As you know, there are many diseases of the organ of vision. Eye pathologies are occupied by an ophthalmologist. According to most people, inflammation of the organs of vision is associated with the penetration of infection. However, this is not always the case. Some eye diseases are endogenous. An example is filamentous keratitis. This pathology develops due to drying of the cornea. Most often, the disease has a chronic course and requires constant eye care.
Keratitis - what is it?
The organ of vision has a complex anatomical structure. The cornea of the eye is a convex membrane, which is one of the refractive media. In addition to the fact that this structure of the organ of vision conducts light rays, it has a protective function. The cornea of the eye is a kind of lens, thanks to which a person can see surrounding objects as needed. In addition, it protects the internal structures of the organ of vision from infection. Corneal inflammation is called keratitis. There are several varieties of this ailment. The classification of keratitis is based on the etiological factor.
One type of pathology is dry inflammation of the cornea. In another way, it is called filamentous keratitis. The essence of the disease is that the cornea is not sufficiently moistened by the lacrimal fluid, leading to dry eye syndrome. The manifestations of this form of keratitis include pain and pain, a feeling of a foreign body and photophobia. With the progression of the disease leads to visual impairment. Treatment of pathology consists in constant moisturizing of the cornea.
Classification and pathogenesis of dry keratitis
Depending on the etiological factors, dry inflammation of the cornea is divided into 2 types. Primary keratitis develops due to endogenous causes. Among them are immune and endocrine disorders. Secondary dry keratitis occurs as a result of damage to the organ of vision. An example is chemical burns and eye injuries.
The notion that tears are released only when a person is crying is not true. In fact, the eyes are constantly moisturized. Lacrimal fluid is produced by special glands and consists of 3 layers. Outside - it is represented by lipids, which help reduce the friction of the cornea on the conjunctiva. The next layer of tear fluid incorporates organic compounds and electrolytes that saturate the eye structures with oxygen and have antimicrobial activity. The last component is mucin. It has a protein nature and protects the cornea from the penetration of foreign bodies.
Hormonal changes and depletion of the body's defenses lead to a change in the composition of the tear fluid. As a result, the protective film becomes unstable and is often damaged. The mechanism of development of secondary keratitis is to reduce or stop the production of tear fluid. This is facilitated by damage to the corneal epithelium by physical or chemical influences. Also, similar causes may interfere with the transport of tear fluid into the conjunctival cavity.
Causes of keratitis
The causes of filamentous keratitis are divided into 2 large groups. The first is endogenous factors that prevent the formation of tears or alter its composition. These include:
- Autoimmune pathologies.
- Liver disease.
- Severe immunodeficiency.
- Endocrine Disorders
- Age-related atrophy of the lacrimal glands.
The following group of causes causes secondary dry keratitis. It is represented by exogenous factors. Among them are bacterial and viral infections of the eyes, surgical interventions (extirpation of the lacrimal glands, laser effects), hormonal drugs, burns and the penetration of foreign bodies.
Among the endogenous causes of keratitis, Sjögren’s disease is given the greatest importance. This disease refers to autoimmune pathologies and is accompanied by damage to the exocrine glands. In addition to keratitis, the disease leads to impaired saliva production and systemic inflammation syndrome. Among liver pathologies, chronic hepatitis and biliary cirrhosis are distinguished. In addition, keratitis is often diagnosed in women during menopause or postmenopause. This is due to hormonal changes in the body.
In addition to these exogenous factors, filamentous keratitis leads to frequent being in a room with a fan or air conditioning, sitting at a computer, improper care of contact lenses and the use of low-quality cosmetic products.
The clinical picture of corneal disease
The clinical picture of this disease is dominated by: dry eye syndrome and inflammation of the cornea. How is filamentous keratitis manifested? Symptoms of the disease are as follows:
- Pain in the eyes, aggravated by concentration of the gaze.
- Itching and foreign body sensation. Most patients complain of sand or dust in their eyes.
- Unpleasant sensations in bright light.
- Inflammatory reaction - redness of the eyes and injection of blood vessels.
- Quick fatigue of the organs of vision when watching a movie or working at a computer.
- A small discharge of tears during crying, and subsequently their absence.
In the initial stage of keratitis, redness of the conjunctiva and cornea occurs and a mucous exudate appears that resembles a thread. With the progression of the disease, small gray foci of blurred eyes are noted. Then, areas of hyperkeratosis appear on the cornea. Subsequent keratinization of the epithelium occurs, leading to visual impairment.
Methods for the diagnosis of keratitis
In order to confirm the presence of dry keratitis, not only an ophthalmological examination is required, but also the consultation of specialists such as an endocrinologist and a rheumatologist. An optometrist conducts sampling and microscopy of the mucous secretion. In this case, desquamation and hyperkeratosis of the epithelium is detected. An instillation test using fluorescein is also performed. Contrast helps to improve the quality of microscopy. To assess the work of the lacrimal gland, tests of Norn and Schirmer are performed.
In Sjögren’s disease, in addition to corneal lesions, symptoms such as dry mouth and nasal cavity, sweating disorders are detected. In addition, with autoimmune pathologies, arthralgia, muscle spasm and a change in the skin are noted.
Filamentous keratitis: treatment of the disease
Treatment of the disease should be aimed at eliminating the etiological factor. This will help eliminate hormonal and autoimmune filamentous keratitis. Preparations in such cases are prescribed by a rheumatologist or endocrinologist. With Sjogren's syndrome and other autoimmune processes, hormone therapy is required. Apply drugs "Hydrocortisone" and "Methylprednisolone."
Symptomatic treatment is aimed at preventing the progression of the disease. For this purpose, moisturizing drops and ointments for the eyes are prescribed. In addition, medications with disinfecting properties are required to prevent corneal infections. If the disease progresses, surgical treatment is performed. It consists in the plasticity of the lacrimal canals. For this, collagen or conjunctival tissue is used.
The drug "Artificial Tear" - eye drops
To avoid dryness of the cornea, it is necessary to replace the natural tear fluid with its analogues. This can be achieved with moisturizing drops, which should be used constantly. The main medicine from this group is the drug “Artificial Tear”. Eye drops, which are its analogues, are medicines “Optiv”, “Vizin”, “Lacrisin”. These drugs contribute to the regeneration of the corneal epithelium, and replace the natural tear film.
Methods for the prevention of dry keratitis
Often, dry keratitis is rarely completely cured. This is due both to the autoimmune nature of the disease and to eye injuries leading to sclerosis of the epithelium. To achieve long-term stabilization of the disease, constant monitoring by an ophthalmologist is required. It is possible to avoid exacerbations if the doctor's recommendations are followed. These include: proper nutrition, the use of moisturizing contact lenses and the use of drops. Also, eye infections, dust particles and foreign bodies should be avoided.