding it is rough, insensitive and increases in thickness.
After some time, the seal disintegrates, the epithelium begins to exfoliate, the tissues die, and ulcers form on the membrane. The patient should conduct a timely diagnosis and begin treatment of the disease of the cornea of the eye.
Ulcers on the shell
An ulcer is a violation of the integrity of the corneal tissue. Education may differ in size and shape. The bottom of the ulcer is painted in a dull gray color (may be clean or contain pus). The edge of the ulcer is smooth or rough. Shell formation can take placeon their own or progress over time.
With self-destruction in the ulcer, the process of detachment of dead tissues begins, the bottom is cleared of pathogens and eventually covered with new epithelium, which is constantly updated. After the epithelium is replaced by a connective tissue scar, which forms corneal opacity of varying severity. In this condition, the patient may begin the process of vascularization and proliferation of blood vessels in the area of the cataract.
As the formation progresses, the area of necrosis begins to increase in size, both in depth and in width, spreading to new tissues. The defect can spread throughout the cornea and grow deep into the anterior chamber. When the lesion reaches the Descemet's membrane, a hernia will form. It is a vial with dark contents, which is separated from adjacent tissues by a separate capsule with a small thickness. Most often, the integrity of the capsule begins to be broken, and the ulcer becomes a passage, affecting the iris, which fuses with the edges of the lesion.
Parenchymal keratitis
It is important to consider the symptoms and causes of corneal diseases. Parenchymal keratitis is a symptom of congenital syphilis. Most often, the disease is transmitted through 2-3 generations. The symptoms of the disease can vary greatly, but doctors have also found some common signs of damage: the absence of ulcers, the involvement of the choroid, the disease spreads to both eyes at once. The prognosis of doctors is favorable - 70% of sick people are completely cured of the lesion andrestore the he alth of the cornea.
Main stages of the disease:
- The first stage is infiltration. Due to diffuse infiltration, the cornea begins to become cloudy. Its color changes to grayish white. The patient informs the doctor about severe tearing of the eyes and intolerance to light. Further, the infiltrate begins to actively spread to all the membranes of the eye. The stage continues to develop in the patient for 1 month, after which it moves to a new stage.
- The second stage of keratitis is vascularization. Vessels begin to actively form on the cornea, spreading into the deeper layers of the eye. As a result, the shell becomes much thicker and begins to resemble frosted glass. The main signs of the second stage: severe pain, pupil constriction, deterioration of visual acuity. On the back side of the cornea, sebaceous formations are formed - precipitates. They adversely affect the endothelial layer and increase its permeability, resulting in a strong swelling of the boundary membrane. The progression time of the second stage is 6 months.
- The third stage of the lesion is resorption. Restorative processes of the cornea continue in the same sequence as clouding. The cloudiness in the center of the cornea resolves last. Recovery continues for a long time, for several years.
Keratitis and doctors' prognosis
With a favorable development, the disease ends with the resorption of the infiltrate, a thorn is formed on the cornea, which can be of different sizes and severity. Vascularization isalso a good ending to the disease, as it helps the nutrients to penetrate the cornea faster, and the ulcers die off. Belmo can lead to complete or partial loss of vision.
Unfavorable course of the disease is a process in which ulcers actively grow on the cornea, the lesion extends to the Descemet's membrane. In this case, pathogenic organisms penetrate into the deeper layers of the eye. As a result, this condition leads to secondary glaucoma, endophthalmitis and panophthalmitis.
Dystrophic and degenerative processes
Corneal dystrophy is a congenital disease that is characterized by rapid development and clouding of most of the membrane of the eye.
Such a lesion does not occur against the background of systemic diseases and does not have an inflammatory nature of origin. The main cause of the condition is an autosomal dominant disorder in some genes. To identify the symptoms and causes of corneal disease, the doctor conducts a thorough examination of the patient and prescribes a genetic study for each family member.
Main symptoms of the lesion:
- severe pain and a feeling of having a foreign body in the eye - this condition indicates the beginning of erosion;
- severe redness of the eye, intolerance to bright light, profuse lacrimation;
- problems with vision, its gradual deterioration, as well as clouding of the cornea and the formation of puffiness.
When the erosive surface is affected, the disease is complicated by keratitis. Treatment is symptomatic. The doctor prescribes special drops that providegood nutrition with useful components of the cornea of \u200b\u200bthe eye. But they do not always give the desired result. With a strong deterioration in visual acuity, doctors most often prescribe penetrating keratoplasty or corneal transplantation.
Fuchs' dystrophy is a disease that affects the endothelium of the cornea, but it occurs extremely rarely in humans. In the cornea, such an area is the thinnest and farthest located. It almost never regenerates. When infected, cells begin to age and cease to function normally. The second name of Fuchs' dystrophy is primarily endothelial-epithelial dystrophy, most often it occurs with physiological cell loss in the elderly. When the cornea is damaged, it begins to become very cloudy, its width increases, and the visual acuity of the patient worsens. Treatment for corneal disease can be one - transplant.
Corneal epitheliopathy
The cause of inflammation in the cornea of the eye can be epitheliopathy of the outer layer of the shell. In this case, the patient experiences detachment of the epithelium from the lower shell, resulting in poor adhesion. Most often, this condition is observed after injury to the eye, getting a burn or a dystrophic process. The patient develops severe pain, there is a sensation of the presence of something foreign in the eye, a fear of light and a rapid deterioration in vision are diagnosed.
Diagnostic measures
Diagnosis and treatment of diseases of the cornea of the eye is carried out using the following methods:
- eye biomicroscopy;
- keratotopography;
- confocal microscopy.
Operating
Surgical treatment of a diseased cornea can be carried out using various techniques. The patient's condition and accompanying symptoms are taken into account. Methods of treatment for corneal dystrophy:
1. Crosslinking of the cornea is a surgical intervention in which keratosis is eliminated. During the procedure, the doctor cuts off the top layer of the cornea, then the eyes are irradiated with ultraviolet light and treated with antibacterial drops. For the next 3 days after the operation, it is important to wear special lenses at all times.
2. Keratectomy - removal of small opacities in the central region of the cornea. Surgery is used, in some cases laser treatment of the cornea is used. The formed defect after the operation overgrows on its own.
3. Keratoplasty (cornea transplant) is used for:
- problems with corneal transparency;
- presence of astigmatism;
- eye injury, acute keratoconus and keratitis;
- to strengthen corneal tissue and improve eye he alth in preparation for optical keratoplasty.
Benign and malignant formations on the cornea of the eye occur very rarely, most often tumors appear on the conjunctiva, sclera or limbus.
Papilloma is a tumor formation located on the outer edge of the cornea. papilloma surfacebumpy and its color is pale pink.
The disease progresses slowly, spreads both in height and width, it can also spread over the entire surface of the cornea, which is extremely dangerous and requires immediate treatment.
Medicated treatment
Antibacterial and anti-inflammatory drugs:
- Antibacterial drugs can be used for corneal infections after preliminary studies (Torbex, Tsiprolet).
- Topical glucocorticoids are used to suppress inflammation and limit scarring, although inadequate use may support microbial growth (Sofradex, Maxitrol).
- Systemic immunosuppressive drugs are used in some forms of severe peripheral corneal ulceration and thinning associated with systemic damage to the connective tissue ("Advagraf", "Imuran").
Drugs that accelerate the regeneration of the corneal epithelium:
1. Artificial tears (Taufon, Artelak) should not contain potentially toxic (eg, benzalkonium) or corneal sensitizing (eg, thiomersal) preservatives.
2. Eyelid closure is an emergency measure in neuroparalytic and neurotrophic keratopathies, as well as in eyes with persistent epithelial defects.
- Temporary bonding of eyelids with Blenderm or Transpore tapes.
- CI toxin injection. botulinum in m. levator palpebrae with purposecreating a temporary ptosis.
- Lateral tarsorrhaphy or plasty of the medial angle of the eye.
3. Bandage soft contact lenses improve healing by mechanically protecting the regenerating corneal epithelium in conditions of constant eyelid trauma.
4. Amniotic membrane grafting may be appropriate to close a persistent, refractory epithelial defect.
