Human eye disease keratitis. Eye keratitis: how to treat inflammation of the cornea. Treatment of keratitis of different types

- a group of inflammatory lesions of the cornea - the anterior transparent membrane of the eye, having a different etiology, causing clouding of the cornea and decreased vision. For keratitis, the so-called corneal syndrome is typical, characterized by lacrimation, photophobia, blepharospasm; feeling foreign body eyes, cutting pains, changes in the sensitivity of the cornea, decreased vision. Diagnosis of keratitis includes biomicroscopy of the eye, fluorescein test, cytological and bacteriological research smear from the conjunctiva and cornea, immunological, allergological tests. When keratitis is detected, etiotropic (antiviral, antibacterial, antiallergic, etc.) treatment is carried out. With ulceration of the cornea, microsurgical intervention (keratoplasty) is indicated.

next large group keratitis are purulent lesions corneas caused by bacterial non-specific flora (pneumococcus, streptococcus, staphylococcus, diplococcus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Proteus) and specific pathogens of tuberculosis, salmonellosis, syphilis, malaria, brucellosis, chlamydia, gonorrhea, diphtheria, etc.

A severe form of keratitis is caused by an amoebic infection, the bacterium Acanthamoeba; amoebic keratitis often occurs in people who wear contact lenses, and in long term may end in blindness. The causative agents of mycotic keratitis (keratomycosis) are fungi Fusarium, Aspergillus, Candida.

Keratitis can be a manifestation of a local allergic reaction with hay fever, the use of certain drugs, helminthic invasion, hypersensitivity to food or plant pollen. An immune-inflammatory lesion of the cornea can be observed in rheumatoid arthritis, periarthritis nodosa, Sjögren's syndrome and other diseases. With intense eye contact ultraviolet radiation photokeratitis may develop.

In most cases, the occurrence of keratitis is preceded by mechanical, chemical, thermal injury to the cornea, including intraoperative damage to the cornea during eye operations. Sometimes keratitis develops as a complication of lagophthalmos, inflammatory diseases eyelids (blepharitis), mucous membranes of the eyes (conjunctivitis), lacrimal sac (dacryocystitis) and lacrimal ducts(canaliculitis), sebaceous glands century (meibomite). One of the common causes of keratitis is non-compliance with the rules for storage, disinfection and use of contact lenses.

Among endogenous factors that favor the development of keratitis, emit exhaustion, lack of vitamins (A, B1, B2, C, etc.), a decrease in general and local immune reactivity, metabolic disorders (diabetes mellitus, gout in anamnesis).

Pathological changes in keratitis are characterized by edema and infiltration of the corneal tissue. Infiltrates formed by polynuclear leukocytes, histiocytes, lymphoid and plasma cells have a different size, shape, color, fuzzy boundaries. At the stage of resolution of keratitis, neovascularization of the cornea occurs - germination of newly formed vessels from the conjunctiva, the marginal looped network, or both sources into the shell. On the one hand, vascularization improves corneal tissue trophism and accelerates recovery processes, on the other hand, newly formed vessels become empty and reduce the transparency of the cornea.

At severe course keratitis develop necrosis, microabscesses, ulceration of the cornea. Ulcerative defects in the cornea are further scarred, forming a thorn (leukoma).

Classification of keratitis

Keratitis is classified depending on the etiology, the course of the inflammatory process, the depth of the cornea lesion, the location inflammatory infiltrate and other signs.

Depending on the depth of the lesion, superficial and deep keratitis are distinguished. With superficial keratitis, up to 1/3 of the thickness of the cornea (epithelium, upper stromal layer) is involved in inflammation; with deep keratitis - the entire stroma.

According to the localization of the infiltrate, keratitis is central (with the location of the infiltrate in the pupil zone), paracentral (with the infiltrate in the projection of the iris belt), and peripheral (with the infiltrate in the limbus zone, in the projection of the ciliary belt of the iris). The more central the infiltrate is located, the more visual acuity suffers during the course of keratitis and in its outcome.

According to the etiological criterion, keratitis is divided into exogenous and endogenous. Exogenous forms include corneal erosion, keratitis of traumatic, bacterial, viral, fungal origin, as well as keratitis caused by damage to the eyelids, conjunctiva and meibomian glands (meibomian keratitis). Endogenous keratitis includes infectious lesions of the cornea of ​​tuberculosis, syphilitic, malaria, brucellosis etiology; allergic, neurogenic, hypo- and avitaminous keratitis. Endogenous keratitis unclear etiology include filamentous keratitis, corneal ulcer, rosacea keratitis.

Symptoms of keratitis

A common manifestation characteristic of all forms of the disease is the corneal syndrome that develops with keratitis. In this case, there are sharp pains in the eye, intolerance to bright daylight or artificial light, lacrimation, involuntary closing of the eyelids (reflex blepharospasm), blurred vision, sensation of a foreign body under the eyelid, pericorneal injection of the eyeball.

Corneal syndrome in keratitis is associated with irritation of sensitive nerve endings cornea by the resulting infiltrate. In addition, due to infiltration, the transparency and luster of the cornea decreases, its cloudiness develops, sphericity and sensitivity are disturbed. In neurogenic keratitis, the sensitivity of the cornea and the severity of the corneal syndrome, on the contrary, are reduced.

With the accumulation of lymphoid cells, the infiltrate acquires a grayish tint; with a predominance of leukocytes, its color becomes yellow (purulent infiltrate). With superficial keratitis, the infiltrate can resolve almost without a trace. In the case of a deeper lesion at the site of the infiltrate, corneal opacities of varying intensity are formed, which can varying degrees reduce visual acuity.

An unfavorable variant of the development of keratitis is associated with the formation of corneal ulcers. In the future, when the epithelium is peeled off and desquamated, a superficial erosion of the cornea is first formed. The progression of epithelial rejection and tissue necrosis leads to the formation of a corneal ulcer, which looks like a defect with a cloudy gray bottom covered with exudate. The outcome of keratitis with a corneal ulcer can be a regression of inflammation, cleansing and epithelialization of the ulcer, scarring of the stroma, leading to clouding of the cornea - the formation of a thorn. AT severe cases a deep ulcerative defect can penetrate into the anterior chamber of the eye, causing the formation of a descemetocele - a hernia of the Descemet's membrane, perforation of the ulcer, the formation of anterior synechia, the development of endophthalmitis, secondary glaucoma, complicated cataracts, optic neuritis.

Keratitis often occurs with simultaneous inflammation of the conjunctiva (keratoconjunctivitis), sclera (keratoscleritis), choroid (keratouveitis). Often, iritis and iridocyclitis also develop. Involvement in purulent inflammation of all the membranes of the eye leads to the death of the organ of vision.

Diagnosis of keratitis

In the diagnosis of keratitis, its connection with past general diseases, viral and bacterial infections, inflammation of other structures of the eye, microtrauma of the eye, etc. is important. During an external examination of the eye, the ophthalmologist focuses on the severity of the corneal syndrome and local changes.

The leading method for the objective diagnosis of keratitis is eye biomicroscopy, during which the nature and size of the cornea lesion is assessed. Corneal thickness is measured using ultrasonic or optical pachymetry. In order to assess the depth of corneal damage in keratitis, endothelial and confocal microscopy of the cornea is performed. The study of the curvature of the corneal surface is carried out by performing computer keratometry; refraction study - using keratotopography. To determine the corneal reflex, a corneal sensitivity test or esthesiometry is used.

In order to detect erosions and ulcers of the cornea, a fluorescein instillation test is indicated. When applied to the cornea with a 1% solution of sodium fluorescein, the eroded surface turns greenish.

An important role to determine medical tactics with keratitis, bacteriological seeding of the material from the bottom and edges of the ulcer plays; cytological examination of the scraping of the epithelium of the conjunctiva and cornea; PCR, PIF, ELISA diagnostics. If necessary, allergological, tuberculin tests, etc. are carried out.

Treatment of keratitis

Treatment of keratitis should be carried out under the supervision of an ophthalmologist in specialized hospital within 2-4 weeks. General principles pharmacotherapy of keratitis includes local and systemic etiotropic therapy with the use of antibacterial, antiviral, antifungal and other drugs.

Forecast and prevention of keratitis

The outcome and consequences of keratitis largely depend on the etiology of the lesion, the nature and location of the infiltrate, and associated complications. Timely and rational therapy of keratitis leads to the complete resorption of corneal infiltrates or the formation of light cloud-like opacities. With deep keratitis, especially complicated by a corneal ulcer, as well as with a paracentral and central location of the infiltrate, corneal opacities develop varying degrees expressiveness.

The outcome of keratitis can be a walleye, secondary glaucoma, optic nerve atrophy, atrophy of the eyeball and complete loss of vision. Especially life-threatening are septic complications in the form of thrombosis of the cavernous sinus, phlegmon of the orbit, sepsis.

Prevention of keratitis includes the prevention of eye injuries, timely detection and treatment of conjunctivitis, blepharitis, dacryocystitis, somatic diseases, common infections, allergies, etc.

The concept of "keratitis" combines a group of pathologies of the cornea of ​​​​an inflammatory nature. Keratitis may have different nature, but all of them can lead to a decrease in visual acuity due to corneal clouding.

Symptoms of keratitis

The clinical picture with keratitis includes symptoms such as high photosensitivity of the eyes, lacrimation, blepharospasm, and pain.

Diagnostics

Diagnosis is aimed at identifying the degree of decrease in visual function, the cause and causative agent of the disease, for which biomicroscopy, bacteriological and cytological examination of discharge from the eyes, various tests are performed.

Therapy of keratitis is reduced to the elimination of provoking factors, strengthening the cornea of ​​​​the eye. In some cases it is shown surgery(for example, with the formation of ulcers on the cornea or with septic complications of the disease).

Epidemiology of Keratitis

Among the inflammatory pathologies of the organs of vision, conjunctivitis (more than 65%) occupies the first place in the frequency of detection. Keratitis occurs only in 5% of all patients who consult an ophthalmologist for inflammation of the eye tissues.

Causes of keratitis

Most often, keratitis develops as a result of damage to the cornea of ​​\u200b\u200bthe eye with viruses. Up to 70% of viral keratitis is caused by HSV (virus herpes simplex) and the causative agent of chicken pox and shingles (Varicella-zoster).

In people with weakened immune systems and in children, the causative agents of measles and adenoviruses can lead to viral infection of the cornea.

Often on their own or against the background of a protracted viral disease inflammation of the cornea develops due to the ingestion of pathogenic bacteria on it.

Most often they are coccal flora (staphylococci, streptococci, pneumococci), as well as Escherichia and Pseudomonas aeruginosa, Klebsiella, etc.

Possible etiological factors of keratitis can be bacterial pathogens a specific type - salmonella, mycobacterium tuberculosis, organisms that cause diphtheria, malaria, gonorrhea, chlamydia, mycoplasmosis.

Amoebic keratitis is characterized by severe manifestations of the pathology. It develops as a result of infection of the eye with the bacterium Acanthamoeba and often leads to loss of vision.

decline immune protection of the body can provoke infection of the eyes with fungal flora (aspergillus, candida), which causes mycotic keratitis.

Inflammation of the cornea is also seen in allergic conditions organism - with hay fever, high sensitivity to certain drugs, with helminthic lesions, allergies to food, dust, animal hair, plant pollen, etc.

High eye sensitization from exposure to solar radiation sometimes causes photokeratitis.

Some autoimmune and systemic diseases can also contribute to the appearance of keratitis. Often this is observed in nodular polyarthritis, rheumatoid arthritis, vasculitis.

Infectious keratitis in most cases develops against the background of eye injury or corneal burn (thermal, chemical), as well as after surgery on the organs of vision or if the rules for wearing and storing contact lenses are not followed.

Keratitis can also be a complication of blepharitis, lagophthalmos, conjunctivitis, dacryocystitis, meibomitis. Contribute to the occurrence of keratitis malnutrition and beriberi, immunodeficiencies, metabolic disorders, bad habits.

Pathomorphology

Changes in the tissues of the cornea with keratitis are the occurrence following processes. The cornea of ​​the eye is infiltrated and swells due to the formation a large number polynuclear leukocytes, lymphoid cells.

Infiltrates have vague borders, different sizes and form. After the subsidence acute processes there is vascularization of the cornea (formation of new vessels).

This phenomenon is twofold: it improves the trophism of the cornea, but, at the same time, contributes to a decrease in its transparency. With prolonged keratitis, zones of necrosis, abscesses, and corneal ulcers may develop. Large ulcerations after scarring form an eyesore.

Types of keratitis

By depth of coverage inflammatory phenomena keratitis are:

• superficial (up to 1/3 of the thickness of the cornea);
• deep (the entire stroma becomes inflamed).

At the location of the infiltrated tissue, keratitis can be:

• central ( pathological area located in the pupil area);
• paracentral (inflammation is localized in the region of the iris belt);
• peripheral (infiltrate is present in the limbus).

The closer to the center of the cornea an infiltrate is formed, the more the functional properties of the eye decrease.

Due to the occurrence of keratitis, they are classified into:

• endogenous (caused by specific bacterial flora, allergies, autoimmune processes, beriberi). This group also includes keratitis with an unexplained etiology (rosacea-keratitis, filamentous keratitis).
• exogenous (traumatic, viral, mycotic keratitis, pathologies resulting from the multiplication of nonspecific microbes, against the background of conjunctivitis, meibomitis).

Clinical picture of keratitis

With any form of the disease, the so-called corneal syndrome manifests itself.

It includes:

• increased sensitivity of the eye to light;
• pain in the eye;
• tearing above normal;
• blepharospasm;
• decreased visual acuity;
• feeling of the presence of a foreign body under the eyelid.

Corneal syndrome develops due to irritation of the nerve roots located in the cornea, formed by an inflammatory infiltrate.

Subsequent inflammation leads to a decrease in the transparency of the cornea, which causes its clouding and changes in sensitivity.

If lymphoid cells predominate in the infiltrate, it acquires gray shade. With a large number of leukocytes, the infiltrate turns yellow due to purulent fusion.

In the case of the development of a superficial form of pathology, it can independently end in a complete recovery. Deep keratitis often leads to clouding of the cornea, which reduces the visual acuity of the eye.

A severe complication of the disease is the appearance of ulcers on the cornea. As the epithelium detaches from the affected tissue, erosion of the cornea is formed, after which a small and shallow ulceration may form.

Further desquamation of cells and tissue necrosis causes the appearance ulcer defect, which looks like a spot with a grayish bottom with a cloudy liquid.

If the ulcer heals after the inflammation subsides, this leads to scarring of the stroma. As a result, a thorn forms on the cornea.

If left untreated, deep ulcers can lead to the formation of a hernia of the Descemet's membrane. Complications of ulcerative keratitis can also be perforation of the ulcer, secondary glaucoma, cataracts, neuritis, endophthalmitis.

If the disease proceeds with inflammation of several parts of the eye, the patient may lose an eye.

Consequences of keratitis

In addition to the above severe complications a persistent decrease in visual acuity is often recorded (up to 50% of cases of keratitis), which requires surgical operations.

Advanced variants of the disease, including a purulent corneal ulcer, carry a high risk of anatomical death of the eye with urgent need enucleation of the eyeball.

Diagnosis of keratitis

An important link in the program of examining a patient with suspected keratitis is to find out the causes of the pathology. The task of the ophthalmologist is precise definition etiology of the disease - viral, bacterial, immune, traumatic, etc.

Often, a presumptive diagnosis is made already during a visual examination of the eye and an anamnesis from the patient's words.

The main method for diagnosing pathology is eye biomicroscopy. During biomicroscopy, the doctor analyzes the area and nature of the lesion of the cornea.

To determine the parameters and depth of the cornea, as well as the thickness of the affected tissue layer, ultrasound or optical pachymetry, endothelial, confocal microscopy of the eye are performed.

The characteristics of the corneal surface are calculated using computerized keratometry. The refractive power of the eye (refraction) is examined during keratotopography.

To diagnose ulcerative defects of the cornea, a fluorescein instillation test is performed (under the influence of the dye, erosion and ulcers acquire a greenish color).

In order to identify the causative agent of the disease, bakposev of the detachable ulcerative defect, as well as a smear from the conjunctiva, cornea, is done. The analysis is performed by PCR, ELISA. According to indications, tuberculin and allergological tests are prescribed.

Treatment of keratitis

Keratitis is treated in a hospital for at least 14 days (average 14-28 days). To eliminate disease-provoking factors, antibiotic therapy, antiviral agents, antimycotics, etc. are performed.

When viral keratitis is detected, the drugs of choice are interferon derivatives in the form of instillations, systemic preparations of acyclovir, pyrogenal.

Local treatment consists in laying behind the eyelid antiviral ointments(virulex, bonafton). Be sure to supplement therapy with immunostimulants (amiksin, taktivin, etc.).

Keratitis bacterial etiology treated with antibiotics, which are selected based on the data of the analysis for bacteriological culture. Most often, drops are used, funds for subconjunctival, parabulbar injections.

Keratitis caused by the causative agent of tuberculosis is treated in a specialized hospital under the supervision of a phthisiatrician, using chemotherapy drugs. Specific treatment it is also indicated for syphilis, gonorrheal keratitis, and it is prescribed together with a venereologist.

Allergic keratitis is treated antihistamines, eye ointments based on glucocorticosteroids. With any type of keratitis, local mydriatics are used to prevent complications.

To restore the tissues of the cornea, epithelial ointments or drops (actovegin, taufon) are prescribed. If vision continues to decline, physiotherapeutic techniques are introduced into the course of therapy - phonophoresis, electrophoresis with drugs, vitamins, enzymes.

With erosion and ulcer of the cornea, instrumental intervention is required, most often - cryoapplications, laser cautery, diathermocoagulation. When scar tissue is formed, keratoplasty is performed to prevent blindness or laser excision scars.

Complications of keratitis (eg, glaucoma) are treated only operational way. In some cases, advanced disease forces the doctor to recommend the removal of the eyeball.

Forecast

The prognosis for recovery is determined by the type of keratitis, its cause, the depth of the cornea lesion, the area of ​​eye coverage by inflammatory phenomena, and the presence of complications.

Seeking help quickly often leads to complete cure diseases: the infiltrate resolves or only a slight clouding of the cornea remains.

Deep keratitis with an accompanying ulcer often leads to persistent clouding of the cornea. In this case, the result of inflammation of the cornea may be glaucoma, an eyesore, dysfunction different departments eye and optic nerve, loss of vision (complete or partial). The prognosis worsens with purulent complications keratitis.

Prevention of keratitis

Prevent unpleasant and sometimes serious disease it is possible, observing hygiene and eye care measures, as well as following the doctor's advice on the treatment of conjunctivitis, blepharitis. Any systemic, allergic, immune, infectious pathologies should also be subject to adequate therapy.

Keratitis is ophthalmic disease, in which the patient has an inflammatory lesion of the cornea of ​​\u200b\u200bthe eye, which is accompanied by its ulceration, clouding, pain and hyperemia.

Keratitis

Eye keratitis is a fairly common disease, so when making this diagnosis, patients usually do not ask what it is. In the absence of treatment of this pathology, patients may experience a decrease in visual function.

To date, doctors distinguish the following causes of keratitis:

• any injury to the cornea that adversely affected its integrity;
• viral infection of the cornea of ​​​​the eye (usually the causative agent of herpes in this case is herpes);
• bacterial or fungal infection eyes;
• complications after untreated conjunctivitis;
• violation or complete impossibility of closing the eyelids as a result of any injuries, disruption of the activity of the facial nerves;
• allergic reactions;
• deficiency of vitamins, especially vitamin A;
• negative impact on the cornea of ​​contact lenses.

Types of keratitis

Ophthalmologists distinguish the following types of keratitis: deep and superficial.

In the first case, the disease is usually a complication of conjunctivitis or other inflammatory eye diseases. After superficial keratitis the patient does not undergo cicatricial tissue measurements, and the cornea does not darken.

At the same time, deep keratitis of the eye is characterized by damage to the deeper layers of the eyeball. After therapy for deep keratitis, many patients experience scarring of the cornea of ​​the eye, which further negatively affects vision.

That is why, when the first symptoms of this pathology occur, it is recommended not to hesitate and not to engage in self-diagnosis and self-treatment, but to contact a specialist. Only the doctor knows correct symptoms and treatment of keratitis.

In order to avoid serious complications of keratitis, specialists often prescribe hormonal drops and other “heavy” medications to patients.

Varieties of pathology

As a rule, this form of the disease develops after an injury to the eye or when prolonged wear contact lenses, if hygiene is not observed when wearing lenses. Pseudomonas aeruginosa usually causes bacterial keratitis. Although in some cases other bacteria can be the causative agents of the disease. Acanthamoeba keratitis is one of the most complex forms of bacterial keratitis. In this case, the disease often affects both eyes at once and often leads to complete blindness.

Viral keratitis

In 80% of cases, the causative agent of viral keratitis is the herpes simplex virus;

Onchocercal keratitis

The cause of this pathology is usually various allergic reactions that occur in severe form. In this case, the pathology can affect both the anterior and posterior parts of the eyeball. In the absence of timely treatment, pathology often leads to sclerosis. eye membranes. The first signs of this pathology are itching, increased lacrimation and photophobia. At the same time, patients often complain of corneal redness and severe swelling century. With absence medical care illness can lead to a strong decline vision and, in some cases, total blindness.

As a rule, this form of the disease develops in patients who have previously received injuries to the cornea of ​​​​the eye with foreign objects. Ulcerative keratitis often combined with purulent inflammation lacrimal sac. The disease is very difficult and, if left untreated, can result in perforation of the cornea.

In this form of the disease, the causative agent is usually various kinds of pathogenic fungi. In this case, the patient experiences severe pain, the cornea of ​​\u200b\u200bthe eye begins to turn red. With fungal keratitis, the patient develops ulcerations in all layers of the cornea (both superficial and deepest). AT advanced cases in patients, a through hole may form in the eyeball. In this case, the inflammatory lesion affects not only the cornea of ​​​​the eye, but also nearby vessels (vascular keratitis). Often fungal infection leads to the formation of a thorn and deterioration of vision. Fungal keratitis is very difficult to diagnose. That is why the treatment of this disease often begins at the wrong time and goes wrong.

As a rule, this pathology occurs in patients in the spring season, when various plants begin to bloom. The main cause of the disease in this case is an allergy.

Non-ulcerative keratitis

This is enough mild form a disease in which the cornea of ​​the eye swells, but ulcerative lesions do not form on it. Often develops due to ingestion pathogenic bacteria on the cornea of ​​the eye;

Photokeratitis

This form of keratitis usually develops as a result of getting burned from ultraviolet rays or artificial bright lights. Often, patients with this pathology turn to doctors after a long exposure to the sun without sunglasses or after using welding machines and neglecting protective parts.

Herpetic keratitis

The causative agent of this pathology, as a rule, is herpes simplex, much less often - the herpes zoster virus. After this form of the disease, patients often have deep ulcers on the corneas of the eyes. It is a form of keratitis prone to relapse. It can be both superficial and deep. At surface form pathologies on the cornea of ​​the eye are formed cloudy spots. Superficial herpetic keratitis almost always proceeds without bright severe symptoms. However, this kind of disease is extremely rare. Much more often, patients turn to doctors with deep herpetic keratitis of the eye. With it, the patient develops extensive ulcerative lesions on the surface of the cornea. When such patients recover, cicatricial changes occur in the tissues of the eye, and a thorn often forms.

Prognosis and prevention of the disease

If the patient noticed signs of keratitis in time and immediately consulted a doctor, then the prognosis of the disease will be quite favorable. Physicians, if available huge amount medications today it will not be difficult to stop the pathological process in the cornea of ​​​​the eye. This means that the loss of vision and the formation of a walleye can be completely prevented.

Prevention of the disease includes measures by which a person can avoid the development of pathology. These measures include proper storage and use of contact lenses. Lenses should be stored only in a special container. They can't be touched dirty hands or wear them longer than the prescribed period.

In addition, the prevention of corneal keratitis also lies in the timely treatment of conjunctivitis, since it is often a complication. It is also important to treat herpes in time, strengthen the immune system, use enough vitamins.

It is also worth avoiding injuries that can lead to the development of keratitis, and if they are received, immediately consult a doctor.

Symptoms of keratitis

Keratitis is almost always accompanied by pain, the severity and nature of which largely depend on the prevalence of the process, as well as the reasons that provoked it.

With this pathology, the human sclera turns red, and the surface of the cornea of ​​​​the eye loses its healthy luster.

Often, keratitis is combined with corneal syndrome, the main symptoms of which are:

• photophobia;
• involuntary blinking or complete closure of the eyelids and the inability to open them;
• pathological tearing;
• sensation of a foreign body in the eye;
• decreased sensitivity of the cornea.

When examining such patients, ophthalmologists can see blood and lymph impurities (infiltrates) in the cornea, which are usually accompanied by clouding of the eye. These infiltrates different patients may have different sizes, shapes, colors and be present in different quantities.

Depending on how deep the pathological process has spread into the tissue, infiltrates can be superficial or deep.

Superficial infiltrates often resolve on their own without any treatment and leave a slight haze behind.

At the same time, deep infiltrates often disappear only after long treatment“heavy” preparations and often leave behind cicatricial changes that negatively affect visual functions person.

In order to determine how long the patient has an infiltrate, doctors examine its borders. So, blurry edges usually have fresh infiltrates, while clear ones have old ones that will soon begin to resolve.

Almost always, signs of keratitis include active vascularization of the cornea. In this process, the vessels begin to grow into the cornea of ​​​​the eye. This has an extremely negative effect on the resorption of infiltrates.

On the one hand, vascular ingrowth is a protective reaction of the cornea, and on the other hand, it has an extremely negative effect on its transparency, as it is normal for healthy person there are no vessels in the cornea of ​​the eye (which is why the cornea is transparent).

In severe cases, inflammation in keratitis can also spread to the iris and ciliary contour. If keratitis is not treated on time or attempted to be treated on its own, it can lead to corneal ulceration and even rupture.

In addition, a frivolous attitude to one's health in this case can result in infection of the cornea of ​​the eye, which can provoke a purulent-necrotic process, which in turn almost always entails complete loss eyes.

In general, the symptoms of keratitis can vary quite a lot depending on the age of the patient, the state of his body (and immunity in particular), individual features pathogens, etc.

Viral keratitis

The causative agent of viral keratitis is often the herpes simplex virus. With it, the lesion of the cornea of ​​\u200b\u200bthe eye can be both deep and light, superficial.

The very first and characteristic symptom herpetic keratitis is the formation on the cornea of ​​the eye of a large number of small vesicles filled with liquid. These vesicles subsequently open up on their own and leave behind ulcerations, which often resemble tree branches in shape. At the same time, the more advanced form of keratitis the patient has, the deeper ulcerations on his cornea will be present. Often the symptoms of viral keratitis include the formation of a large number of deep infiltrates.

Filamentous keratitis

Filamentous keratitis in humans occurs as a result of various pathological processes in the body. The main symptom of filamentous keratitis is pathological dryness of the eye (in some cases, patients may even have no tears when crying), cutting pain, photophobia, a sensation of the presence of a foreign body in the eye, and involuntary closing of the eyelids.

In this case, a filamentous viscous secret is usually formed in the eye. In advanced cases, patients may experience signs of hyperkeratosis. In severe cases, hyperkeratosis can cover the entire area of ​​the cornea. In this case, its clouding occurs, as a result of which the vision of patients deteriorates sharply.

If left untreated, patients may experience recurrent erosions and ulcers, which can eventually lead to the appearance of a through space in the eyeball.

Purulent-ulcerative keratitis

A purulent ulcer of the cornea of ​​the eye also has characteristic features of the course, the causative agents of which, as a rule, are different kinds cocci. Even the most insignificant trauma of the cornea of ​​the eye or an inflammatory lesion of the eyelids can lead to this pathology. At the very beginning of the disease, patients usually have a gray spot in the center of the eye or in the paracentral part of the eye, in place of which, after a short period of time, an acute ulcerative process develops. In this case, one of the edges of the ulcer is often slightly raised, which often leads to its infection and the occurrence of a purulent-necrotic process. It should be noted that this phenomenon proceeds extremely rapidly. So, already 3-5 days after the onset of ulcer formation, the pathological process can spread completely to the entire cornea. In this case, at the bottom of the eyeball, as a rule, there is an accumulation of a sufficiently large amount of pus.

If at these stages the disease is not treated, then a through hole may form in the eyeball, through which pus will subsequently come out on its own. As a rule, after this, the patient begins to recover, and rough scars or thorns begin to form on the cornea, which further negatively affects vision.

It should be noted that recovery in such patients does not always occur. In some cases, the purulent-necrotic process can spread to healthy tissues of the human body.

Neurogenic keratitis

The main cause of neurogenic keratitis is the defeat of the trigeminal nerve. As a result, a flat ulcer begins to form in the center of the eye. Wherein this process can take a lot of time and not be accompanied by any special sensations, since the cornea of ​​​​the eye often completely loses its sensitivity.

With this form of keratitis, the clouding of the cornea is insignificant, and the ulcers, which have a small area, heal quickly. However, if to ulcerative lesion an infection joins, then the pathology may be complicated by a purulent-necrotic process.

Acanthamoeba keratitis

Patients who prefer contact lenses to glasses are at risk of Acanthamoeba keratitis. The disease got its name due to the causative agent - Acanthamoeba bacteria. This form of the disease is difficult to treat. However, it often affects both eyes. After such keratitis, the cornea of ​​\u200b\u200bthe eye often becomes cloudy, which in the future can negatively affect vision.

At the first symptoms of keratitis, patients should immediately contact an ophthalmologist, and not self-medicate. This pathology treated only in stationary conditions under the close supervision of doctors, since this disease can threaten significant changes in the structure of the tissues of the eye, which in the future can provoke a decrease in vision and even lead to complete blindness.

Treatment of keratitis

Keratitis is a serious inflammatory disease of the cornea of ​​the eye, manifested by a variety of ophthalmic symptoms. The treatment of this disease is carried out by an ophthalmologist in a specialized medical hospital. Treatment of keratitis is determined by three factors: the cause that caused the disease; the depth of corneal damage and the severity of the process.

The following types of therapy are used in the treatment:

• Medication methods of exposure, including antibacterial and antiviral agents, antiseptic solutions, drugs that promote epithelialization on the cornea, etc.
• Surgical methods: keratoplasty, corneal transplant, etc.

Medical therapy

Treatment of keratitis is recommended to be carried out in a medical hospital (due to the risk of developing severe complications for the patient's vision). The basis of the treatment of keratitis is the elimination of the causative factor. Most often, in adults it is bacterial or viral infection that affects the cornea both initially and against the background of an infectious disease of another localization that is current in the body. In children, the most common cause of keratitis is a viral infection and eye trauma. It is very important to stop using lenses for the duration of the treatment of keratitis.

Treatment of viral keratitis requires an appointment antiviral agents, which, as a rule, are used in the form of drops or ointments that must be placed in the conjunctival sac. In addition, it is possible to use interferon preparations and interferon inducers both locally and in the form systemic use. Interferons allow blocking the reproduction of the virus and its transition from cell to cell, thereby reducing the intensity of the course of the disease and damage to the cornea. Additionally, immunomodulators are used orally or intravenously to stimulate the activity of the immune system.

If, against the background of antiviral therapy, ulcers form on the cornea, then it is necessary to use microsurgical methods (microdiathermo and laser coagulation, cryoapplication), which allow closing the resulting defect and preventing its spread to healthy eye tissues.

Herpetic keratitis is treated with aciclovir, taken both orally in the form of tablets and topically, in the form of drops. This allows you to easily and quickly block the virus in the body and destroy it. The most modern drug of the acyclovir group is ganciclovir ( tradename eye gel- zirgan). In no case should you use glucocorticosteroid ointments, since their use against the background of infectious keratitis can lead to the formation of extensive corneal ulcers and the spread of infection to other parts of the eyeball. If therapy is not effective within a month, then surgical treatment in the form of a cornea transplant is recommended.

If keratitis is caused by a bacterial infection, then the key point of treatment is the appointment of antibacterial drugs. Most often, sulfonamides, penicillins and cephalosporins are used in the form of drops, ointments and special medicinal films. It is recommended to conduct a study on the sensitivity of the pathogen to antibiotics before prescribing these drugs. In severe purulent processes in the cornea (often when infected with staphylococcus and Pseudomonas aeruginosa), antibacterial drugs are administered subconjunctivally, as well as intramuscularly or intravenously. In cases of ulcer formation, microsurgery methods are indicated.

For specific types of keratitis, such as tuberculosis, use medicines, aimed at a specific pathogen - anti-tuberculosis drugs, anti-syphilitic, etc.

Along with drugs aimed at the causative factor of keratitis, other medications are also used:

Mydriatics, which improve the outflow of intraocular fluid from the eye cavity. Their use is due to the increased formation of intraocular fluid in keratitis due to the development of the inflammatory process in the cornea. They are usually used in the form of drops.

Antiseptic solutions allow you to quickly clean and disinfect the surface of the conjunctiva, clearing it of bacteria. Used in the form of drops for instillation or washing of the conjunctival sac.

Drugs that promote epithelialization of the surface of the cornea are especially often used against the background of formed and emerging ulcers. Allows you to quickly close the epithelial defect without formation connective tissue which helps maintain clear vision.

At allergic component diseases, it is recommended to use eye drops with antihistamine properties (Opatanol) or containing glucocorticosteroids. It is especially important to eliminate the allergen that causes keratitis.

Vitamin therapy is also used to improve regenerative processes in the body and increase the rate of epithelialization of the cornea.

For the treatment of common herpetic ulcers, a corneoplast is used - this is a crushed dried and preserved cornea of ​​a person and a number of animals (pigs, sheep, etc.). The corneoplast contains a large amount of collagen and keratin sulfate, which determine the main properties of the cornea. Corneoplast has a good therapeutic effect. With long-term, recurrent herpes keratitis, an anti-herpetic vaccine is used to cause a long-term remission of the disease in a patient.

With bullous keratitis, baths with a 10-20% glucose solution are used and 0.5% thiamine ointment is placed in the conjunctival sac. In addition, collazine is used in the form eye drops or subconjunctival with novocaine solution.

Surgery

Surgical treatments for keratitis are used in various forms diseases. It is important to remember that during treatment and rehabilitation it is necessary to stop wearing contact lenses for keratitis due to the risk of complications and progression of the disease. If ulcers form on the cornea, then microsurgical interventions are used: laser and microdiathermocoagulation or cryoapplication of the defect. These methods allow you to quickly stop the spread of the ulcer and improve the prognosis of a person in the long term.

If, against the background of keratitis, there was a clouding of the cornea and, as a result, a decrease in vision, then excimer laser scar removal techniques or keratoplasty are used. Select operation - layered keratoplasty to preserve the healthy layers of the cornea. Only corneal tissues that have been changed as a result of the disease are subject to removal.

The development of secondary glaucoma against the background of keratitis requires laser or surgical correction. given state, which consists in the normalization of the outflow of intraocular fluid from the internal cavities of the eyeball.

If keratitis does not respond to conservative treatment for a long time surgical methods, then in the best possible way treatment is enucleation of the eye.

Prevention of keratitis

Exodus and long-term effects transferred keratitis depend on a number of factors: the cause of the disease, the depth and duration of the inflammatory process. Modern methods treatments allow you to quickly cope with keratitis and prevent the development of opacities in the cornea.

Prevention of keratitis consists of several points: rapid detection and treatment of inflammatory diseases of the eye (conjunctivitis, blepharitis, dacryocystitis) and infectious diseases in the body. In addition, it is recommended to avoid traumatic effects on the eye, as well as undergo treatment for somatic and allergic diseases. Timely treatment herpetic infections minimizes the risk of developing the most commonly detected herpetic keratitis.

In conclusion, you can answer the most common question, is it possible to cure keratitis? Yes, of course you can, timely handling to the doctor and start treatment. It is important to remember that keratitis is a disease that requires hospitalization of the patient due to the risk of complications from the eyeball and visual impairment. Diagnosis and treatment of keratitis should be carried out by an ophthalmologist.

Under keratitis should be understood as inflammation of the cornea of ​​the eye. It can occur as a primary disease, or develop as a result of any pathology in the body.

Endogenous keratitis can occur when there is various infections with a chronic course, such as herpes, tuberculosis and a number of other conditions. However, it can be considered as a complication of the underlying disease.

In terms of symptoms, it may be similar to, but, as an independent nosological form, it has more extensive and severe complications.

Eye keratitis - photo in a person

After such a condition, with a favorable prognosis, recovery occurs. If only the superficial layers of the cornea are involved in the process, then the disease, as a rule, does not leave scars behind. The outcome of deep keratitis is always associated with the formation of scars, which, of course, can affect visual acuity.

Eye keratitis - photo

Causes

The etiological aspects are as follows:

Types of keratitis

The disease can be observed in various forms.

filamentous

The cause of its occurrence is the hypofunction of the lacrimal glands. As a rule, it develops against the background.

Filamentous keratitis - photo

Due to the insufficient function of the lacrimal glands, the conjunctiva and cornea dry out, which leads to the occurrence of inflammatory-dystrophic changes. As a result of a decrease in the transparency of the cornea, vision deteriorates. In severe cases, it may be perforated with prolapse of the membranes of the eye.

Fungal

Acanthamoeba

The cause of its occurrence are amoeba, which belong to the simplest. It can occur when swimming in fresh water in contact lenses, washing them with water from a reservoir and other liquids not intended for these purposes. This form is characterized by a sluggish course.

Viral

It develops against the background of the presence of a viral infection. It can be measles, mumps, chickenpox and others infectious diseases viral etiology. It is characterized by rashes that look like bubbles, redness of the eye, swelling.

Viral keratitis - photo

Corneal syndrome is always present. The cornea becomes cloudy and may ulcerate. This nosological form is typical mainly for children and persons young age.

Herpetic keratitis, treatment

The cause of herpetic keratitis is the herpes virus. Once in the body, it remains in it for life, forming a biological balance with it. This balance can be disturbed under the influence of various negative factors. If the immune forces of the body are reduced, the virus is able to manifest itself. It is enough to transfer herpes on the lips after hypothermia, after which it can spread to the cornea.

With this form of keratitis, there are symptoms of corneal irritation, which is characterized by photophobia, blepharospasm. This is a characteristic triad for keratitis. The cornea loses its original luster.

Treatment of this form should be complex. The virus easily adapts to antiviral drugs. Very positive effect can give electrophoresis on the eye with interferon. The procedure is carried out until the corneal epithelium is completely restored.

After such procedures, patients feel a significant improvement and a decrease in the manifestations of the corneal irritation syndrome.

Symptoms

Regardless of what form keratitis has developed, the symptoms have a certain similarity.

First of all, it comes to the fore pain syndrome. The degree of its severity is different and depends on the form and severity of the disease.

A characteristic feature is photophobia. Subjectively, the patient feels the presence of a foreign body in the eyes.

May take place blepharospasm in which the eyelids close involuntarily. This is due to the fact that the receptors of the trigeminal nerve are irritated.

If keratitis occurs, then clouding of the cornea will be required. It has fuzzy edges and is blurry. Can join headache, which are more pronounced on the side of the diseased eye.

Eye keratitis: treatment

For the correct appointment of treatment, it is necessary to clearly diagnose the disease.

For this purpose, the following methods :

- perform eye biomicroscopy;

– method of endothelial and confocal microscopy;

– use of computer keratometry;

- carrying out keratotopography;

– carrying out bacterioscopic research;

- setting a fluoroscein luminescent test.

Treatment will be assigned according to the results obtained:

At bacterial keratitis is treated with antibiotics. Eye ointments and are used. In severe cases, ophthalmic injections are used.

At herpetic keratitis, the drug of choice is acyclovir. In addition, treatment aimed at immunostimulation is carried out. Painkillers are prescribed to relieve pain.

Allergic keratitis suggests the appointment antihistamines. The body is being desensitized.

Treatment of keratitis of various origins

Symptomatic treatment is carried out with the aim of stopping the symptoms that occur with keratitis. In some cases, it is indicated - an operation to transplant parts of the cornea.

Many are interested in what is keratitis of the eye. This disease is characterized by the presence and deterioration of the quality of vision. In this case, inflammation of the cornea of ​​​​the eye develops, which can spread to one organ or affect both at the same time. Before you start treating keratitis, you need to figure out what it is.

Allergic

The allergic form of keratitis usually develops as a result of nontuberculous intoxication of various etiologies. It may be one or the other medications, food products, pollen. In most cases, the symptoms of such a pathological process include the development of a corneal syndrome characterized by profuse lacrimation, photophobia and a strong narrowing of the eye incision.

Because this type of disease is severe irritation nerve endings may occur, as well as pain and burning sensation of varying intensity. As a result, it becomes difficult for a person to open their eyes. A pericorneal or mixed conjunctival-pericorneal infection develops, i.e. redness of the surface of the eyeball. Due to the significant clouding of the cornea, a gradual deterioration of vision occurs, which cannot be restored even after the exposure to allergens has been eliminated.

In order to heal this form diseases, it is necessary first of all to get rid of the provoking factor. The question of how to treat allergic keratitis should be decided by a doctor.

In order to eliminate unpleasant symptoms, eye drops or ointments are prescribed. In the most severe cases, injections may be required. A prerequisite for successful treatment is the use of antihistamine drugs, vitamin-mineral complexes and sedatives.

When significant reduction visual ability, the doctor may prescribe physiotherapeutic procedures, such as electrophoresis or phonophresis. AT advanced stage surgery may be required (especially if there is secondary form glaucoma).

Stromal

Stromal keratitis is a deeper lesion of the cornea caused by the penetration of the herpes virus into it. Such a pathological process can lead to the formation of scar tissue in the cornea or on its surface, which in turn provokes a gradual decrease in vision, up to its complete loss. Scientists argue that this type of disease is directly related to the lack of the necessary defensive reaction organism to the penetration of the virus.

The main cause of the appearance of the stromal form of pathology is the herpes virus. This infection can be transmitted through airborne droplets or by contact. It should be remembered that once it enters the body, the herpes virus remains in it forever. For a long time it does not show any symptoms, but at the slightest failure in the body (decreased immunity, surgical intervention) causes a pathological process.

Symptoms of this disease can be different. In most cases, as the disease progresses, the following symptoms are observed:

• irritation and pain in the eye;
• clouding of the cornea, causing a decrease in vision;
• puffiness near the eyes;
• severe lacrimation;
• constant sensation of the presence of a foreign object inside the eye;
• photophobia;
• redness of the mucous membrane of the eye;
• formation of ulcers on the surface of the eye.

All of these symptoms are nonspecific and may indicate the presence of many diseases. This greatly complicates the diagnostic process. The method of treatment of herpes infection depends on the location and stage of the pathological process.

If the pathogen affects only the superficial layer of the cornea, therapy is limited to the use of antiviral agents. eye ointments or drops. In this case, it is necessary to take antiviral drugs in the form of tablets (Acyclovir, Zovirax). In some cases, the doctor may prescribe curettage of the affected corneal tissue. After such a procedure, the patient needs to wear a special contact lens for some time, which will help speed up the healing process.

If conservative treatment fails desired effect used ophthalmic surgery. In this case, a corneal transplant or keratoplasty is performed.

Infectious

Infectious keratitis is caused by exposure to pathogenic microorganisms. Most often, staphylococci, streptococci, pneumococci and Pseudomonas aeruginosa act as pathogens. The first infection, in addition to the underlying disease, calls for the development of concomitant pathological processes.

In most cases, keratitis bacterial origin characterized by an acute onset, accompanied by pronounced painful sensations, profuse lacrimation and increased photosensitivity. This pathology progresses quite quickly. In the area of ​​the cornea, the patient may notice the presence of yellow or brown infiltrates. They may differ in shape, size and depth of localization. Very often there are purulent discharge from the diseased eye. In the process of progression, the cornea begins to become cloudy, as a result of which vision is reduced.

The infection may be:

1. Primary. If the infection occurred for the first time. In this case, a rash appears in the area of ​​​​the lips, eyelids or on the mucous membranes.
2. Secondary - if there is an exacerbation of the latent form of the virus.

Most often, this type of disease develops in a child who has recently had chickenpox. Depending on localization infectious form keratitis is divided into the following types:

1. Superficial keratitis - in case of penetration of the pathogen from the external environment.
2. Deep - if the infection entered the body through the blood.

Before starting therapy, you must stop using contact lenses. Treatment of the disease involves the use of the following drugs, which include:

• immunomodulators;
• antibacterial drugs;
• vitamin complexes;
• antiviral agents.

Sometimes physiotherapy treatments are used.

tuberculous

Tuberculous keratitis, depending on the origin, is divided into several types:

• metastatic form;
• tuberculosis-allergic type;
• metastatic form.

With keratitis caused by tuberculosis, various symptoms can be observed, depending on the form of the pathological process, each of which has some features.

The deep form of the disease is characterized by the presence of separate infiltrates that are not prone to fusion. In many cases, this disease is complicated by iritis or iridocyclitis. The lesion affects only one eye.

The diffuse form is the appearance of infiltrates in the deeper layers of the cornea, which causes its strong clouding. Vascularization of the corneal tissue begins approximately 2-4 months after the onset of the pathological process. This disease develops for a very long time and leads to the formation of scars in the vascular tissue, as a result of which the quality of vision deteriorates.

The sclerosing form occurs in conjunction with the inflammatory process of the sclera, as a result of which infiltrates are formed in the cornea. Such a process has a sluggish course and can progress for several years. If left untreated, there may be consequences in the form of iritis or secondary glaucoma. Keratitis, which has developed as a result of the progression of tuberculosis, is usually diagnosed in adults.

neurotrophic

Neurotrophic keratitis is an inflammatory-dystrophic change in the structure of the cornea that occurs as a result of an infectious lesion or mechanical damage trigeminal nerve.

Factors provoking such a pathological process may be infectious diseases or injuries. Violation of tissue permeability ophthalmic nerve often occurs under the influence of adenovirus or herpes infection.

Mechanical damage to the tissues of the trigeminal nerve can occur due to its intersection in the process surgical intervention, after injections into the eyeball and ingestion of a foreign object.

Unlike other forms of keratitis, the symptoms of this disease have some features. For a long time, the pathology may not show any signs. As they progress, they appear pain gradually increasing.

Neurogenic disorders in the structure of the cornea can develop over several weeks, and sometimes even months. The disease can be present in a person for several years. In this case, the ulcers then disappear, then reappear. Treatment of keratitis of this origin requires the mandatory use of antibacterial eye drops and injection of antimicrobial agents.

adenovirus

Adenovirus keratitis is characterized by the development of an inflammatory process in the cornea, which is provoked by a viral infection. With this disease, the following symptoms are usually observed:

• bubble rashes on the mucous membrane of the eye;
• puffiness;
• redness of the eyeball;
• decreased quality of vision;
• the formation of ulcers;
• pain in the eye area.

Viral keratitis of the eye can be both superficial (affects only the outer layer of the epithelial tissue) and deeper (affects the entire stroma). Most often, such keratitis is diagnosed in children and young people. This pathological process is accompanied by a decrease in the transparency of the cornea, as a result of which the visual ability is impaired.

The causes of pathology are the infection of the body with viruses. different nature. These include: smallpox, measles and herpes. Provoke acute keratitis in this case may decrease protective functions organism.

To get rid of keratitis of this nature and completely eliminate inflammatory focus, it is necessary to conduct a comprehensive treatment aimed at increasing immunity, suppressing viral pathogens and accelerating the healing process.

For fixing therapeutic effect Your doctor may prescribe antiseptic eye drops and antibiotic ointments.

Traumatic

Traumatic keratitis occurs when non-penetrating damage to the surface of the cornea, which can be triggered by a foreign object entering the eye, chemical or thermal burns.

After the onset of this disease, a person may find themselves having the following symptoms:

• increased lacrimation;
• formation of erosions and ulcers;
• twitching of the upper or lower eyelid;
• painful sensations of varying intensity.

As the disease progresses, corneal vascularization may develop. In this case, new vessels grow into the corneal tissues.

Treatment for such a pathology should be comprehensive. First of all, it is necessary to eliminate the symptoms, and then get rid of the underlying disease.

Ulcerative lesions should be treated with eye drops containing vitamins. Healing ointments can be used, which are placed in the conjunctival sac. This will help speed up the healing process and repair of affected tissues.

If primary keratitis of this form was caused by a foreign object entering the eye, it is necessary first of all to remove it. It is not recommended to carry out such a procedure at home, since it can damage the mucous membrane. To remove a foreign body from the eye, the specialist performs the following manipulations:

• anesthesia (local anesthesia);
• disinfection;
• removal of a foreign object with a special tool.

dotted

Punctate keratitis is an inflammatory process in the cornea, which is characterized by the formation of small defects on the mucous membrane. In this case, the following symptoms are observed:

• severe lacrimation;
• clouding of the cornea;
• increased photosensitivity;
• blurred vision;
• narrowing of the eye incision;
• redness of the eyeball;
• swelling in the eye area.

The cause of such a pathological process in many cases is a viral infection, which, in addition to the main symptoms, provokes an increase in lymph nodes.

With the development of this form of keratitis, symptoms and treatment are closely interrelated, since the methods of therapy directly depend on the signs of the disease. Antibacterial and antiviral drugs may be used. This type of disease very often develops into chronic keratitis.

Prevention of the disease in adults and children is aimed primarily at protecting the eye tissue from mechanical damage, preventing infectious and viral pathologies. It is necessary to observe the rules of hygiene when wearing contact lenses and avoid contact with the eye foreign objects and chemicals.

Keratitis of various etiologies requires a specific approach to therapy, so you should not self-medicate. At the first symptoms, it is recommended to consult with your doctor.

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