Tuberculous keratitis can occur when the penetration of Mycobacterium tuberculosis in the corneal tissue from other sites of infection, then it is called metastatic or hematogenous. In another case tuberculous keratitis develops as an allergic process due to effects on the tubercle bacillus. There are three forms of hematogenous or metastatic
tuberculous keratitis:
diffuse deep
deep focal
sclerosing keratitis.
All three of these forms usually occur in middle-aged people who have had previous tuberculosis. Tubercle bacilli at the same time fell into the cornea during the illness, but the development of keratitis occurs in a few, sometimes many years.
Deep diffuse tuberculous keratitis. In this case there is a deep keratitis infiltration (thickening) in the cornea and the inflammatory process captures most of the corneal tissue. The patient complaints appear watery eyes, feeling the sand, pain in the eyes. There is redness of the sclera near the cornea. Itself cornea becomes cloudy. Gradually grow into the cornea and blood vessels in the course of vessels sometimes have small hemorrhages. The disease extended to periodic exacerbations. Prognosis is usually poor, because the cornea is formed a dense cataract (wall-eye).
Deep focal tuberculous keratitis. In this form of keratitis focus of tuberculous inflammation is deep in the tissue of the cornea and iris in process and the anterior chamber of the eye.
Tuberculous sclerosing keratitis. Sclerosing keratitis begins at the border of the sclera and cornea. In this dense infiltrate slowly spread, like creeps, from the periphery to the center of the cornea. Disease is a long, hard. In the inflammatory process involves the iris. There are iritis, iridocyclitis. Prognosis is usually poor, the site of the infiltrate formed a dense scar, similar to the sclera. Tuberculous-allergic keratitis include phlyctenular keratitis, an itinerant fliktenu phlyctenular and pannus. Ill usually children or young people who have TB lung disease, bronchial, submandibular, cervical lymph nodes. At the same time TB occurs in the active period. For the occurrence of tuberculous-allergic keratitis should decrease the body's defenses.
Phlyctenular keratitis. Phlyctenular (conflicts-bubble) keratitis is characterized by the appearance of small infiltrates (seals), called fliktenami in the surface layers of the corneal tissue, most often on the periphery. The sizes of these infiltrates is about 1 mm. The patient complains of tearing, stinging eyes, feeling the sand in the eyes. There is blepharospasm (spasmodic contraction of eyelids), swelling of the eyelids and face. In the contents conflicts Mycobacterium tuberculosis are not detected. Often conflicts are formed on the spot ulcers, which are then scar to form opacities. Sometimes there is a perforation of the cornea, with the subsequent formation of cataracts, fused with the iris.
A wandering conflict. A wandering conflict or puchochkovy keratitis develops, if conflicts formed slowly spreading from the periphery to the center of the cornea. At the same time for stretches fliktenoy beam vessels sprouted into the cornea. A wandering conflicts takes place very long, slowly moving through the cornea. After the inflammatory process remains stable turbidity.
Phlyctenular pannus. Phlyctenular pannus enhanced germination of different vessels in the cornea. The cornea becomes cloudy, penetrated the vessels, which greatly disturbed function of vision.
Treatment of tuberculous keratitis.
Treatment of tuberculous keratitis performed with the mandatory treatment of the basic process of tuberculosis. Treatment of long-term. Various groups of drugs (tubazid, ftivazid, Pasco, streptomycin, cycloserine, kanamycin, tibon, etc.) for instillation into the eye of assigned solutions of glucocorticoid hormones, calcium chloride, absorbable drugs. Carry out physiotherapy.
If persistent corneal opacity there is a need for surgical treatment. Perform keratoplasty. Prognosis with prolonged duration is questionable to maintain visual function.
