Follicular conjunctivitis in humans. Follicular conjunctivitis: treatment in adults and children. Why does conjunctivitis occur?

This is a chronic inflammatory disease that affects the lymphatic follicles of the mucous membrane. Follicular conjunctivitis in dogs is often a complication of other forms, usually catarrhal or allergic. So named because formation of follicles filled with pus. Other symptoms are typical for conjunctivitis.

The reasons for the development of the disease are:

injury from sand, branches, grains;
burn from ultraviolet rays;
dusty air, smoke;
unsanitary conditions;
ingress of various substances (household chemicals, construction dust);
allergies to paints, pollen.

There have been no cases where bacterial or viral infection of the eyes led to follicular inflammation. But it can develop as an addition to more dangerous diseases, for example, or infections.

Important that follicular inflammation develops as a complication of catarrhal conjunctivitis. That is, it is almost always secondary. This disease is typical for young dogs under one year old, most often due to the breed.

Symptoms of the disease

Both eyes are usually affected, but with varying degrees of intensity. Initially, the disease proceeds according to the catarrhal type of inflammation, which is characterized by the following symptoms:

photophobia;
conjunctiva;
blepharospasm;
mucous discharge from the eye;
soreness of the conjunctiva and eyelids.

Then the disease progresses to follicular conjunctivitis. it may remain mucous, or it may become mucopurulent, transparent gray, its amount can be large or small, it all depends on the severity of the inflammation. When follicles are involved in the process, the third eyelid becomes like a raspberry, it is red, completely covered with “warts”. The eyelids become swollen, and in severe cases they may turn in, which leads to inflammation of the cornea. If the disease is not treated, ulcers appear on the cornea.

Treatment of follicular conjunctivitis

When the first signs appear, you need to start cleaning the sore eye with a cotton ball, moistening it in chamomile decoction. It is prohibited to use the same ball twice, even if there are no visible signs of contamination. It would be useful to limit walks with your pet so that he does not catch an infection and so that the disease is not complicated by purulent inflammation.

With further development of the disease and intensification of symptoms, you should definitely contact a veterinarian for the correct treatment. The most commonly prescribed medications are drops or ointments containing antibiotics. These can be drops of 10%, 20% and 30% sodium sulfacyl solution or 25% Sofradex solution 4-5 times a day.

The following ointments are used:

chlortetracycline ointment;
30% sulfacyl sodium;
tetracycline ointment;
ointment containing 30-50% etazol.

A novelty in the world of veterinary medicine turned out to be ophthalmic medicinal films developed by E.P. Kopenkin. Their structure includes kanamycin, neomycin, sulfapyridazine sodium. They are used by injection into the conjunctival sac once a day. Upon contact with a tear, the film swells, attaching to the conjunctiva. Then they dissolve, giving the mucous membrane nutrients.

A veterinarian may perform surgery to remove follicles:

First, anesthesia is performed using 10% novocaine.
Use tweezers with soft teeth to push back the eyelid.
A silver nitrate stick is used to “extinguish” the swollen follicles (do not touch the cornea).
Then the conjunctiva is immediately washed with an isotonic solution to wash away any remaining silver nitrate.

Usually 4-5 procedures are enough. In the presence of large follicles, surgical removal can be used, but it is not advisable, as it leads to curvature of the eyelid.

Follicular conjunctivitis is one of the types of inflammation of the conjunctiva. The disease affects people of all age groups, and children are especially susceptible to it. The pathological process tends to affect the connective tissue of the eye. The disease manifests itself with a characteristic symptom complex. Treatment requires a responsible approach, since advanced forms provoke damage to the deep layers of the visual organs and reduce the quality of vision.

Etiology, features of the course

Another name for follicular conjunctivitis is hyperpapillary conjunctivitis. During its course, the disease provokes morphological changes in the tissues of the eye organs, in particular the mucous membrane (conjunctiva). “Loosening” of the conjunctiva is observed. Miniature compacted elevations begin to form on it, usually round in shape. The diameter of pathological formations reaches 1-2 millimeters. This is a collection of lymphocyte cells that the body produces in response to infection and sends to the site of inflammation. The lumps disappear without a trace after treatment as you recover (with the exception of trachoma).

The main causative factor is a violation occurring in the human “resistance” system. The disease is aggravated by a number of factors (dust, smoke, small foreign objects falling on the mucous membrane).

Often, the follicular form becomes a consequence (complication) of untreated, severe catarrhal conjunctivitis, often viral and allergic.

Manifested by inflammation of the lymphatic follicles. The course of the disease is divided into acute, subacute and chronic.

Follicular conjunctivitis can be provoked by:

The cause of the development of this type of eye disease may be prolonged exposure to the mucous membrane of aggressive components of solutions intended for storing contact eye lenses. An unscrupulous manufacturer uses certain types of preservatives and disinfectants prohibited for use in ophthalmic practice. The negative long-term effects of such solutions lead to the development of eye disease.

Chronic follicular conjunctivitis

The causes of the chronic process are chemical and physical factors that affect the mucous membrane of the eyes on an ongoing basis. These may be unfavorable conditions in production - flour mills, sawmills, woodworking organizations, chemical plants, brick, cement factories, etc. Chronic helminthiasis, allergies, anemia, pathologies of the nasopharynx, sinuses predispose to eye disease.

Chronic conjunctivitis occurs in parallel with blepharitis, dacryocystitis, and entropion. Treatment of the chronic form, as well as the acute form, begins with eliminating its immediate cause and factors predisposing to the disease.

Allergic hyperpapillary conjunctivitis

Plant pollen, house dust, animal hair, bird feathers, and medications can provoke allergic inflammation of the mucous membrane of the eyes. It can be seasonal or last year-round. Spring catarrh is considered the most severe form, associated with a deterioration in general condition, bronchial asthma, and eczema.

Hyperpapillary conjunctivitis is a type of allergic conjunctivitis, which is a consequence of the constant presence of a foreign body in the eye, in close contact with the mucous membrane. It can be provoked by prolonged, continuous wearing of contact lenses - soft or hard - in the presence of protruding postoperative sutures on different parts of the eye (with a history of ophthalmological surgery).

The diagnosis - follicular conjunctivitis - is made on the basis of a distinctive clinical picture and interview:

interaction with an allergen;
seasonality;
change in general condition;
watery eyes or dryness;
“grains of sand” in the eyes, etc.

Differentiate with bacterial and viral conjunctivitis. A distinctive feature is the presence of eosinophils and basophils in the cytogram. Treatment involves the prescription of antihistamines, local treatment with special anti-inflammatory, antiallergic drops. A prerequisite is the elimination of the provoking allergen.

Prevention consists of seasonal desensitization with medications; it is necessary to avoid, if possible, contact with an allergenic factor in the body. It is necessary to periodically stop wearing lenses and replace them with glasses.

Follicular keratoconjunctivitis

You can become infected in public places, in a hospital, or at home from a sick relative. The incubation period is up to 10 days. The clinical picture of viral keratoconjunctivitis is quite characteristic. The disease always begins violently: pronounced swelling of the mucous membrane, hyperemia of the eyelids, redness of the folds and surface of the eyeball. In the area of the lower transitional fold, pink-grayish follicles appear already in the first few days.

After about five days, pinpoint infiltrates and bubbles with liquid appear on the corneal layer (usually in the central optical region). Morphological changes are manifested by symptoms such as lacrimation, blepharospasm. The number of inflamed follicles decreases gradually, somewhere after the second week of the course. Deteriorated vision usually returns.

The infection is transmitted through the air, contact, and nutrition (through food). The doctor prescribes the treatment. The course of the disease can be long - up to two months, even if treatment is present.

Trachoma

The incubation period lasts approximately two weeks. The infection spreads indirectly (through various objects used simultaneously by different people, including sick people), due to poor hygiene, and in disadvantaged social categories of the population. The disease occurs with redness of the mucous membrane, mucopurulent discharge, hardening of the conjunctiva, and a feeling of dustiness in the eyes. The eyelids stick together due to excessive discharge during sleep. Noticeable, gray, cloudy follicles form in the conjunctiva. The surface of the mucous membrane is uneven, bumpy, and purple.

When small vessels are involved in the process, pannus appears:

With severe tissue destruction, dry eye syndrome may occur. There are 4 clinical stages of trachoma according to the severity of morphological changes. The disease is dangerous due to its consequences (loss of visual ability). Treatment must be carried out under the supervision of a doctor; the disease cannot be started.

Treatment includes the prescription of antibiotics, local application of ointments, drops. Surgery or surgical tissue restoration (transplantation) may be required.

Diagnosis of follicular conjunctivitis

Before prescribing treatment, the doctor conducts a thorough visual examination of the mucous membrane of the affected eyes. A microscopic examination of the discharge is prescribed. The appearance of inflamed follicles is considered the most accurate sign of this form of the disease. They never form on healthy tissues.

Carry out:

establish the allergen.

The histological nature of such formations is identical in all forms of follicular conjunctivitis. Only with trachoma are degenerative processes characterized by the formation of permanent scars.

It is necessary to distinguish follicles from similar papillae. The papillae are hyperplastic capillaries that grow in bundles into the epithelial layer of the ocular mucosa.

Examination of the eyes using a slit lamp reveals roughness and tuberosity of the conjunctiva caused by hypertrophied papillae and follicles.

Principles of therapy

Timely treatment prevents the development of severe complications. Self-medication can lead to serious problems with a person’s vision later. It is necessary to identify and eliminate the internal etiological (causal) factor as quickly as possible.

The following therapy methods are used:

A specialist (ophthalmic surgeon) performs therapeutic actions.

Follicular conjunctivitis is a characteristic sign of viral damage to the organs of vision. This is a chronic non-infectious inflammation of the conjunctiva and lymphatic follicles, which are located on the inner surface of the third eyelid. The special structure of the mucous membrane of the eye is susceptible to the influence of external factors - this usually causes inflammation.

The disease can occur in people of any age, children are especially at risk. It is even common in animals. The pathological process affects the connective tissue of the organs of vision and manifests itself with characteristic symptoms. It is important to apply timely and effective treatment, since in its advanced form the disease affects the deep layers of the visual organs, reducing its quality.

Etiology

Follicular conjunctivitis begins to develop when various substances lead to irritation of the conjunctiva of the third eyelid. This usually occurs as a result of poisoning, infection, disorders of cellular metabolism, exposure to UV radiation and the presence of allergens, and untimely therapy.

The follicular form of conjunctivitis is often observed in conjunctivitis with an adenoviral nature and an accompanying cold. This form of inflammation is contagious and is transmitted by airborne droplets.

Large gatherings of children during periods of exacerbation are especially dangerous.

Symptoms and causes of pathology

Follicular conjunctivitis is manifested by a characteristic symptom complex, including:

headache;
rhinitis;
general weakness;
a sore throat;
lack of appetite;
cough;
sensitivity to light;
elevated temperature;
redness of the eyes;
swelling of the eyelids;
involuntary lacrimation.

The causes of conjunctivitis are completely different. Infectious conjunctivitis is caused by bacteria, viruses, chlamydia, and fungus. The disease can also be caused by various allergens, the influence of a chemical drug, physical impact, for example, during treatment with eserine or pilocarpine, various chronic diseases such as worms, sinusitis. The contact and household method of infection in humans is the most common. If family members, employees, children get sick, everyone who comes into contact with them will also get sick.

With mild conjunctivitis, vision does not decrease. The cornea of the eye becomes inflamed very rarely. The incubation period is approximately 8 days. On the fifth day, the appearance of bubbles with liquid on the corneal layer (point infiltrates) is observed. The symptoms of this pathology are similar to those of trachoma, but it causes cicatricial changes in the conjunctiva and cornea.

Nasopharyngitis and increased body temperature, swelling of the eyelids, redness of the mucous membrane, mucous discharge and enlarged regional lymph nodes may also be observed.

Treatment

Treatment of conjunctivitis is carried out only by an ophthalmologist based on clinical studies. It is necessary to find out the form of the disease. To do this, an analysis of bacteriological, bacterioscopic and cytological smears, analysis of scrapings and secreted fluid from the conjunctiva are carried out. This allows you to find out the cause and prescribe the right treatment.
Self-treatment at home is dangerous and can lead to complete loss of vision, since only a doctor can accurately determine the type of disease.

This pathology must be treated by a qualified specialist, since self-therapy increases the risk of burning the cornea and sclera of the eye. The patient is given local anesthesia with dicaine or 10% novocaine due to poor absorption of the drug. For about 5 days, the follicles are treated with a 10% solution of silver nitrate. The doctor turns the eyelid in and treats the protruding follicles. Then he rinses with saline solution. In the intervals between procedures, disinfectant eye ointment is used. The procedure itself is repeated 4 times.

Curettage (curettage) of inflamed follicles is considered one of the most effective means.

It is carried out in several stages:

Anesthesia.
Disinfection of the palpebral fissure.
Inversion of the eyelid.
Scraping of inflamed follicles.

Afterwards, it is recommended to use a disinfecting ointment or eye film. Curettage of inflamed follicles can cause deformation of the third eyelid. Its removal is contraindicated, since this can contribute to the rolling of the eyelid and retraction of the eyeball, inflammation of the cornea (keratitis), and the occurrence of ulceration and perforation. Treatment of follicular conjunctivitis with medication is considered ineffective.

Antibiotics treat bacterial forms of the disease (phlyctenular, angular, gonococcal). In case of strong discharge, it is recommended to treat the conjunctival sac with disinfectants. When treating viral conjunctivitis (catarrhal), interferon ointment or eye drops are prescribed; it helps resist the virus. The fungal form of the disease requires interval use of antifungal agents and nystatin solution; it is recommended to apply the ointment behind the eyelids at night.

Prevention

A person needs to instill simple rules of hygiene from childhood. To prevent inflammation in the conjunctiva, simple preventive recommendations should be followed:

do not touch your eyes with dirty hands;
maintain constant hand cleanliness;
follow the rules of personal hygiene;
do not visit places with large crowds of people, especially if outbreaks of the disease are known;
wash only with boiled water;
Strengthen your immune system and lead a healthy lifestyle.

It is necessary to wash your hands with soap after visiting the street, contacting animals, or eating food, at least seven times a day. You should not touch your face, eyes or rub them with your hands. Only use a personal face towel or disposable handkerchiefs. Prevention of allergic conjunctivitis involves identifying the allergen and eliminating or minimizing contact with it. The fungal form of pathology can be prevented by careful care of contact lenses, moderate use of antibacterial agents, and regular and timely cleaning of the room.

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Follicular conjunctivitis

Follicular conjunctivitis is a chronic non-infectious inflammation of the conjunctiva and lymphatic follicles, which are located on the third eyelid, on its inner side. With the disease, follicles appear in the lower half of the conjunctival sac. This disease can develop against the background of an age-related condition of the adenoid tissue called folliculosis.

Etiology of follicular conjunctivitis

The development of the disease occurs when the conjunctiva of the third eyelid is irritated by various substances, in the process of poisoning due to various infections, disruption of cellular metabolism, exposure to sunlight or pollen. Most often, the follicular form occurs with adenoviral conjunctivitis, especially against the background of ongoing colds. This form of conjunctivitis is characterized by a contagious infectious nature, and the causative agents are adenoviruses of various types. Outbreaks of the acute form of the disease occur in the spring or autumn, and mainly in places with large concentrations of children. Infection occurs through airborne droplets - through coughing and sneezing, and sometimes due to contact of the pathogen directly with the mucous membrane.

Symptoms of the disease

Initial symptoms of the disease:

The mucous membrane of the eye becomes inflamed and conjunctivitis develops. By the way, children, compared to adults, tolerate the disease much easier. The cornea of the eye is involved in the pathological process extremely rarely, and overall visual acuity does not decrease. The incubation period lasts about 8 days.

In the clinical picture of the disease, in addition to the appearance of follicles, infiltration and looseness of the conjunctiva are noted. The secreted pus overnight glues the eyelids together. Sometimes this disease is mistaken for trachoma. Although follicular conjunctivitis differs from trachoma in that it does not leave scar changes in the conjunctiva and does not affect the cornea.

At the onset of the disease, pronounced nasopharyngitis appears, which occurs with an increase in temperature. Conjunctivitis begins in one eye, and after a while it moves to the other eye. The eyelids become swollen, and the mucous membrane becomes red. Mucous discharge appears, and regional lymph nodes become enlarged.

Adenoviral conjunctivitis can occur in three forms:

exposure to various types of toxins;
introduction of an infectious agent (adenovirus infection, trachoma, herpes virus);
pathologies of cellular metabolism;
the influence of allergens, some eye drops, intense solar radiation.
interaction with an allergen;
seasonality;
change in general condition;
watery eyes or dryness;
“grains of sand” in the eyes, etc.
thin – slight infiltration;
vascular - a significant number of affected vessels penetrate the cloudy cornea;
fleshy – pronounced infiltration of the corneal layer, granulations are present;
sarcomatous - the follicles disintegrate, become necrotic with the formation of scars.
cytological diagnosis of scraping;
bacteriological culture of secreted eye secretions;
determine the titer of antibodies to pathogens;
establish the allergen.

In severe cases, the doctor may prescribe cauterization of the inflamed follicles with special solutions; local anesthesia is first performed. They cauterize approximately once every five days, with extreme caution - only an experienced doctor can do this procedure. A side effect of the manipulation can be a chemical burn of the cornea and sclera. The eyelid is turned outward, and the damaged surface is treated with a sterile cotton swab. Then the mucous membrane is treated with sodium chloride solution. At the same time, various antiseptic ointments are prescribed for eye application.
Curettage of damaged follicles is used. The palpebral fissure is anesthetized and thoroughly disinfected. The eyelid is carefully turned away, and pathological nodules are scraped out using a special instrument. After the intervention, you need to use antibacterial ointments and films prescribed by your doctor. Complications of manipulation: keratitis, perforation of the cornea, ulceration of the mucous membrane, deformation of the eyelid.

All of the above-described invasive surgical interventions are performed exclusively in a hospital hospital, using sterile instruments intended strictly for such medication purposes.

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Conjunctivitis

Inflammation of the conjunctiva - conjunctivitis Depending on the course, they are acute, subacute and chronic. For any conjunctivitis, it is necessary to identify its causative agent. To do this, examine the discharge from the conjunctival sac.

Acute conjunctivitis most often occurs suddenly or has a very short incubation period. The disease is usually bilateral, but sometimes one eye and then the other eye become ill. The disease is caused by an infection, so it is absolutely necessary to send a smear of the discharged conjunctival sac for examination. The patient's complaints: a feeling of pain in the eyes, a sensation of a foreign body, photophobia, lacrimation, purulent discharge.

Objectively: swelling of the eyelids, sometimes significant, in the conjunctival sac the discharge is initially mucopurulent, then purulent. Significant photophobia, and sometimes even blepharospasm. Conjunctival hyperemia. It is bright red or brick red, usually more intense in the vaults; Individual vessels are also visible. Sometimes swelling is noted - chemosis (Fig. 76). There are also films on the conjunctiva of the eyelids. The cornea may also be involved in the process.

Rice. 76. Edema (chemosis) of the lower transitional folds of both eyes.

In case of conjunctivitis of any etiology, under no circumstances should bandages be applied to the sore eye. Under the bandage, thermostat conditions (moist heat) are created and microbes have all the conditions for rapid growth.

The most typical acute conjunctivitis is conjunctivitis caused by the Koch-Wicks bacillus. It is very common in southern countries and takes on the character of an epidemic, which is why it is called epidemic. Often this conjunctivitis complicates conjunctivitis, which is observed during cotton picking. The disease (especially in children) may be preceded by a short incubation period lasting 1-2 days, mild malaise, runny nose, and even fever. The eyes become ill suddenly with the development of all these symptoms. Particularly characteristic are small pinpoint hemorrhages in the conjunctiva of the eye and swelling of the lower transitional fold. Sometimes there are films on conjunctivitis that are easily removed with a cotton ball and do not leave a bleeding surface. Epidemic conjunctivitis is a highly contagious disease. Its transmission can be facilitated by both personal items (a shared towel) and poor sanitary and hygienic conditions (in particular, flies). If one eye is sick, disease in the other can be prevented by injecting a 30% sodium sulfacyl solution 5-6 times a day.

Treatment. Due to the epidemic nature of the disease, much attention should be paid to prevention (personal hygiene, fly control, etc.). The eyes must be washed several times a day (depending on the severity of the process) with solutions of mercury oxycyanide, potassium permanganate, furatsilin (1:5000), etc. When washing the eyes, not only the infected discharge is removed, but the conjunctival cavity is also disinfected. Drops of 30% sulfacyl sodium solution are injected into the eye 4-6 times a day, at night - 20% sulfacyl sodium ointment, 1% synthomycin liniment, 1% tetracycline ophthalmic ointment. In severe cases, sulfadimezin, etazol, etc. are prescribed orally 3-5 times a day. The same treatment also helps with small infiltrates of the cornea, which in severe cases of the disease complicate acute epidemic conjunctivitis.

Pneumococcal conjunctivitis proceeds in the same way, but usually all the phenomena are not so pronounced; in some cases it flows subacutely. Differential diagnosis is made on the basis of microscopic examination of conjunctival discharge. Pneumococcal conjunctivitis is usually accompanied by slight swelling of the eyelid margins.

Treatment. It is advisable to determine the sensitivity of the microbe to antibiotics. A solution of penicillin (100,000 units in 10 ml of physiological solution), 1-10% liniment of syntomycin, 30% solution of sulfacyl sodium is instilled into the conjunctival sac every 2-3 hours, and penicillin is injected intramuscularly. You can give chlortetracycline (biomycin) 0.2 g (200,000 units) orally 5 times a day.

Gonoblenorrhea is caused by Neisser's gonococcus, which in turn causes gonorrheal inflammation of the genital organs. There are gonoblenorrhea of newborns and adults.

Gonoblenorrhea of newborns(Fig. 77) appears 1-4 days after birth. If inflammation begins 5 days after birth, then the infection did not occur during childbirth. At first, the eyelids of newborns become dense like wood (the first period is infiltration, stiffening), their skin turns red, they are sharply swollen. The discharge is small, serous-bloody. After 2-4 days (the second period), a profuse purulent, creamy discharge appears, the swelling of the eyelids becomes less, they can already be turned out. The conjunctiva of the eyelids and eyes is sharply hyperemic and swollen. Swelling of the conjunctiva of the eye in the form of a roller surrounds the cornea (chemosis) and disrupts its nutrition, which leads to the formation of corneal ulcers. After 2-4 weeks, all acute phenomena pass and the third period begins - recovery - papillae develop in the conjunctiva of the eyelids, it becomes uneven. To confirm and clarify the diagnosis, it is necessary to conduct a bacterioscopic examination of the conjunctival discharge.

Rice. 77. Gonoblenorrhea (gonorrheal conjunctivitis) of a newborn

Prevention of gonoblennorrhea for newborns consists of sanitation of the mother in the prenatal period. Immediately after the birth of a child, he is required to undergo preventive measures according to Matveev (the name “according to Creda” is incorrect!). In the delivery room, the newborn's eyelids are wiped with a damp cotton swab moistened with a 2% solution of boric acid, and 1-2 drops of a 2% solution of silver nitrate (lapis) are injected into the conjunctival sac. After instillation, the eyes are not washed. Due to the fact that the very instillation of a silver nitrate solution can cause irritation of the conjunctiva, recently, instead of this classical method of prevention, several drops of a freshly prepared penicillin solution - 250,000 units - are successfully injected into the child’s eyes twice (immediately after birth and 2 hours later). in 1 ml of saline solution. Although these methods of prevention do not provide a 100% guarantee, they are so effective that gonoblenorrhea in newborns has practically been eliminated. Before this, gonoblennorrhea was in first place among the causes of childhood blindness.

Gonoblenorrhea adults In general, it proceeds in the same way as in newborns. The cause of its occurrence is the same gonococcus, but, as a rule, it comes from the genital tract of the patient himself, suffering from gonorrheal urethritis, due to non-compliance with personal hygiene skills. Sometimes medical workers become ill with gonoblenorrhea when they examine the eyes of patients without sufficient precaution. When examining a patient, you must wear canned glasses with large lenses or use a special transparent mask. In all cases, you should first open the inner corner of the palpebral fissure with a glass rod, release the pus that has accumulated there, and only then open the eyelids with an eyelid lifter.

Gonoblenorrhea in adults is more severe than in newborns, since the former are more likely to develop corneal lesions. If in newborns gonoblenorrhea is always bilateral, then in adults it is more often unilateral, so the healthy eye must be protected with an airtight bandage with a watch glass (see Fig. 63) so that pus from the diseased eye does not accidentally get into the healthy eye.

Treatment. Penicillin is a powerful means of combating gonococcus. It is administered intramuscularly at 200,000-300,000 units 3 times a day and instilled at a concentration of 100,000 units per 1 ml of saline into the conjunctival sac every hour. Instillation of a 30% sodium sulfacyl solution is also used, and penicillin ointment (40,000 units in 1 g of petroleum jelly) or 20% sodium sulfacyl ointment is applied at night. If tolerated well, sulfonamides are given orally.

Diphtheria conjunctiva(Fig. 78) is caused by Leffler's wand. It can also occur as a complication of diphtheria in other organs, but it can also be an independent disease. The disease begins acutely. It may also be accompanied by general phenomena. First, the skin of the eyelids turns red. Their swelling is so great that it is impossible to turn the eyelid out. The discharge at first is quite scanty, but after 3-5 days, when the swelling of the eyelids decreases, it becomes abundant.

Rice. 78. Diphtheria of the conjunctiva (film of the conjunctiva of the lower eyelid).

On the conjunctiva of the cartilage, in the intercostal space, grayish films appear that are difficult to remove. After they are removed, bleeding spots remain. Films can also be present in other types of acute conjunctivitis, but then they are superficial and after their removal the conjunctiva does not bleed. With burns of the conjunctiva, films also sometimes appear, but they are usually in the lower half of the conjunctival cavity, and with diphtheria, more on top. Mild diphtheria of the eyelids is also observed.

Diphtheria of the conjunctiva can be complicated by a disease of the cornea, which, as with gonoblenorrhea, is severe and can lead to the formation of a cataract and a significant decrease in visual acuity. After diphtheria of the conjunctiva, the affected areas are replaced by a scar; Adhesions may form between the conjunctiva of the eyelids and the eye (symblepharon).

Treatment. If diphtheria is suspected, the conjunctiva should be cultured as soon as possible from the conjunctival sac for a special serum. Before receiving a response, the patient must be administered 6000-10,000 IU of anti-diphtheria serum. The patient must be urgently hospitalized in an infectious diseases hospital (not in the eye department!). Locally, the eyes are washed with a solution of potassium permanganate (1:5000), instilled with a 30% solution of sulfacyl sodium, and be sure to prescribe 20% sulfacyl sodium ointment or 1% synthomycin liniment, which can prevent the development of eyelid adhesions. If the cornea is damaged, appropriate treatment is carried out.

Viral conjunctivitis. There are many viruses that can cause conjunctivitis. The most common are adenoviral and epidemic viral conjunctivitis.

Adenoviral conjunctivitis often occurs in children, it begins with fever; hyperemia and follicles appear on the back wall of the nasopharynx (with epidemic conjunctivitis, general phenomena are usually absent). Swelling of the preauricular and submandibular lymph nodes is often observed. The conjunctiva is somewhat hyperemic, there are follicles and sometimes films. There is almost no separation. After 1-2 weeks, with viral conjunctivitis, delicate pinpoint infiltrates are detected in the superficial layers of the cornea. The sensitivity of the cornea decreases sharply. The disease is very contagious. It lasts for several weeks.

Treatment. Isolation of the patient for 2-4 weeks, strict adherence to hygiene rules. Etazol is prescribed orally 0.5 g 4-5 times a day for 7-10 days, locally - chloramphenicol (0.25% aqueous solution 3-4 times a day and 1% liniment), oxolin, interferon.

Measles conjunctivitis. Sometimes measles is preceded by viral conjunctivitis. In this case, a slight hyperemia of the mucous membrane develops, and the discharge is small. Measles conjunctivitis can be complicated by a common infection. Treatment, as with ordinary viral conjunctivitis, is prescribed restorative therapy.

Subacute angular blepharoconjunctivitis is typical of subacute conjunctivitis. It is caused by diplobacillus Morax-Axenfeld. Since diplobacillus is quite common in nature, this conjunctivitis is quite common. Patients complain that their eyes itch. The edges of the eyelids and their conjunctiva (especially in the corners) are hyperemic. The discharge is scanty. The skin in the corners of the eyelids may become macerated and painful cracks may form. Conjunctivitis usually occurs subacutely, but can also become chronic.

Treatment. A specific remedy is a 0.5-1% solution of zinc sulfate. In severe cases, a 2% solution can be used, but it is very irritating to the eyes. Macerated areas of the eyelid skin are lubricated with zinc ointment or Lassara paste. Usually, a cure occurs quite quickly, but in order to avoid relapses, it is necessary to continue instilling the zinc sulfate solution for another 10-12 days.

Chronic conjunctivitis- a very common disease of the conjunctiva. Patients complain of itching, burning, a feeling of sand in the eyes, and fatigue when reading. Objectively: the conjunctiva of the eyelids is slightly hyperemic and velvety (due to hypertrophy of the normally present papillae). Sometimes small grains are found in the corners of the eyes, and the discharge is scanty. The causes of chronic conjunctivitis are varied. Often these are occupational hazards (conjunctivitis of flour millers, woodworkers, stone cutters, chemists, etc.), intoxications from the gastrointestinal tract (helminthiasis, constipation, hypovitaminosis, etc.). Uncorrected refractive errors (especially hypermetropia, astigmatism, presbyopia) can cause chronic conjunctivitis.

It is almost natural that chronic conjunctivitis is combined with inflammation of the edges of the eyelids. Very often their reasons are common.

Treatment consists of eliminating the underlying causes of the disease. General strengthening therapy and occupational health improvement are indicated.

Locally, a 0.25-0.5% solution of zinc sulfate, pure or in combination with a 1% solution of resorcinol and a 0.1% solution of adrenaline. 2-3% solutions of protargol or collargol, instilled 2-3 times a day, help. At night, yellow mercury ointment or 0.5% hydrocortisone ointment is prescribed. It is recommended to alternate the products.

Follicular (granular) conjunctivitis. There are folliculosis and follicular conjunctivitis.

Folliculosis- usually this is age-related hyperplasia of adenoid tissue in children under 10-15 years of age. Superficial grains appear mainly on the healthy conjunctiva of the lower eyelids. There are no subjective complaints, but often the adenoid tissue enlarges - follicles appear in the nasopharynx, and the tonsils enlarge. Conjunctivitis does not require special treatment and goes away without a trace with the onset of puberty (for folliculosis in adults, see “Allergic conjunctivitis”).

Follicular conjunctivitis- this is conjunctivitis complicated by follicles. All the signs of conjunctivitis are present (hyperemia, discharge, edema), but there are also superficial follicles, mainly in the lower half of the conjunctival sac; they are almost never found on the mucous membrane of the upper eyelid.

Treatment consists of eliminating the irritating factor and treating chronic conjunctivitis - washing the conjunctival cavity with a solution of mercury oxycyanide, furatsilin or potassium permanganate (1:5000). Prescribe eye drops containing 100,000-200,000 units of benzylpenicillin sodium salt in 1 ml of isotonic sodium chloride solution. A 0.25% solution of zinc sulfate in the form of eye drops is also used as an antiseptic and astringent.

Conjunctivitis of various kinds is the most common eye problem that an ophthalmologist has to deal with. One of the varieties is follicular conjunctivitis, which is chronic and develops due to prolonged exposure to the mucous membrane of the eyeball of various irritating factors, adenovirus infection, allergens, colds, chemicals, etc.

This ophthalpathology refers to granular conjunctivitis, when morphological changes occur with the lymphoid tissue of the conjunctiva and its lymphatic vessels and pathological round formations (follicles) begin to form. They are a collection of lymphocentral cells that are produced by the body and are a response to an invading infection or other irritant.

Follicular, small, translucent growths are most often localized on the inner surface of the third eyelid, in the conjunctival sac in its lower half, as well as in the connective tissue of the eye. In especially severe cases, follicular growths can cover the entire surface of the mucous membrane lining the lower and upper eyelids.

Causes of follicular conjunctivitis

The main factors predisposing to the appearance of follicular formations on the mucous membrane of the eyeball:

failures and pathological conditions in the cellular metabolism system (metabolism);
complicated conditions resulting from prolonged, severe viral or allergic catarrhal conjunctivitis;
harmful working conditions when fine dust-like media are suspended in the air of the working room. These include: coal, wood, paper, wool, cement dust. Occupational conjunctivitis in welders, workers in hot shops and various chemical industries;
existing infection of the whole body with adenovirus or herpetic infection, the presence of pathological enterovirus, measles virus, smallpox virus;
exposure to various toxic substances on the entire body and the mucous membrane of the eye;
predisposition to seasonal or year-round allergic reactions of the body to bird feathers, plant pollen, animal fur, etc.;
age-related growths in schoolchildren prone to hypertrophy of the adenoid tissue of the upper eyelid (folliculosis);
ophthalmomycosis, damage to the mucous membrane of the eye by pathogenic fungi;
foreign body getting into the eye;
bacterial streptococcal, pneumococcal, staphylococcal infections that have entered the body;
insufficient illumination of the workplace;
adverse reactions to the introduction of various ophthalmic agents into the eyes;
wearing contact lenses with high elasticity. They have a mechanical, reflex, irritating effect of the edge of the lens on the conjunctival mucosa. An adverse reaction to the solution in which they are stored is possible;
strong ultraviolet radiation;
chronic systemic, concomitant diseases - paranasal sinuses, gastrointestinal tract, helminthic infestation;
poor or low-quality nutrition, vitamin deficiencies, anemia.

Symptoms

The appearance of the follicular form of conjunctival disease is indicated by the following symptoms:

the appearance of areas with pinpoint infiltrates (fine-bubble rash), inflamed lymphatic follicles on the inner surface of the eyelid and the mucous membrane of the eye;
wrinkling and thickening of the conjunctiva;
problems with the respiratory organs: nasopharyngitis, runny nose, sore throat, sinus discharge, cough;
enlarged parotid and submandibular lymph nodes, high fever, chills;
heaviness when opening the eye due to the discharge of serous-purulent or serous-mucosal exudate from the eye (depending on the pathogen);
looseness and inflamed infiltration of the conjunctiva;
hyperemia and swelling of the conjunctiva and eyelids, pain and burning sensation in the eye;
redness or severe redness of the eyeball;
itchy pain in the outer or inner corners of the eye;
feeling of blurred vision, photophobia, lacrimation;
narrowing of the palpebral fissure (chemosis);
painful sensations of a foreign object in the eye, decreased visual acuity (especially at the end of the working day);
uncontrolled contraction of the orbicularis oculi muscle (blepharospasm).

The lesion begins in one eye, then gradually spreads to the second. In childhood, the follicular form of conjunctivitis occurs with more smoothed symptoms; if the pathology occurs against the background of colds, the symptoms of the disease are pronounced. Children aged 8-16 years can often have a follicular condition of the conjunctiva without any negative subjective sensations. This may be an age-related feature of lymphoid adenoid tissue that does not require medical or surgical treatment. Follicular hyperplasia (growth) in the conjunctival mucosa disappears over time, leaving no unpleasant marks.

Diagnostic methods

Before prescribing treatment, after studying a complete history and visual examination, the doctor will prescribe tests such as:

- diagnosing characteristic inflamed follicles using an ophthalmological microscope (slit lamp). Allows you to study in detail the surface of modified conjunctival tissues, identify their structure, depth, differentiate inflamed follicles from hyperplastic capillaries;
allergy tests - allow you to identify an allergen or several allergens that led to the appearance of pathological formation of conjunctival follicles;
electron microscopy (cytological analysis) - using a microscope, the microstructure of tissue scrapings (pre-stained) from eye discharge from the affected area of the conjunctiva is studied, and the data obtained is analyzed;
bacterial culture of a smear isolated from the conjunctiva of the eye, antibiogram - helps to determine the microflora, identify the type of pathogenic bacteria that have affected the mucous membrane;
analysis of blood serum for antibody concentrations or analysis of antibody titers to various pathogens - allows us to identify serious infections leading to follicular conjunctivitis.

Treatment methods for follicular conjunctivitis

Treatment of this ophthalmopathology requires a responsible attitude; untreated, advanced forms can significantly reduce the quality of vision and provoke serious damage to the deep layers of the eye and its optic nerve. To get rid of emerging follicles, various infiltrations and loosening of the mucous membrane of the eye, ophthalmologists prescribe general therapy, which will allow the conjunctiva to return to normal functionality and will help in its healing processes:

to prevent the proliferation of pathogenic infections in the eye area - antiseptic or antibiotic agents for washing them: mercury oxycyanide, potassium permanganate (weak solution 1:5000), Furacilin, Albucid, Tobramycin, Ofloxacin, Floxal, Vitabact;
antiviral chemotherapy and eye drops based on interferon: Actipol, Oftan Idu, Berofor, Gludantan, Poludan, Interferon, Ganciclovir, Gludantan;
to relieve painful swelling of the conjunctiva - anti-inflammatory non-steroidal or corticosteroid ophthalmic agents: Indocollir, Diklo-F, Diclofenac, Maxitrol, Dexamethasone, Sofradex, Tobradex;
if follicular growths of the upper eyelid appear as a result of damage by fungal pathogens, local antifungal drugs are prescribed in the form of eye drops, ointments, suspensions: Natamycin, Amphotericin, Ketoconazole, Fluconazole, Nystatin, Terbinafine, Ciclopirox;
ophthalmic agents (drops, gels, films) with a healing effect - Aktipol, Balarpan, Solcoseryl, Cornerigel, Vitasik, Hyphenislez;
if an allergic component is identified that provokes follicular growths of the conjunctiva, antihistamine eye medications are included in the therapeutic treatment complex: Cromohexal, Visin, Allergodil, Opatanol, Azelastine, Catotifen;
if the background for the appearance of follicles is mycotic (fungal) lesions, fungicidal or fungistatic drugs are prescribed;
restorative treatment, taking vitamin and mineral complexes.

Surgical methods

In case of deep or acute follicular lesions of the conjunctiva of the gas, and if drug therapeutic methods of treatment have not brought results, resort to invasive (surgical) methods to eliminate the disease:

Cauterization of the conjunctival area affected by the follicles. The procedure is performed in a hospital setting. Under local anesthesia, the eyelid is turned outward, and a sterile 1% solution of silver nitrate (silver nitrate or lapis) is dripped onto its affected surface. After the cauterization process, the treated area is thoroughly washed (neutralized) with saline solution of sodium chloride. The number of cauterizations is prescribed by an ophthalmologist (usually it ranges from 1, but not > 5 times at intervals of 3-5 days), and is carried out until the infiltration disappears and scar tissue forms. In the period between cauterizations, ointments or antiseptic drops are injected into the eye space, which help relieve inflammation and eliminate the risk of infection.
Curettage or surgical correction of inflamed follicles. After disinfection of the palpebral fissure, local anesthesia is administered and the affected eyelid is turned outward. Using a special miniature curette, the hypertrophied follicles are carefully scraped off, after which medicinal eye films and antiseptic ointments are placed inside. The duration of administration of these drugs is not< 7-и дней. Чтобы не спровоцировать появление тяжелых осложненных состояний (западание глазного яблока, кератит, закручивающаяся деформация третьего века) после процедуры кюретажа, нужно неукоснительно следовать всем послеоперационных назначениям хирурга-офтальмолога.

Follicular conjunctivitis in children

Various therapeutic measures, applying ointment, instilling drops or washing the eyes for this ophthalmological pathology in children, can be carried out independently. Performing procedures requires compliance with special rules:

Both eyes are always treated, even if there are no signs of disease in one of them;
for injection, use different pipettes for each eye, rinse with different sterile wipes;
the ophthalmic agents used should not be cold, but at room temperature;
in case of independent preparation of an ophthalmic agent for processing or application, it must be freshly prepared for each procedure;
if the child cannot yet follow the command to open the eye, you need to drop the product on the inner corner of the eye, a reflex will occur and the eye will open;
during therapeutic manipulation, the child should lie on his back, with his head slightly turned to the side;
before the procedure, you need to soak and remove the hardened purulent crust from the eyelids;
the upper and lower eyelids are moved apart with the thumb and forefinger, until a cavity-pocket is formed under the lower eyelid, into which the product is introduced or injected;
after the procedure, the child should blink for better distribution of the medicine, or the adult should cover the upper eyelid with his hand and lightly massage the eye socket.;
It should be remembered that the affected eye should not be covered with a bandage. Beneath it, favorable conditions are created for the rapid growth of pathogenic cells.

Prevention

To prevent chronic processes from occurring in the conjunctival mucosa with the subsequent formation of follicular growths, you should not only eliminate the cause of their appearance, but also adhere to the following rules:

do not allow the organs of vision to become overcooled;
to avoid the appearance of conjunctivitis against the background of a cold, at the slightest sign of an onset of illness, preventive eye drops should be done;
do not touch or rub the conjunctiva, eyelid, or mucous membranes of the eyes with dirty hands;
observe general sanitary and hygienic requirements and personal hygiene;
Ventilate rooms more often, especially dusty ones, and wet clean them;
try not to come into close contact with people showing signs of infection;
do not use other people's handkerchiefs or towels;
when working in hazardous conditions, you need to use personal eye protection;
support your immune system, especially if it is weakened.

Etiology of follicular conjunctivitis

The main factors in the development of such conjunctivitis are disorders that occurred in the resistance system. Various irritations intensify the disease: dusty air, smoke, foreign bodies. According to researchers, it is these reasons that first cause catarrhal conjunctivitis, which is further complicated by inflamed lymphatic follicles. Repeated studies have not confirmed either the bacterial or viral etiology of this disease.

Symptoms of the disease

Initial symptoms of the disease:

Headache;
Runny nose;
Weakness;
Sore throat;
Cough;
Chills;
Temperature increase.

Adenoviral conjunctivitis can occur in three forms:

In the catarrhal form, the inflammation is mild, the discharge appears in small quantities, and the redness is slight. The duration of the disease lasts a week, with a mild form of the course.
In the membranous form, almost 25% of cases of adenoviral conjunctivitis occur. Thin, easily removable gray-white films appear on the mucous membrane of the eye. Sometimes they may be tightly sealed to the surface of the conjunctiva and their removal may result in exposed bleeding areas. These manifestations require testing for diphtheria. After the films disappear, no traces remain, except in some cases when minor scars may remain.
With the follicular form, the mucous membrane is covered with bubbles, which can be of different sizes. A consequence of adenoviral conjunctivitis can be dry eye syndrome, which is formed due to a disruption in the function of creating tear fluid. The consequences of the disease of the follicular form are not severe, but the help of a doctor is necessary, especially when the disease occurs in children. It is necessary to take immediate preventive measures to prevent rapid outbreaks of conjunctivitis in groups of adults and children.

Treatment of the disease

Early intensive treatment is also considered as anti-epidemic measures. The diagnosis of this disease is made by an ophthalmologist after a routine examination. Along with this, the necessary treatment is prescribed. It is better not to engage in independent treatment for this disease, as this can lead to serious consequences, including complete blindness, since the type of conjunctivitis cannot be determined without the participation of a doctor.

When treatment begins, the internal causes of the disease are eliminated. Next, therapy is carried out to improve the condition. Before the intervention, anesthesia is performed with dicaine or novocaine in a 10% concentration, since the mucous membranes do not absorb novocaine well. Every five days, the follicles are cauterized with a 10% solution or a stick of silver nitrate. Cauterization must be performed very carefully, as this can cause burns to the cornea and sclera of the eye. The surface of the eyelid is turned outward, and the protruding follicles are treated with a moistened swab. The conjunctiva is immediately washed with sodium chloride solution. Antiseptic eye ointments are used between cauterizations. Cauterization is carried out up to four times.

Curettage of inflamed follicles is also effective. The palpebral fissure is anesthetized and disinfected, then the eyelid is turned outward and the inflamed follicles are scraped off. Then, antiseptic ointments or eye films with a therapeutic effect are used for a week. Surgical removal of inflamed follicles can lead to complications, such as deformation of the third eyelid. The third eyelid is not removed under any circumstances, as the eyelid may roll up and the eyeball may retract. Keratitis, ulceration and perforation of the cornea may begin. Treatment of follicular conjunctivitis with medications alone is ineffective.

What is follicular conjunctivitis?

Follicular conjunctivitis is damage to the eye membrane by a virus. The disease itself is not infectious; it cannot be considered as a separate disease or species.

Follicular conjunctivitis is manifested by several inflammatory processes at once: follicles (vesicles) appear on the conjunctiva due to exposure to an adenoviral infection.

Causes of the disease

Reasons contributing to the appearance of follicular conjunctivitis:

untreated catarrhal conjunctivitis progresses and turns into inflammation of neighboring tissues;
dusty or smoky air (near flour mills, cardboard factories, mines, etc.) causes constant irritation of the eye membrane;
exposure to intense sunlight reduces local immunity and irritates the mucous membrane of the eye;
entry of a foreign body into the eye and eye injuries cause adenoviral infection;
disturbances of local cellular metabolism.

Carefully! Follicular conjunctivitis in cats and dogs can be contagious to humans through contact.

Self-medication is strictly prohibited! This can lead to complete blindness, since it is possible to establish a diagnosis of follicular conjunctivitis and prescribe the necessary treatment only in a medical setting.

Symptoms and diagnosis

The course of the disease begins with infection of the mucous membranes of the upper respiratory tract and an increase in body temperature, and possibly enlarged lymph nodes. Apart from damage to the respiratory system and the appearance of follicular nodules, the disease is not particularly different from other forms of conjunctivitis.

This is what a sore eye looks like

Symptoms include:

sensation of itching and pain in the corner of the eye;
hyperemia and inflammation of the conjunctiva;
sensation of a foreign body in the eye;
swelling of the eyelids and heaviness when opening the eyes;
increased photosensitivity;
dry eye syndrome;
the appearance of slight eye discharge after sleep;
increased body temperature, feeling of chills;
runny nose, cough;
headache and general weakness.

Fact! Infection occurs through household contact, so epidemiological outbreaks often occur in teams, kindergartens, and families.

The disease is also transmitted from an infected eye to a healthy one. Diagnosis and treatment are made by an ophthalmologist after examining the patient, collecting anamnesis and obtaining the results of a laboratory study of the secreted secretions.

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Features of the treatment of follicular conjunctivitis

The sooner therapy is started, the more successful its results. In some cases, at the first appearance of symptoms, it is possible to stop the development of the pathological process if you strictly follow medical recommendations.

Follicular conjunctivitis in children occurs in a milder form than in adults, but also requires appropriate medical treatment.

To eliminate symptoms, use:

antiviral drugs (directly combat the causative agent of inflammation);
immunostimulants (strengthen the general background of the body);
ophthalmic drops and ointments for local antiseptic effects.

Important! If the appearance of follicles is caused by allergens (smoke, dust, honey, wool, etc.), anti-allergy therapy is carried out, and the source that provokes inflammation is isolated.

In particularly severe and advanced cases, treatment is supplemented by washing the conjunctival sac using a furatsilin solution. In the absence of positive dynamics, the follicle cauterization procedure is performed.

In case of acute inflammation, be sure to rinse your eyes

The prescription of any drugs is made exclusively by a doctor, taking into account the age characteristics of the patient and the presence of contraindications, the duration of the disease and the severity of its stage.

In the absence of the necessary treatment, the disease lasts until the necessary medications are applied.