Ophthalmoroscea, whose manifestations can be seen below, is one of the subtypes of the common chronic dermatological disease - rosacea, expressed in persistent reddening of the skin and the formation of rashes on the face. Most often, this disease affects women from 35 to 50 years.
More than half of all patients with rosacea develop eye manifestations, however, serious lesions of the cornea, sclera and eyelids occur only in a small number of patients.
Doctors-oculists often do not observe skin manifestations of this disease, despite the fact that it is characterized by extremely pleomorphic criteria, consisting of a combination of signs that appear on the face: skin hyperemia, the appearance of telangiectasias and nodules or vesicles.
Rosacea eye can outrun the appearance of skin manifestations for several years, and can also proceed in isolation, without skin lesions.
The exact causes of the development of this disease are still unknown. It is believed that its appearance is affected by a combination of many factors: for example, genetic predisposition, endocrine disorders, lack of vitamins. In many cases, the disease is accompanied by pathology of the gastrointestinal tract.
Symptoms of rosacea of the eye
One of the key mechanisms of ocular manifestations in rosacea is a violation of the function of meibomian glands, leading to a disruption in the stability of the tear film and, as a consequence, excessive evaporation of the tear fluid. As a result, there is a so-called "dry eye" syndrome.
The severity of damage to the organ of vision is not related to the severity of skin lesions. The eye symptoms of rosacea, as a rule, have a slight degree of severity and usually consist in the development of two interrelated processes: inflammation of the eyelids( blepharitis) and the connective shell of the eyes( chronic conjunctivitis).
The edges of the eyelids thicken and become uneven and hyperemic. From the apertures of the channels of the meibomian glands, when pressing a finger on the edge of the eyelid, an opaque material, sometimes granular or porridge-like, is allocated. Outlets of these glands can be clogged with yellowish stoppers.
The eye symptoms of rosacea, the photos of which can be seen below, appear quite nonspecifically.
These may include a burning sensation and a foreign body, may be in the form of irritation and itching or act as a fluctuation in visual acuity. The mucous membrane of the eyelids can be diffusely hyperemic, but it is also possible that there is no hyperemia. Most patients also complain of a feeling of dryness in the eyes.
Complications of ophthalmorosceum
Complications of ophthalmosorsea include conjunctival fibrosis, which can lead to progressive shortening of the arches, as well as to the development of a fusion of the connective membrane of the eyelids and eyes, or the formation of an abnormal growth of the eyelashes towards the eyeball, and as a result, irritation and injury to the cornea.
Possible development of inflammation of the cornea( including ulcers), inflammation of the sclera or episclera.
A rare, but, nevertheless, possible complication is phlyctenular keratoconjunctivitis.
In isolated cases with advanced treatment, blindness develops.
Treatment of ophthalmic haze: hygiene and massage
First of all, it is necessary to inform the patient that due to the chronic course, treatment of ophthalmic solution will undoubtedly be prolonged. Treatment of ophthalmic manifestations should be combined with parallel specific treatment of rosacea.
It should also be noted that, despite the availability of effective therapies, improper treatment can lead to the development of complications that threaten vision.
One of the main moments in the treatment of this disease is the daily hygiene of the eyelids. A very good effect is given by warm compresses, which are done once a day for 10 minutes. This leads to the heating of the fat secretion and the opening of the excretory ducts of the meibomian glands. It should be remembered that more frequent compresses can intensify the irritation of the eyelids.
Usually for a compress use a cotton swab or gauze soaked in warm water, which is put on the closed eyelid. As they cool down, they are again moistened in water.
The massage of eyelids is also applied. To do this, a little shampoo( better children's) or some bactericidal soap is applied to the index fingers of the washed and warmed-up hands in warm water and rubbed until the foam forms. After that, the fingers are placed on the closed eyelids and energetic massaging horizontal and vertical movements are performed( approximately 10 times).Then, with the moistened tampon moistened with warm water, the crusts and accumulated detachment are removed from the eyelids.
Medical treatment of rosacea of the eye
Medical treatment of rosacea of the eye, in particular antibiotics, is used only in the progressive course of the disease, when there is a threat to vision. In this case, tetracycline and its derivatives( eg, doxycycline or oxytetracycline) are most often used. It is believed that they are most effective in rosacea, including in its ocular form.
This effectiveness is due not only to the anti-inflammatory effect, but also to the ability of these drugs to positively influence the function of meibomia gland and help stabilize tear film. This is due to the fact that these drugs suppress the formation of bacterial lipases - special enzymes that reduce the production of free fatty acids and as a result lead to destabilization of the tear film and the development of inflammation.
The use of corticosteroid drops is indicated for a very short time in case of severe exacerbation of inflammation. Alternative to steroid drugs in the treatment of rosacea in children may well be cyclosporine and azithromycin.
In order to reduce discomfort, the feeling of dryness and burning is well suited preparations of artificial tears.
Vitamin A derivatives are considered quite effective in eliminating lesions of inflammatory nature in rosacea. But it must be remembered that they can lead to severe erythema and blepharoconjunctivitis, and also can increase telangiectasias and promote the development of severe keratitis. Therefore, their use is possible only in cases where other methods have not produced a result.
It is worth saying a few words about the surgical treatment of ophthalmosomes. In particular, for the elimination of dry eye syndrome, the so-called occlusion of tear points is performed, i.e.they are simply clogged with silicone plugs, thereby creating an obstacle to the outflow of tears along natural paths.
In severe cases of rosacea of the eye, when non-healing corneal defects develop, a good effect results from the use of the amniotic membrane that covers the cornea. This membrane is characterized by anti-inflammatory action and promotes the restoration of the cornea.
In the case of end-to-end corneal integrity disorders, such as layered or through keratoplasty are used as surgical methods of treatment, it is also possible to use cyanoacrylate adhesive.