Inhabit the inflammation of the vascular shell of the eye. Uveite - inflammation of the iris or vascular shells of the eyelary eye

The date: 19.10.2019

The pathology of the vascular shell (involuntary path) includes the iris, the clarity body and the actual vascular shell occurs in the form of congenital anomalies, inflammatory diseases, traumatic changes, dystrophy and tumors.

Congenital anomalies of vascular shell.

These anomalies can be identified immediately after the birth of a child.

These include:

aniridia (lack of iris),
polycarium (the presence of several pupils),
ectopia (displacement of the pupil),
koloboma (defect) of iris or all parts of the vascular shell.

Inflammatory diseases of the vascular shell.

Uveta.

This is a fairly frequent pathology of the eye, explaining that the vascular shell consists of a large number of vessels that form a thick network with a very slow blood flow.
Due to the slow blood flow in the vascular shell, many toxic and infectious agents (bacteria, viruses) causing sharp and chronic inflammations are settled (uveitis). If the whole vascular shell is inflated, it develops panubeit.

Often, due to the fact that its front department (iris and the ciliary body) and the rear (choroid) have separate blood supply, inflammation is developing only front - iridocyclite (front will avy) or only rear - horoiditis (rear injections) Department of the vascular shell. Sometimes one is inflated rainbow (Irit.) or ciliary body (cyclit).

Causes.

Inflammation of the vascular shell may occur with common infectious diseases (influenza, tuberculosis, syphilis, toxoplasmosis, etc.), with so-called focal infections (foci of inflammatory processes in carious teeth, sandy sinuses, almonds and other organs), rheumatism, polyarthritis, allergic diseases and etc.
The examination and treatment of patients with uveitis is carried out in an ophthalmic hospital.

Irit (inflammation of iris).

Irit (inflammation of iris) It usually begins with britting pain in the eye, which can spread to the temple, the whole half of the head on the side of the sick eye. The patient is difficult to look at the light (light-free, tearing, blefarospasm), the vision of the sick eye deteriorates. The eye blues (a pink-purple wreath appears around the limb - perikornal injection). Unlike conjunctivitis, the conjunctival cavity is clean, no separated, unlike keratitis, the cornea remains brilliant, transparent. The iris changes its color.

If you compare the iris of a healthy and sick eye, it can be seen that on a sore eye of the iris clump, there is no characteristic drawing of recesses - crypt of iris, extended vessels are visible in it. Due to the swelling tissue edema, the pupil is narrowed, which is also particularly noticeable when comparing a patient and a healthy eye.

The pupil of the sick eye is much smaller and not so vividly responds to light, like a healthy one. That irit is different from the acute attack of glaucoma .
With an acute attack of glaucoma, the pupil on the patient is wider than on healthy, and does not be narrowed when illuminating the eye. In addition, from glaucoma, Irit is characterized by the fact that when the eye palpation seems softer than healthy, and with a sharp attack of glaucoma - much harder.

Especially peculiar symptom of Irite are the so-called spikes (synechia). These are spacing iris with the front surface of the lens (rear spikes of iris) or cornea (front spikes of iris). They are most distinctly detected when prescribing drugs that can cause an expansion of the pupil (MIDRIATICS): 1% solution of platifylin, 1% hydrobromide homatropine solution, 0.25% solution of the hydrobromide scopolmine solution or 1% solution of atropine sulfate.

If the instillation of these solutions in a conjunctival bag of a healthy eye leads to a uniform expansion of the pupil, which retains the correct round shape, then if there is an iris, the pupil is expanding unevenly and the form becomes incorrect. The moisture of the front chamber is mutaging, in "She may appear pus (hypone).

Iridooclite.

Iridocyclit - inflammation of the iris and the ciliary body It is characterized by the same clinical symptoms as Irit, but even more pronounced. The pain in the eye and headaches, a decline in vision, light-friendly, tear, are changing the color and structure of the iris, the moisture of the anterior chamber. The deposition of cell elements on the rear surface of the cornea - precipitates - different colors and size can appear.

Due to the fact that the exudate falls into the vitreous body, it matures and with ophthalmoscopy, the reflex from the eye, the floating semi-impaired or fixed clouds in the form of threads, heavy, cereal is revealed in the vitreous body.
Another symptom characteristic of cyclitis is pain in the field of ciliary bodies, which are detected during palpation of the eyeball through closed eyelids (as well as is done to determine intraocular pressure.

Due to the violation in the ciliary body of the formation of a water-melting moisture, intraocular pressure decreases, the eye during palpation is soft, hypotonic. If the iris throughout the pupil edge of the ladle with a lens (the fusion of the pupil) or the whole pupil is zyatyanut exudate (occlusion of the pupil), then, due to the violation of the outflow of water-melting moisture, intraocular pressure can increase and the eye during palpation will be solid.

Horioitis (rear injections).

Horoiditis (rear injections) Almost always flows without visible changes from the eye. Due to the fact that there are few sensitive receptors in the choroid, patients do not feel pain, there are no redness, light-free. Average medical worker can only suspect the process in a choroid, if in a patient with a common disease (rheumatism, polyarthritis), infectious process, etc. A sharply decreases visual acuity, in the field of view, flashes and sparks (photos) appear in the field of view, distortion of the considered letters and objects (metamor -Fopsy), poor twilight vision (hemoralopia) or loss in sight (cattle).

Diagnosis can only be installed oculist, which, with ophthalmoscopy, see the changes characteristic of choroidite on the eye day.

Complications of Uveitov may lead to a significant reduction in visual acuity. These include the degeneration of cornea, cataract, secondary glaucoma, atrophy of the optic nerve.

Emergency prefigure When Irite and Iridocyclite, it is primarily in the prevention of the formation of the rear height of the iris (synechs) or a break of them if they have already been formed.

For this apply:

repeated instillations of mydriatics (0.25% solution of scopolamine hydrobromide, 1% solution of atropine sulfate). Midships can be buried if the intraocular pressure is reduced (the eye when palpation is soft),
if the intraocular pressure is increased (the eye when palpation is solid), instead of an injection of atropine, it is possible to lay on the lower eyelid, moistened with a solution of 0.1% adrenaline or 1% mesaton, or drip a 1% atropine solution and give inside the tablet (0.25 g) diakarba (Phonuries
Following this, in the eye, it is necessary to repair an offan-dexamatasone solution or a hydrocortisone suspension.
It is necessary to immediately begin the overall antibacterial and nonspecific anti-inflammatory therapy: inside or intramuscularly antibiotic of a wide range of action - tetracycline, erythromycin, zesetin, etc.,
according to the tablet Analgin - (0.5 g) and butadion (0.15
feldsher can introduce an intravenous 40% solution of glucose with ascorbic acid or a 10% sodium chloride solution, if there are no contraindications, - 40% solution of methylenetetram hex (urotropin).
It is necessary to impose a dry warming bandage on the eye and send the patient to hospitalization to the eye separation of the hospital.

Treatment.

Treatment of Uveitov general and local.

General treatment Depends on the etiology of uveitis.

Patient S. uvea tuberculosis etiology Inside are prescribed fivazide, isoniazide (tubazide) and other drugs specific effects,
- intramuscularly - streptomycin (at least 20-30 g per course).
- Simultaneously prescribe desensitizing agents.
Toxoplasmosis uveitis Treats are treated with chlorine preparations (0.025 g 2 times a day for 5 days) and sulfadimezine (0.5 g 4 times a day for 7 days).
After a 10-day break, the course of treatment should be repeated 2-3 times.
Treatment infectious uveitis Earth-developing after influenza, angina, rheumatoid and other infections are carried out by sulfanilamine preparations and antibiotics of a wide range of action (bicillin, morphocyclin intravenous, tetracycline antibiotics inside), salicylate, locally corticosteroids.
The vitamin therapy is shown (vitamins of group B, C, polyvitamins),
osmotherapy (hexamethylenetereminine, glucose intravenous).

Locally shown:

the appointment of mydriatics, which create peace of the iris, reduce hyperemia, exudation, prevent the formation of rear aircraft adhesions and a possible infection of the pupil.
- the main mydritic means is a 1% solution of atropine sulfate. Atropine is often prescribed in combination with 0.1% adrenaline solution.
the distracting therapy is shown (leeches on the temple, hot foot baths).
with the already rear spikes of the iris, the introduction of fibrinolysine, lexiny (papain) and mixtures of meydriatics by electrophoresis are effective.
to reduce inflammatory phenomena, thermal procedures are carried out with the help of heating, paraffin, diathermy.
apply independently of the etiology of the process anti-inflammatory and anti-allergic agents - Corticosteroids (installation of 0.5% of the cortisone solution daily 5-6 times a day, parabulbar or concubitative injections of 2.5% suspension of the cortisone acetate or hydrocortisone of 0.5-1 ml, dexamethasone).
as inflammatory phenomena, they spend solving therapy (Installation of ethylmorphine hydrochloride in increasing concentrations, aloe extract electrophoresis, lidases, thermal procedures).
in some cases, under the complications of uveitis (secondary glaucoma), surgical treatment is carried out.

Nursing uveta is carried out, as a rule, in eye hospitals, where, depending on the cause of the disease, a complex general and local dosage and physiotherapy treatment corresponding to the diet is obtained.
In the process of treatment, aggravating disease may occur against the background of improvement. In this, an important role is played by violations of nutrition and treatment regimens, so observation and care must be long (2-3 months). It is necessary to follow the timely and. Careful implementation of all appointments of the doctor: frequent injection of drops, physiotherapeutic procedures, conducting intramuscular injections and intravenous injections.

Prevention Uveteits lies in the timely identification and treatment of common diseases that can lead to uveitis (rheumatism, polyarthritis, tuberculosis), the rehabilitation of chronic infections (treatment of caries of teeth, inflammation of the incomplete sinuses, etc.), the overall recovery and hardening the body.

2965 09/18/2019 5 min.

Eyes - an important component of the whole organism. Sometimes during the diagnosis, the source of the problem is not at all where it was previously searched. To treat any health problem, it is necessary to approach comprehensively. This is especially true of such an eye disease, as will take away. It is important to treat not only symptoms, but to identify the cause of the disease.

What will take away?

Uveite - a general concept that means inflammation of various parts of the vascular eye shell (iris, ciliary body, choroids) is quite common and dangerous. Often (in 25% of cases) will take away leads to and even to blindness.

The emergence of this disease contributes to a large prevalence of the vascular eye network. At the same time, blood flow in the authentic paths is slowed down, which can lead to a delay in microorganisms in the vascular shell. Under certain conditions, these microorganisms are activated and lead to inflammation.

Tear as one of the signs of uveit

The development of inflammation also affects other features of the vascular shell, including various blood supply and innervation of its different structures:

the front section (iris and the ciliary body) is supplied with blood due to the front ciliated and rear long arteries, and is innervated by ciliary fibers of the first branch of the trigeminal nerve;
the rear department (choroid) is supplied with blood using the rear short ciliary arteries and is characterized by the absence of sensitive innervation.

These features determine the place of damage to the mutual path. May suffer the front or rear department.

Classification

Anatomy of the eye predisposes to the fact that the disease can be localized in different places of an involuntary path. Depending on this factor distinguish:

Front uveitis: Irit, front cyclitis. Inflammation develops in the iris and. This species is most often found.
Mid-median (intermediate) uveitis: rear cyclitis, Pars-Plantes. A wilderness or vitreous body, retina, chorioide are affected.
Rear uveitis: choroiditis, retinit, neurowitis. Horioide, retina and.
Generalized will take away - Panubeit. This type of disease develops if all the departments of the vascular shell suffer.

Forms

The character of inflammation when you learn may be different, in connection with which the following forms of the disease are distinguished:

serous;
hemorrhagic;
fibrinous plastic;
mixed.

Depending on the duration of inflammation, there is an acute and chronic (more than 6 weeks) of uveita.

Causes of inflammation

Uveteit can develop due to a wide variety of reasons, the main of which are:

infections;
injuries;
systemic and syndromic diseases;
violations of exchange and hormonal regulation.

Infectious uveitis are most common: they are found in 43.5% of cases. In this case, the infectious agents in this case are the mycobacteria of tuberculosis, streptococci, toxoplasm, pale treponema, cytomegalovirus, herpesvirus, fungi. As a rule, such uveitis are associated with infection in the vascular channel from any focus of infection and develop with sinusite, tuberculosis, syphilis, viral diseases, tonsillitis, sepsis, caries of teeth, etc.

In the development of allergic uveitis, an increased specific sensitivity to the factors of the medium is plays a role - drug and food allergies, hay fever, etc. Often, with the introduction of various sera and vaccines, whey will act.

Uveta may occur against the background of systemic and syndromic diseases, such as:

rheumatism;
rheumatoid arthritis;
psoriasis;
spondylitrite;
sarcoidosis;
glomerulonephritis;
autoimmune thyroiditis;
multiple sclerosis;
ulcerative colitis;
reiter syndromes, Fogta-Koanagi-Harad, etc.

Post-traumatic uveitis arise due to penetrating or contusion damage to the eyeball, ingress of foreign bodies.

The following diseases also contribute to the development of uveitis:

violations of exchange and hormonal dysfunction (diabetes mellitus, climax, etc.);
diseases of the circulatory system;
diseases of the organs of vision (, conjunctivitis, keratitis, blufarites, sclerites, corneal ulcers).

And this is not the entire list of diseases, as a result of which will arise and will avail.

Symptoms and diagnostics

At the initial stage of the disease, the color of the iris is changing and spikes appear. Crystal eye becomes muddy. Next will take away can manifest itself in different ways, depending on the type and form of inflammation. General symptoms are:

photophobia;
chronic tear;
other or sharp pains;
pain and unpleasant sensations;
deformation;
the appearance of a light "fog" before the eyes;
deterioration of visual acuity, up to blindness;
fuzzy perception;
an increase in intraocular pressure (this is felt in the eye);
the transition of inflammation to the second eye.

CONSIDERATION OF THE ARTICLE: ClassList.Toggle () "\u003e Expand

Hurt the eye - this is inflammation of the vascular shell. This is a fairly common problem in ophthalmology, which in 25% of cases leads to a decrease in vision.

Anatomical features of the building of the vascular shell

It is known that the vascular eye sheath includes several departments:

Front uveitsubmitted by the ciliary body (Corpus Ciliare) and iris (IRIS);
Rear UweitLocated under the retina. It is represented by a vascular shell, which is called chorioide (Chorioidea).

The vascular network of the eyeball is very branched, and the rate of blood flow slows down. These conditions create a favorable sphere to disseminate the inflammatory process.

The blood supply to the front and rear sections of the vascular shell is carried out separately. That is why inflammation in them proceeds in isolation and practically does not move from one department to another.

Noteworthy is the fact that on the actual vascular shell, choroids, there is no sensitive innervation. In this regard, its defeat is not accompanied by soreness.

Causes of occurrence

In 43% of cases, the disease is infectious.

Most often, the cause of uveitis is infectious (about 43% of all cases of the disease). Streptococci, cytomegalovirus, tuberculosis mycobacteria, a virus of herpes, streptococci, staphylococci, fungi, pale treponema, can act as causative agents.

Second place at often occupied by an allergic injection. Chemicals, pollen of plants, household allergens are usually performed as provoking factors. There are cases of serum uveitis, which arose in response to vaccination.

Uveterates the choroid envelope of the eye often accompanies severe systemic diseases, such as psoriasis, multiple sclerosis, autoimmune damage of the thyroid gland, glomerulonephritis, rheumatoid arthritis, diabetes mellitus.

Sometimes you will take away as a complication of some eye diseases. (, corneal ulcer).

Classification of the disease

By the nature of the flow of the inflammatory process of uveitis, the eyes are divided into:

Sharp (last no more than 3 months);
Chronic (continues over 3 months).

Depending on the anatomical localization of the inflammatory processseveral types of uveitis are isolated:

Depending on the nature of the inflammatory responseuveta are divided into the following forms:

Purulent;
Serous (with watery discharge);
Fibrinous plastic (with a seal of inflamed tissue);
Hemorrhagic (accompanied by hemorrhages);
Mixed.

Due to the occurrenceuveta can be:

Exogenous (caused by burns, injuries);
Endogenous (caused by infectious agents inside the body).

In addition, inflammation of the vascular shell can be primary (that is, it appeared in a previously healthy eye) and secondary (appeared against the background of the systemic disease).

Symptoms of uveita eyes

The clinical picture of uveitis directly depends on the anatomical location of the inflammatory process.

Front upes

The front uveitis is accompanied by feeling that a person looks through a thick fog. Hyperemia appears (redness) of the mucous membrane, pain is growing.

Over time, the fear of light and abundant tearing is joined. Gradually reduces visual acuity. The front will utter can cause an increase in the number of intraocular pressure.

Rear uveiti

Rear uveitis are accompanied by such bright manifestations. This is largely due to the fact that the choroid does not contain nerve endings.

This form is characterized by a progressive reduction in vision and distortion of contours of objects. Some patients may complain about the appearance of floating points or stains.

With the rear, they might be affected by the retina of the eye and even the visual nerve. It is manifested by the symptoms of a sharp decline in view, losing sights, photopsy (glowing points before eyes) and even a violation of color vehicles - the patient ceases to distinguish between the colors or their shades. This is due to retinal and nerve hypoxy due to the damage to the vessels.

Uneeis generalized

The most serious flow has a generalized will take away. As a rule, it flows against the background of severe sepsis (blood infection) and represents a serious threat to the sick life.

In general, you will learn the inflammatory process captures all the structures of the eyecontaining vessels: iris, vascular shell and even retina.

Therefore, the symptoms will be pronounced: pain in the eyes, reducing vision, tear, light-friendly. In case of inspection, the injection (expansion) of the vessels is visible, redness is expressed.

Diagnosis of the disease

For the integrated diagnosis of uveit, the following surveys must be carried out:

In some indications, complex instrumental methods can be used: an ultrasound examination of the eyes, electricoreoretinography, angiography of blood vessels of the retina, laser scanning tomography, biopsy.

In suspected, the secondary will take advice to the consultation of the phthisiartra, neuropathologist, rheumatologist and other related specialists.

Treatment of uveita eyes

Treatment of uveitis of any etiology begins with appointments - preparations that expand the pupil. It applies to them.

The expansion of the pupil prevents the spasm of the ciliary body and prevents the appearance of adhesions between the crust and iris capsule.

Depending on the origin of Uveta, the doctor prescribes antihistamine () or drugs (in the form of eye drops or ointments).

Must be assigned steroid anti-inflammatory funds, such as, betamethasone or.

In the launched cases, surgical intervention may be needed.

Surgical intervention with leaving lies in the removal of the affected vitreous body - internal transparent eye environment. In modern clinics today they are replaced by a synthetic gel based on silicone.

If the process has spread to all structures of the eye, it is completely removed to keep the second eye, because the inflammation can pass along the vessels.

So as not to reduce "no" the result of treatment of uveitis, as well as prevent the occurrence of relapse, need to observe the following measures:

Folk Medicine in Uneete Treatment

Among the folk remedies for the treatment of uveitis are used by healing herbs: chamomile, calendula, linden, sage. Of these, preparing infusions at the rate of 3 tablespoons of crushed grass on 1 cup of boiling water. Invast for an hour, cooled. Soft cotton swab is wetted with infusion and wash their eyes.

You can buy in a pharmacy glass overhead baths for eyes. They must be pre-boiled, fill in infusion and attach to the eye for 3-5 minutes.

The healing effect on the eyes is aloe juice, it relieves inflammation, improves blood circulation and stimulates rehabilitation processes.

It can be bought in a pharmacy or cook at home, squeezing out of a fresh plant.

In both cases, the juice needs to be diluted with boiled water in a ratio of 1:10. Put 2 drops in every eyes in the morning and in the evening.

Complications

If you do not cure the front lead, it can cause the following complications:

Keratopathy (violation of the horn shell);
Macular swelling swelling;
Synechia (sobbing) between lens and iris);

The complications of the rear uveit:

Ischemia (dysfunction) in the field of yellow retinal stain;
Blockage of retinal vessels;
Neuropathy (violation of the functioning) of the optic nerve;
Macwean swelling swelling.

Forecast and preventive measures

The treatment is better to start immediately, otherwise there may be complications.

With a timely manner, absolute recovery occurs, as a rule, already on 3-4 weeks. The earlier the integrated therapy was started, the sooner the cure occurs. Otherwise, it will take away can go into chronic shape and continuously recur.

During treatment it is very important to comply with all the recommendations of the doctor. And in no case before the time not to stop the reception of drugs. If this is neglected, the likelihood of the development of complications, including loss of vision, is great.

As for the prevention of uveitis, it lies, first of all, in the timely appeal to the ophthalmologist and the regular passage of annual preventive inspections. An important role also plays compliance with personal hygiene rules.

2-02-2015, 00:38

Description

Inflammation of the vascular shell - Uveta are one of the frequent causes of weakness and blindness (25%). The proportion of endogenous uveitis is 5- 12% of cases of eye pathology in children and 5-7% among sore hospitals.

Unematis in children They have a variety of clinical manifestations and multiplicity of options, which makes it difficult to diagnose, especially in the initial stage and atypical development.

The frequency of uveitis is explained by the set of vessels branched on the capillaries and repeatedly anastomosing each other in the vascular shell, which sharply slows down blood flow and creates conditions for sedimentation and fixation of bacterial, viral and toxic agents

Separate blood supply to the front (iris and the ciliary body) and the rear (actual vascular sheath or choroid) of departments, as well as the anastomoses between all sections of the vascular shell lead to the emergence of anterior uveitis (Irites, iridocyclites) and rear uveitis (choroidites), inflammation of the entire vascular shell ( Panubeit).

Cyclospia allows you to highlight the inflammation of the flat part of the ciliary body (rear cyclitis) and the extreme peripherals of the vascular shell itself (peripheral will take). With uveitis, the retina and the visual nerve are involved in the process, neurochororetinite occurs.

Bad outcomes of the disease and insufficient effectiveness of therapy are associated with etiological and pathogenetic peculiarities of uveitis. This is a genetic predisposition to immune disorders, acute and chronic infections in violation of protective mechanisms, chemical and physical impacts leading to the formation of alien antigens, impaired immunity, neurogormonal regulation and hematophalmic barrier permeability.

In patients with uveitis, the organism is depleted with protective factors, there is a pronounced accumulation of inducers of the inflammatory reaction, the activity of biogenic amines is increasing, the autoimmune process is pronounced, which is not so much vascular, how many mesh shell; There is a significant activation of the peroxidation oxidation processes of lipids. Disruption of physiological isolation of eye tissues, increasing the permeability of the hematophthalmic barrier contribute to the transition of uveitis into a recurrent form.

Uveta divide on serous, fibrous (plastic), purulent, hemorrhagic, mixed

Uveta flow can be sharp, subacute, chronic and recurrent. The process can be endogenous and exogenous. Endogenous uveitis can be both metastatic (when the pathogen is inserted into vascular channel) and toxico-allergic (when sensitizing the body and eye tissues). Exogenous uveits occur upon penetrating injuries of the eyeball, after surgery, cornea ulcers and other diseases.

Over the past 20 years, the incidence of endogenous uveitis increased 5 times. Most often, unesses are found in schoolchildren (68%). Viral uveitis prevail (25%), strepto- and staphylococcal, toxico-allergic, associated with chronic foci of infection (25%).

The number of uveitis of tuberculosis etiology (24%) and bacterial-viral (27%) increased. There was a tendency to reduce the frequency of rheumatoid uveitis from 24% in the 70s to 9% in recent years, which is associated with the early diagnosis of this disease and timely complex therapy.
At an early age, viral and bacterial and viral uveitis prevail.

The leading form of uveit is iridocyclite (up to 58%); Peripheral will be detected in 21-47% of patients.
The etiological diagnosis of children's uveits is difficult, detected causal agents are often only permitted provoking. To detect the disease in the early stages and timely start treatment, the ophthalmologist should examine the eyes and check the visual acuity in any disease of the child.

The diagnosis of uveitis is based on the anamnesis data, the clinical picture, accounting for the general condition of the body, the results of clinical and laboratory research.

Survey diagram of patients with uveitis

Anamnesis of life and illness.
An examination of the organ of sight: visual acuity without correction and correction, period and campmetry, color vision, front and rear biomicroscopy, gonoscopy, ophthalmoscopy reverse and straight, tonometry, cyclospia.
Additional methods of research: X-ray studies of the chest organs, apparent sinuses, consultation of specialists (therapist, otolaryngologist, phthisiartra, neurologist, dentist, etc.); ECG.
Clinical and laboratory studies: general blood test: the content of protein fractions, the definition of C-reactive protein. DFA, sowing blood for sterility; general urine analysis; urine analysis and blood on sugar; Analysis of the feces on the eggs of worms.
Immunological studies: - study of the reaction of the humoral immigration - the reaction of vazserman or microreactment to syphilis with a cardio-cardin antigen, the reaction of Wright Huddleson if brucellosis is suspected: complement binding reaction; Passive hemaglutination: neutralization, fluorescent antibodies, etc.; The microprecipitation on Wanne with the set of antigens (strepto- and staphylococcus, tuberculin, tissue antigens), the reaction of the Boyden with the antigen of the vascular shell, lens, retina, etc.;
- Cellular immunity reaction:
and) The reaction of the blasttransformation of peripheral blood lymphocytes, inhibition of microphagne migration, leukocytolysis, etc. with strepto- and staphylococcus antigens, tuberculin, toxoplasmic, antigens of a simple herpes virus, cytomegalovirus, tissue antigens;
b) study of the content of immunoglobulins in blood serum;
in) intradermal samples with different antigens, taking into account the focal reaction of the eye in the form of exacerbation of the inflammatory process or his subsoge;
d) Study of antibodies to DNA.
Selecting viruses and detecting virus antigens in eye tissues using the method of fluorescent antibodies.
Biochemical methods of research: a study of blood and urine on acidic glycosaminoglycans, a study of urine on oxyprolin, the content of 17-oxycorticosteroids, biogenic amines (serotonin, adrenaline) in the blood.

The rapid method of etiological diagnosis remains a focal reaction of the eye to intradermal administration of tuberculin, toxoplasamin, bacterial allergens (streptococcal, allergens of intestinal sticks, protest, neasery), etc.

Front upes (irita, iridocyclites, cyclites) are accompanied by a pericornal injection associated with the dilatation of gloil vessels; Changes in the color and pattern of iris due to the expansion of vessels, inflammatory edema and exudation, the narrowing of the pupil and its sluggish reaction to light due to the swelling of the iris and the reflex reduction in the sphincter of the pupil; The incorrect form of pupil, as the exudation from the iris vessels on the front surface of the lens leads to the formation of adhesions (rear synechs).

The rear synefias can be separate or forging the combat on the entire pupil edge of the iris with a lens. When organizing an exudate in the field of pupil, an infection occurs. The circular synechia and the pre-crash membrane lead to the disunity of the front and rear chambers of the eye, thereby causing an increase in intraocular pressure. Due to the accumulation of fluid in the rear camera, the iris sputs into the front chamber (the bombing of the iris).

The moisture of the anteroraous chamber is muttered due to serous, fibrinous, hemorrhagic, purulent, mixed exudation. In the front chamber, the exudate settles in the lower departments in the form of a horizontal level. The purulent exudate in the front chamber is called hypocoon, hemorrhage into the front chamber - the hypheth.

On the rear surface of the cornea, single-caliber, polymorphic precipitates are determined. Precirates consist of plasma cell lymphocytes, macrophages, pigment particles and other elements indicating the increase in the permeability of the vessels of the ciliary body.
A frequent sign of cyclitis is a decrease in intraocular pressure.

Possible complaints of pain in the eye and pain when palpation of the eyeball. The change in the composition of the intraocular fluid leads to a disruption of the pressure of the lens and the development of cataracts. Pronounced and long cyclites violate the transparency of the vitreous body due to exudation and mooring. All these changes determine visual discomfort and reduced vision.

In young children, pain syndrome is usually expressed weakly or there is absolutely no harness to reduced vision. Maybe the lack of corneal Sidroma. Perikornal injection.

Peripheral uveitis (Rear cyclites, basal inntitinites, steamplants) are characterized by inflammatory changes on the extreme periphery of the eyeboard. The predominantly flat part of the ciliary body is affected, but its ciliary part can also be involved in the process, the peripheral departments of the vascular shell, retinal vessels.
The disease is more often bilateral (up to 80%), amazing young people and children; Children are most often sick of 2-7 years.

In the pathogenesis, the main place is given to immune factors, the role of herpetic infection is discussed.
Different types of the flow of nonspecific uveitis are isolated. The process in children proceeds more hard as adults.
In case of acute, they appear exudative foci on the extreme periphery of the eye dna, more often in the lower domain or concentral across the entire circumference.

With the serious course of the disease, the exudate becomes visible behind the lens. Often, the exudate appears in the angle of the angle of the anterior chamber, forming trabecular precipitates and goniineoshiy.
In connection with the spread of exudate through the channels of the vitreous body to the rear departments of the eye, destruction and increase in the permeability of the preparapillary and premacular membranes occur, which causes pronounced reactive edema in the peripapillary and purple zones (possibly by the type of autoimmune reaction).

The progression of inflammation may be accompanied by an exudative retinal detachment on the periphery
In the stage of reverse development, the turbidity of the vitreous body of different seversions and lengths that cause a sharp decline in view are formed.

On the extreme periphery of the retina, atrophic chorioretinal foci can be revealed, semi-letters of retinal vessels, relatinosisis of varying degrees, dystrophic changes in the macular region

A complicated cataract becomes one of the complications, which is formed from the rear pole of the lens.

Guineosinechia and the organization of exudate in the trabekutar zone can lead to secondary glaucoma. However, peripheral uveitis in children is more peculiar to hypotension.

The phenomena of the eye irritation and changes in the front segment are extremely scarce, the decline in view in the acute phase of the disease may not be, so often peripheral uveitis are detected with the intake, during the progression and dissemination of the process or in the reverse development stage.

To avoid diagnostic errors, it should be suspected peripheral to take away with various vitreous bodies of the vitreous body of unclear genesis, with a macular edema or dystrophic changes in the macula, rear cortical cataracts.

For the focused detection of peripheral uveitis, the extreme periphery of the eye dNA is inspected with the help of indirect (mono- and binocular) ophthalmoscopy with a spool by pressing with a three-merical lenses. With changes in the macular region and retinal vessels, fluorescent angiography is shown.

Rear uveiti (Horioidites) The cup has a sluggish, ashautive, imperceptible current and do not cause complaints in children, especially in small. At rear uveitis, single or multiple foci of various shapes and contours, magnitude and colors with peripocal inflammation phenomena (edema) in the choroid can be seen.

Often, respectively, these focal changes in the inflammatory process are involved and the retinth (retinit), and the disk of the optic nerve (Papillic phenomena) is involved. In the adjacent layers of the vitreous body is determined by turbidity.

Horoid is always reflected in the state of the field of view, since respectively focal processes arise in the field of view (micro and macroscotomas). If the lighter focuses are located in the center of the Tyazh bottom, then the acuity of vision is reduced until the light, the central absolute and relative cattle appear, the color is changed.

Senior children and adults can complain about curvature images of objects, change their size (metamorphopsy). Flashing of light, flickering (photos), sometimes on a sharp deterioration in the twilight (night blindness, hemoralopia). Complaints are due to changes in the receptor elements of the retina due to violations of their location due to exudation in the field of focus of inflammation and loss of intimate contact of the choroid with the outer layers of the mesh shell.

Hemaratopia occurs with the extensive lesions of the periphery of the vascular and the mesh shells of both eyes, for example, with a scattered chorioretinate.

There are no pain in the eye with choroid. The front segment of the eye is not changed, the eyes of calm Ophthalmotonus is not broken.
With non-growing (toxic-allergic) uveitis, infiltration of choroids diffuse. The process often involves the visual nerve, which is manifested by hyperemia, the stainedness of its borders, the functional disorders of the exudation foci are sometimes large, their boundaries are blurred.

Perivasculites and retinites are observed, accompanied by exudative effusion, the retinal vessels are covered with exudate, as a cover. In the outcome of the process, as a rule, extensive bright atrophic foci of "vascular shell with pigment deposition are formed. Old foci look white, since a cleaner is visible through a transparent retina and an atrophied vascular sheath.

The foci is flat, with a large or smaller number of brown pigment migrating from the surrounding areas of choroids.

Panubube - defeat of all three departments of the vascular shell. His symptoms are characteristic of the inflammation of each department of the vascular shell. D).

The basic principles of the general and local etiotropic and symptomatic treatment of uveitis. Treatment of patients with endogenous uveitis, regardless of their etiology, is aimed at eliminating signs of inflammation, the preservation or restoration of visual functions and, if possible, preventing the recurrence of the disease.
With endogenous uveitis, the timing of clinical and true recovery does not coincide

At the heart of the pathogenesis of uveitis lie with diverse factors, therefore, in the therapy of this complex disease, it is necessary to take into account etiology and immune status, activity and stage of the process. The impact is aimed at the main links of inflammation - an increase in the permeability of the vascular walls of the hematophalmic barrier, exudation in the eye tissue, followed by destruction and excess fibrosis against the background of the violation of the general immunobiological state.

After determining the diagnosis of uveitis, as a rule, anesthetics, mydriatic agents, antibiotics, non-steroidal anti-inflammatory drugs are prescribed. Local use of steroid preparations is more efficient in acute uveitis.

The use of short-acting medicines (antibiotics, sulfonamides, corticosteroids. Vitamins, enzymes, anesthetics, salicylates, etc.) with a sharp process should be frequent in the form of forced installations (each drops are injected into the conjunctival cavity after 3-5 minutes for an hour 3 times in Day with a 1-2-hour break between time courses; course 3-5 days).

Total treatment includes the sanitation of foci of infection, the use of antibiotics, nonspecific anti-inflammatory, antiviral, anti-tuberculosis, anti-flowsmatic, hyposensitizing therapy and vitaminotherapy.

The total corticosteroid therapy should be long-term taking into account the hormonal background of the body (the presence in the serum of the free and protein-bound hydrocortisone and corticosterone), while it is necessary to keep in mind its inability to prevent the chronic and recurrent increase in uveitis.

It is important to know and prevent serious complications of corticosteroidal treatment (Cushing syndrome, delayed development in children, osteoporosis. Cortisone psychosis, adrenal failure).

With a decrease in the protective forces of the body with a decrease in the content of gamma-globulin and immunoglobulins in the serum in some cases, the use of immunostimulants (Timalin, T-activin, halfdan, deargin), vaccination, introduction into the organism of immunocompetent cells, hyperimmune globulin, levamizol, predishozhan (by 50-75 μg is intramuscularly 2 times a week; per course 7-10 injections).

Indomethacin, as well as acetylsalicylic acid in age doses, is used to inhibit prostaglandin biosynthesis.

In order to reduce the permeability of the vascular walls and the restoration of the endothelium of the vessels, ditinon is prescribed in the age doses by repeated courses of 1.5 months 1 time per quarter, as well as stampmanone and neutin.

Appointing ditinon, take into account its angioprotective effect, which is associated not only with the influence of capillaries and the basic substance of the inter-endothelial space, but also with pronounced antioxidant activity (600 times higher than that of ascorbic acid) and inhibitory effects on the activity of the kinin blood system. This improves microcirculation and giving hemostatically effect drug is used with pronounced exudation, hemorrhages. Retinovasculit.

Among the antihistamine drugs appointed by the patients with uveitis, the first place occupy derivatives of phenothiazine, as they also have high antioxidant activity (150 times higher than that of ascorbic acid), Pipolfen, diprage, etc.

Putting glucocorticosteroids (glucocortisone, dexazone and dexamethasone, methipred, medrol, etc.), take into account their antioxidant effect, the ability to reduce the production of antibodies, delay the decay of acidic glycosaminglikan. These drugs have a pronounced anti-inflammatory effect, reduce the permeability of capillaries and reduce autoimmune reactions.

Along with these drugs to improve microcirculation, normalization of metabolism in the vessel wall, in the tissue of the vascular shell, in the retina, to reduce the hypoxia of tissues, the removal of edema, the normalization of permeability, both in the acute course of uveitis and in the remission prevention, an angioprotectors are used to prevent recurrence. Doxium, Anginin, Nebinetin, Parming (at the same time, take into account their ability to reduce the activity of Bradicycline). For capillaryrotector, vitamin P, ascorbic acid, non-steroidal anti-inflammatory drugs are widely used.

Non-steroidal anti-inflammatory drugs occupy a leading place in the treatment of uveitis, as they influence different units of the pathogenesis of the inflammatory process.

Salicylates. Pyrazolone derivatives (butadion, rope), orthophene, voltaren have a pronounced anti-oscreenonidase, antiprostaglandin, antioxidant, antikinine activity and many other qualities that help brake activity of inflammation mediators. Preparations are used as part of local and overall therapy of uveitis.

At the height of inflammation in the vascular shell of the eye, the activation of the kinine system The action of proteolysis inhibitors is especially pronounced in the initial stages of the inflammatory process, therefore it is advisable to block the formation and launch of functional biochemical systems involved in the development of uveit, the kallicrein-trypsin inhibitor of the city forces.

The drug is inactivating a number of enzymes (plasmin, converting callidineenasis, etc.) and prevents the release of kinines, preventing excessive fibrin emission from the bloodstream, which remains one of the numerous links of the Pathophysiological inflammation mechanism.

The farms are used by phonophoresis (25,000 kes per 100 ml of isotonic sodium chloride solution; for a course of 10-15 procedures), in the form of forced installations of the Gordskos solution to the conjunctival cavity within an hour 2-3 times a day. Patients with severe exudation, retiniovasculitis, sharp uveitis and a tendency to fibrinous exudate Galds are injected with 0.5 ml (5000 bed) in alternation with decxazone and dicinion.

To improve metabolism in eye tissues in complex therapy, carbgen is used as antihypoxant. Inhalation of oxygen with small concentrations of carbon dioxide leads to improved microcirculation in the retina and the vascular shell in the damage zone and the improvement of tissue exchange.

Under the elevation of acute inflammatory phenomena, neurotrophic therapy, which is especially necessary in the swelling of retina, papilli, the development of dystrophic foci on the eye day, are beginning to prevent complications in early stages. To improve the trophic eyes, a 4% solution of the Taufon intramuscularly and in the eye drops, Sermion, Cerebrolysin, Sexax, Cytochrome C, Trental, Cavinton, Starbonon, Vitamins, and others are used.

Preferably local use of drugs, the choice of which depends on the localization of inflammation and age of the child. Electro-, phono, magnetophoresis, endonazal electrophoresis, parabulbar injections, the introduction of drugs through the irrigation system of retrobulbarno and in Tononovo space (5-6 times a day for 7-15 days), which provides a long-term concentration of the drug and leads to Good results.

For the resorption of the exudate, hemorrhages, synechs, the valve is used by proteolytic enzymes (tripsin, chymotrypsin, fibrinolysin, lectures, streptodecase, collalizin, etc.). Not only the fibrinolytic effect of the enzyme, but also improved fabric permeability and braking the development of young connective tissue

The lidase is widely used, the effect of which is associated with a decrease in the viscosity of hyaluronic acid, an increase in the permeability of tissues and facilitating the movement of the fluid in the interstitial spaces.

Enzyme therapy is carried out by a methol of electrical, phonophoresis, installation of drops, injections for conjunctiva and parabulbarno on the background of general and local therapy with angioprotective drugs

With newly formed vessels in the vascular path and retina, photo and laseroagulation are used, as well as the cryocauntying of the zones of newly formed vessels. Vitreotomy is used in turbidity and sovereign in the vitreous body.

In upes patients in the remission stage, an ophthalmologist examines at least 1 time per quarter in the spring and autumn it is advisable to conduct anti-relaxed courses of treatment with anti-contaminant drugs (3 weeks) and angioprotectors with a proctive or stuteron. dicinion (1.5 months). Such a tactic allows to reduce the frequency of the disease of the disease to 6% and gives a positive effect of more than a third of the patients.

Uveite - a general concept denoting the inflammation of various parts of the vascular shell of the eye (iris, ciliary body, choroids). The main factor that contributes to the development of uveit is some slowdation of blood flow in the eyely an enhancement path. In more detail about what kind of eye disease, which symptoms are characteristic of it, as well as methods of treatment - we will look at this article.

Uveite: what is it?

Uverates - this is a group of diseases characterized by partial or complete inflammation of the vascular shell of the eye. In most cases, a person develops infectious inflammation caused by the reproduction of bacteria or viruses (herpetic injections). However, some patients develop allergic or toxic.

What is a vascular shell? This is the middle shell of the eye, permeated with blood vessels with blood. There are vessels in the vascular shell in a certain order. In the outer part there are the largest vessels, and on the inner border with the retina is the capillary layer. The vascular eye envelope performs certain functions, the main of which is to provide the necessary power in the four layers of the retina located outside. These layers have important photocells - sticks and columns.

Medical statistics are such that in 25% of clinical cases, this ailment is the reason for the reduction of visual function or even blindness. The average will be diagnosed with one person out of 3000 (data for 12 months).

The main morphological forms of pathology:

Front uveitis are more often the rest. They are represented by the following nosologies - Irit, cyclitis, iridocyclite.
Rear will fly - choroiditis.
Military will take away.
Peripheral will take away.
Diffuse will take away - the defeat of all departments of an involuntary path. The generalized form of pathology was the name of iridocyclohoroiditis or pantube.

By the nature of the course of uveitis divide on:

sharp;
chronic (in the chronic stage the disease passes in the event that the symptoms of uveitis in the patient continues 6 or more weeks);
recurrent.

Causes

The causal and starting factors of uveitis are infections, allergic reactions, systemic and syndromic diseases, injuries, metabolic disorders and hormonal regulation. Infectious uveitis are the most common. This type of disease is caused by a bacterial or viral infectious agent.

Most often will increase due to the penetration of the following infectious agents:

streptococci;
koch stick;
toxoplasm;
fungi;
herpessurus;
pale Treplema.

In children and the elderly, the eyes will ubinate usually have an infectious nature. In this case, the provoking factors are often allergic and psychological stresses.

Symptoms of Uveta

Depending on these factors, the symptoms may be exacerbated to have a certain sequence. The main symptoms of uveita include:

the appearance of nebula in the eyes;
vision worsens;
the patient feels gravity in the eyes;
appears red
the patient is bothering pain;
pupils are narrow, the reaction to the light is weak;
as a result of the increase, an acute pain occurs;
the patient avoids light, since he brings discomfort;
tears are distinguished;
in severe cases, the patient can completely go blind.

Cardinal sign The pathology appeared, as a rule, protrudes the narrowing of the pupil, the stainedness of the picture of the iris and change its color (the blue iris can become dirty green, and the brown eyes acquire a rusty shade).

	Symptoms
Front uveit	This form is diagnosed in patients more often than others (from 40 to 70% of cases). Manifests: light-in enhanced tear, redness of the eye, sometimes with a purple tint, reduced vision. If the patient has to check it with the help of positive or minus glasses, it will be found that the acuity of sight does not improve.
Peripheral	This is the rare form of this ailment. Inflammation in this case affects the zone located immediately at the ciliary body;
Rear	The rear will uveitis has a low-rise symptomatology, which appears late and does not impair the general state of the patients. In this case, pain and hyperemia are absent, the vision is reduced gradually, flashing points appear before the eyes.

Depending on the nature of inflammation, it is allocated:

serous will take away;
fibrinous-plate;
purulent;
hemorrhagic;
mixed.

When you fly, associated with Fogta-Koyanagi Harad syndrome, are observed:

headaches,
neurosensory touginess,
psychosis
alopecia.

With sarcoidosis, in addition to eye manifestations, as a rule, it is noted:

increased lymph nodes
tear and salivary glands,
dyspnea,
cough.

In children, it will be often found only because of the injuries of the eye. In second place, it arises due to an allergic reaction, metabolic diseases or infectious distribution. Symptomatics Here traced the same as in adults.

Complications

The faster the patient appeals to the doctor, the earlier the specialist will determine the causes of the inflammatory process in the region of the vascular shell of the eyeball. If you fail to treat in a timely manner, it may entail unpleasant consequences:

Partial or complete loss of vision
Cataract
Retinal disinsertion
Vasculit
Glaucoma
Panubube
Damage to the optic nerve
Loss of eyes.

Diagnostics

As soon as the first signs of uveitis appeared, it should immediately consult a doctor. To diagnose such a serious pathology accompanied by inflammation, specialists use modern equipment.

The main diagnostic methods allowing to identify in the patients:

Biomicroscopy,
Gonoscopy
Ophthalmoscopy
Ultrasound eyes
Fluorescent angiography of the retina,
Ultrasonography,
Reeofthalmography,
Electrologyoretianography,
Paracentsis of the front chamber,
Vitreal and chorioretinal biopsy.

Treatment of uveita eyes

The main thing in the treatment of uveitis is the prevention of the development of complications threatening vision loss, and the treatment of the disease underlying pathological changes (if possible).

For treatment of uveitis use:

midities (Atropine, Cyclopentol, etc.) eliminate the spasm of the ciliary muscles, prevent the appearance or tear the breathtaking already.
the use of steroids is local (ointments, injections) and systemically. To do this, use betamethasone, dexamethasone, prednisone. If steroids do not help, immunosuppressive drugs are prescribed.
eye drops to reduce high intraocular pressure,
antihistamines with allergies,
antiviral and antimicrobial means in the presence of infections.

The purpose of medicines depends on the causative agent of Uveita:

To dissolve the formed infiltrates (sections in which blood and lymphs accumulated) such pharmacological means as "lidase" or "hemaz" are prescribed. From antihistamine medicines, as a rule, "Supratine" or "Claritin" are appointed.

Surgical treatment of uveitis is shown in severe cases or in the presence of complications. The spikes between the iris and the lens are dissected by the operational way, remove the vitreous body, the eyeball, the laser solder the retina. Exodes of such operations are not always favorable. It is possible to exacerbate the inflammatory process.

Integrated and timely treatment of acute front uveitis, as a rule, leads to recovery in 3-6 weeks. Chronic uveits are prone to relapses due to the exacerbation of the leading disease.

Prevention

For the prevention of uveitis, it is necessary to observe eye hygiene, avoid infection, injury, hypothermia. It is also important to treat allergic diseases in a timely manner in order to prevent non-infectious uveitis. It is necessary to identify and treat and chronic infectious diseases that can become a potential source of eye infection.

Also an important part of prevention is the regular visit to the ophthalmologist. Children and adults need to inspect the eye at least once a year.