The most difficult situations in ophthalmology (some tin)

In general, remove from the screens of pregnant women, children and nervous companions who cannot watch a movie, as the main character cuts his hand with paper. If you eat - stop for a second. This is a post about what happens if the patient is not brought to the hospital in time.

Fortunately, for us, as well as for surgeons, we usually have time on time, because the nature of the lesion and the symptoms are fairly straightforward. Usually, but not always. A number of cases can be prevented by knowing the features of the development of symptoms, and this is useful, and a number - just to scare you a little.

Let's start with the eyelashes growing inside the eye.

Blepharitis

One of the most frequent cases of transition to the terminal stage of the disease is to start with a light blepharitis (which is treated with a two-week eye wash), but then do not go to the doctor, but simply do nothing. So there is a chance to catch the middle stage with pus and special effects. She has been treated for up to two months and the matter is not limited to washes. From the middle stage is a straight road to hard. Severe blepharitis is a lifelong treatment, lifelong tear-replacing therapy and lifelong hydration of the eye.

There is such a Mongol curse: "Let your hair grow inside the head." In general, on heavy blepharitis, it happens, but with eyelashes. The shape of the eyelid changes, and the direction of eyelash growth changes. It has changed - everything, hello eternal irritation of the cornea. It comes to cloudiness and, in severe cases, perforations, if you do not remove eyelashes. Well, that is, until the eye loses its function, if trauma is in the optical or paraoptic zone, and at least partial blindness. Need hair removal, bulb cryodestruction or other methods. Otherwise, cornea transplantation is not far off, but it costs from a million in Europe, or you will need a long queue for corpse material in Russia. In light cases, you can try to correct the glasses, which is also not always easy and possible.

What is worse, when the eyelid is deformed (this happens in the middle stages of inflammation of the eyelids), it ceases to close its eyes tightly. The consequence - the eye begins to dry more than usual. If a person is accustomed to tear replacement, then you have to drip more and more, which, in turn, leads to the loss of your own tear generation (the body gets used that the tear comes exogenously), but it will end more or less well. “More or less well” in this situation is the continuous use of moisturizing gels prior to blepharoplasty surgery and a long recovery process.



This thing on the upper eyelid has a special name - chalazion . Barley may look the same at the beginning, but chalazion is chronic. The photograph is not the worst stage. Severe and terminal - this is when all this is inflamed and turns into a major abscess. Big is about the eyelid. He sooner or later breaks through pus himself. If out - very lucky. But it can break through into the tissue of the eyelid, and then the next associated disease begins - phlegmon of the eyelid and orbit. It is specifically dangerous. Venous sinuses in the eye are connected with the facial and internal jugular veins, and the cavity of the orbit - with the middle cranial fossa. That is, the complications can be the most unpleasant: from venous thrombosis and panophthalmitis to sepsis and purulent meningitis. And this is already lethal.

In children under 5 years of age, this happens more often than in adults, but it appears bright enough that the parents immediately take the child to the clinic. Then the surgeon cleans everything. Eye on timely treatment can save, and he will even see.

Cornea

Most often, viral and bacterial inflammation leads to loss of function. Herpetic keratitis is most unpleasant - it is diagnosed on 1-2 treatment, because it has a rather characteristic appearance and is rarely isolated. It is often preceded by small herpetic eruptions on the wing of the nose or the edge of the lips. He does not kill in principle. He is not completely cured, goes to sleep in the nervous ganglia. A cold - recurs. When persistent flow causes persistent clouding, deformity of the cornea and reduced vision. In advanced cases can cause uveitis, like this:



This is affected by the inner shell, then - loss of vision. Such panuveit is dangerous not only by a pronounced and often irreversible decrease in vision, but also by the fact that the immune system recognizes the eye as a source of deadly threat, and begins to fight it. At the same time, it is striking the second one, on the principle of sympathetic ophthalmia, in order to prevent this from happening again. Suppression of the second eye will be accompanied by such an inflammatory process that the vision will most likely not remain at all.

Conjunctivitis can be the most unpleasant, and those who often wear contact lenses are especially affected. Do not get tired of repeating: read the damn instructions. There, every word is written pus. Even a simple bacterial conjunctivitis under the lens can go pretty quickly into severe keratitis and bloom so that it leads to an ulcer and perforation of the cornea. Chlamydia conjunctivitis is another story. Wash your hands after using the toilet. This rarely happens in a modern city, but you have to wash your hands. All this is characterized by pronounced expression, the eye is very red, everything is similar to allergic conjunctivitis, but there is immediately pronounced swelling, blepharospasm and fibrinous films.

Particularly affected are small children and newborns, because there was eye contact with the birth canal. If the mother is not very healthy, then all venereal diseases in the eyes of the child are the hell of an ophthalmologist. In severe cases, chlamydial conjunctivitis can lead to scarring of the cornea and stenosis of the nasolacrimal ducts. But thanks to extensive clinical practice, it is very well studied. I can talk about these cases for quite some time and with fervor, but they will not be useful to you.

Occasionally, patients with acanthamic keratitis come. The amoeba lives in water and clings to the eye very well. She usually doesn’t pass through the faucet, in places with fast running water also almost does not live, therefore such keratitis is associated with bathing in a pond in a country house, a creek or a pool without disinfection. Amoeba doesn’t care about most local antibiotics, and it digs very quickly - in a day or two it can lead to perforation of the cornea or the formation of a persistent ulcer. Such keratitis is an indication for hospitalization.

A lot of adenovirus infection and it begins, as usual, with redness. There is a lot of interferon advertising on TV, and my patients at the site often do it themselves quickly. However, it is difficult to independently distinguish viruses from bacteria, and many do not know that it is impossible to use antibiotics without thinking. The consequence - antibiotic drips. And adenovirus is transmitted by airborne droplets. That is, in two days the whole family will get sick, then the office, then we will again uncouple the half-clinic of the clinic and wash it with bleach. It is resistant in the external environment. The bad thing is that it is stable and very contagious.

Do not be treated without a doctor! There was a case when a patient was smeared with gels on his own for a long time. He was from a different city, and when he came to us, he had the whole cornea struck, very thin, he almost did not see. There was a threat of perforation. A few days later, the cornea didn’t sustain the pressure and burst. Perforation is when fluid flows out of the eye. And that's all. We sewed a biocover for a while.

Traumatology

When a patient jumps on a dispute into the snowdrift from the second floor and eye on the armature, it is usually brought immediately. And often in advance pain-free alcohol (do not need to, it will complicate the use of antibiotics). That is, an injury usually leads to circulation at least to the nearest emergency room.

But what the patients do not know is that it is impossible to wait for the mote in the eye to pass. The mote sensation occurs during the initial stages of conjunctivitis and keratitis, but there is, in fact, no mote in the eye. This is - see item above.

Worse, it happens, it got dross, for example, a spark from under a tram or electric train, or in a working situation. If you walk with this for a long time, then dross causes a pronounced swelling and clouding of the corneal stroma. And the stroma regenerates hard, and there may remain turbidity, well, if small, but even after 40-50 years you can see it. There will be swelling and inflammation around the dross. This can lead to inflammation of the other membranes of the eye. There are still good viruses and bacteria on top. Therefore, it is better to be frightened and run at least in injury, than to walk for a couple of days, and then come when nothing is visible. Previously turned - better forecast. With early treatment, the prognosis is favorable, with late - partial loss of function.

Selected cases

Neuritis of the trigeminal nerve - hellish pain throughout the face or half, sometimes just around the eye. It happens that you tear your teeth, and the pain comes around in the eye - in principle, this is normal, but it is better to appear to a neurologist (or an oculist, we will check our part and take it to a neuropathologist).

On my site the most frequent cases of loss of function - with systemic pathologies. If the grandmother came with the fact that the eyes are constantly itching and itching, then you need to watch it all. We not only check it for demodicosis or other blepharitis, but also send it to an endocrinologist to check sugar, because dryness and itching of the eyelids may be a consequence of its increase. In diabetes, the vessels become brittle, fragile, and grow in the wrong place, and can often grow from the eyes that feed them to the macular area, where they should not be in principle. Neovascularization (retinal or anterior chamber angle) leads to secondary blindness.

Important! If there is a sharp decrease in vision, large floating flakes (dark maroon and brown) - do not wait for the opening of the clinic, you need to get to the nearest injury and immediately get absorbable therapy (anticoagulants, etc.) to remove the blood.

Hemophthalmus, if large (blood in the eye), then we try to hospitalize in the hospital. In the most difficult cases - quick operations to evacuate the blood. The same can happen with hypertension. Vessels burst - it is unpleasant and dangerous, although more often it happens, fortunately, that the eye just turns red.

In case of disorders of the thyroid gland, inflammation of the eye muscles may occur, the causes of which are still being discussed, an autoimmune factor is not excluded. They increase 2-3 times and squeeze the eye out. The process is long, but the patient’s photo now and a year ago is well marked. The patient himself notices usually. Sometimes it is one way. This is a reason to go to the endocrinologist to check the thyroid gland. The consequence is squeezing of blood vessels and nerves, the ability to close the eyes loosely. And if the eyes dry, see figure 1. The treatment here is not ours, the maximum can be a little help. Until the hormonal status is compensated, everything is useless.

Neurological diseases stand apart. These are autoimmune diseases such as multiple sclerosis (now referred to as autoimmune, yes) and neuritis. It may be neuritis in the background of infectious diseases, such as Lyme disease or Epstein-Barre. They damage the optic fibers and nerves, and, if misdiagnosed, vision may decrease dramatically and irreversibly. If the patient is doing well in the eye itself, he should definitely do a visual field test and take him to a neurologist. It is very important to accurately and correctly collect anamnesis, therefore the ophthalmologist, in the absence of visible reasons, has a long conversation with the patient. For example, Lyme disease is a tick. If the patient admitted that he removed the tick a few months ago (8-10 ago), then we will not find the tick itself, but we can check for antibodies to borrelia. It happens that the patient is prescribed PCR, but this analysis does not always work, because the agent itself is hidden in the tissues.

But antibodies continue to persist for a very long time. In the same picture there are associated headaches and joint pains. Patients complain of recurrent pain, for example, in the knees and weakness, as with a cold or flu. Epstein-Barr is often found together with multiple sclerosis. The immune system beats nerve cells, most often - the brain and spinal cord. And then - a decrease in vision, loss of fields, a change in color sensation (my patient did not distinguish pink and orange from the side of a lesion with one eye). We can only diagnose, further treats a neurologist - there are heavy hormones and various immunomodulators. Some drugs may cost about 40 thousand rubles a month or just not be sold at all, but you can collect a lot of pieces of paper for a preferential receipt. There is no way to protect yourself - there is no one hundred percent connection with autoimmune processes, and the disease can be against the background of complete health.

Neurology is even more important tumors - they can squeeze the nerves. Here is the whole end of the post about nervous control and injuries.

There are a number of heavy drugs, with side effects like medicinal keratitis: the cornea dries, inflames, and terrible discomfort appears. Daylight seems to the patient too bright, eyes do not open once again. Here it is necessary to maintain moisture and ointments, and drops. Typically, these drugs are prescribed in very severe cases, so they do not cancel. Until the drug is withdrawn, the eye will suffer. May suffer after application with a delay of weeks.

In the “Graft versus host” reaction (for example, during bone marrow transplantation), the skin, mucous membranes and the endothelium of the intestine are affected first, and corneal lesions can be connected. It is expressed as keratitis. The person will squint and squint, we will see how the skin flakes, falls apart. As a rule, it is clear from the main diagnosis what is happening. If you ask around, the patient will also complain of diarrhea or other enteritis phenomena. In this situation, symptomatic treatment: until hematologists do not understand - we prescribe the same lubricants for the eyes, be sure to Blefarogel 1 for the eyelids and different anti-inflammatory topical. Dosages and duration look together with the hematologist.

In my practice there was one case of eye removal, but there was invasion of tumor cells. At the time of treatment, it was necessary to remove it in order to preserve the rest of the body. Previously, when oncology appeared inside the eye, it was immediately removed. Now not in all cases are removed, there are options for maintaining the eye for small tumors. In children, it is important to monitor this. Reduction of vision and a change in the color of the pupil (usually by the light of a light bulb it is red, and turned yellowish) - immediately run to the hospital. This may be a congenital cataract in the smallest, but there is also an incorrect growth of cells. Either this is a change on the retina. You can treat in time and save the eye. And life. Not the fact that the eye will be good after that to see, but it will remain.

There are pigment type of moles in the eye. At first, they try to examine the whole person, because the system history is important. If this is a mole, then it should just be regularly looked at by one doctor, or take pictures of it on a special device - if it does not change, then let it be. Began to change - it is necessary to be examined again systemically.

For the elderly are characterized by their own diseases - a constant sore, crust on the eyelid. Here you need to understand the system history. If the place does not heal, then there is either a malignant process or an infection with an incomprehensible genesis, most likely from the end of the directory. And at the end of the handbook, who know, there is usually such that it is better not to go there. Areas of hyperkeratosis are removed to avoid complications. It happens, fibrous nodule, then okay. And if there are other cells and fibers, which should not be - a reason to think. One child was rescued solely because his parents noticed a strange tissue in his time under the conjunctiva on the eyelid that looked like a muscle. Muscle and it turned out, however, quite unkind.

In general, almost everything is treated. If the time to turn. On weekends, it is worth running into an injury or the nearest commercial clinic, on the road - do not be shy in handling insurance claims.

In the end, it is good that you do not have a cryptophthalmus - this is when the uterus is formed in utero incorrectly and is a solid skin flap, and the eyeball is usually underdeveloped. Presumably, this is a mutation caused by a gene translation error. I can tell about other rare cases of mutations, for example, about a double pupil. If you have not run away.