Despite the achievements of modern medicine, tuberculosis annually kills about 3 million people on the planet. This disease can affect not only the lungs of a person, but also many of its other organs and systems. Eye tuberculosis is an infectious disease that is difficult to diagnose and completely treat. The development of this ailment in children is especially dangerous, since in the absence of adequate and timely therapy, it can lead to meningitis, sepsis, and other serious complications.
Causes of the disease
If a person’s immunity is functioning normally, then mycobacteria do not necessarily cause tuberculosis to enter the body. 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 still develops is very high.
Factors that contribute to the development of the disease:
- unbalanced diet and vitamin deficiency;
- adverse living and working conditions;
- insufficient human exposure to fresh air and the sun;
- psycho-emotional stress, stress;
- lack of sleep and rest;
- bad habits;
- the presence in the body of chronic foci of inflammation;
- 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:
- tuberculosis of the mucous membrane;
- 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 and allergic lesions of the ocular apparatus.
In the first two cases, we are talking about primary infection with mycobacteria and their reproduction directly in the tissues of the eye. Such types of pathologies are less common than forms of the disease associated with an allergy or the primary focus of tuberculosis in other organs. In these cases, ophthalmic signs can sometimes be ignored due to the pronounced underlying symptoms. But this may 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 its adnexa
Some diseases, due to the lack of specific signs, are difficult to recognize at an early stage. One of such ailments is eye tuberculosis, the symptoms of which are similar to many ophthalmic diseases. They may differ depending on the location of the infection.
During the initial infection with tuberculosis and its development in the patient’s organs of vision , the symptoms initially characteristic of ordinary conjunctivitis are noted: vascular redness, swelling of the eyelids, lacrimation. But along with this, lymphatic seals form inside the eye, which increase in size and with time without treatment can lead to an abscess.
Tuberculosis of the adnexa (for example, eyelids or lacrimal canals) is rare. At the same time, inflamed tubercles appear on the skin and mucous membrane, the tissues of which necrotic and suppurate over time. This can lead to an eversion of the upper and lower eyelids, and also cause 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 have no incubation period. Both eyes are usually involved in the pathological process, although manifestations can be more pronounced on one side. The duration of the acute period is from several days to 2 months. For this form of the disease, the following signs of eye tuberculosis are characteristic:
- lacrimation
- mucosal inflammation;
- 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, as a rule, are only an addition to the general neurological symptoms. In such patients, the posterior part of the choroid is most often affected, where there are foci of inflammation (granulomas) with lymphoid tissue. Clinically, this is manifested by a decrease in visual acuity and blurred eyes. The disease can develop acutely or progress gradually.
How to identify the disease?
Diagnosis of eye 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 complicates the diagnosis. If there are complaints indicating possible tuberculosis, it is advisable for the patient to undergo a number of such examinations as prescribed by the doctor:
- determination of visual acuity and fields of vision;
- measurement of intraocular pressure;
- fundus examination;
- Ultrasound eyes ;
- retinal angiography;
- sample with tuberculin;
- diagnostic treatment with anti-TB drugs.
In addition, the patient must do a chest x-ray and mediastinal tomography, because it is in it that with allergic eye tuberculosis often find inflamed foci. To understand the general condition of the body, the patient may also be prescribed clinical blood and urine tests.
Infection pathways
Eye tuberculosis 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 healthy person are as follows:
- airborne droplets (during a conversation, coughing or a long stay in the same room with the patient);
- contact-household method (when using infected household items);
- fecal-oral mechanism (when bacteria enter with food or water).
Mycobacteria can retain pathogenic activity in dark, dusty rooms for years, so if you breathe such air in a person with a weakened immune system, there is a high risk of infection. Sometimes the disease is transmitted through the blood when damage to the integrity of the skin or in a vertical way (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 the child’s immunity does not function as actively as an adult, any serious illness is a serious danger to him. Eye tuberculosis in children is most often allergic 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, tuberculosis treatment should always include inpatient treatment until complete recovery. At the same time, the ability to regenerate in affected tissues in childhood is higher, therefore, a child always has a chance of a successful cure without subsequent relapses and complications.
Surgery
Effective therapy should include general antibacterial chemicals, even if it is an extrapulmonary form of the disease that affects one organ. So, for example, eye tuberculosis, whose symptoms are most often concentrated in this area, should still be treated with the help of a comprehensive scheme.
With the appearance of surgical pathologies, in some cases, emergency surgical intervention 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 completion of the course of therapeutic treatment.
Tuberculosis of the eye: treatment without surgery
Comprehensive 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-TB drugs according to the severity of action can be divided into 3 classes:
- potent drugs ("Isoniazid", "Rifampicin");
- medications of medium strength (Kanamycin, Streptomycin, Protionamide);
- medicines with a moderate therapeutic effect ("Paraaminosalicylic acid", "Thioacetasone").
The regimen of their intake and dosage should be selected by a TB specialist, taking into account the peculiarities of the pathological process in each individual case. With severe hemorrhages in the retina, before using these drugs, it is necessary to carry out therapy that normalizes the state of the blood vessels of the eye. Before stabilization of the patient's condition, 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 be administered to children after birth in order to form active immunity.
For non-specific prevention of tuberculosis, it is important to observe the following rules:
- lead a healthy lifestyle;
- eat rationally;
- regularly carry out wet cleaning in the apartment and thoroughly wipe the dust;
- spend enough time in the fresh air;
- to do gymnastics or any simple sport to improve the body;
- have a good rest and get enough sleep;
- undergo fluorography once a year (starting from the age of 15).
For any strange symptoms, you must immediately consult a doctor, because in the case of tuberculosis, this can help maintain good health, normal vision and a full life.