Diseases of the teeth and eyes

A significant amount of the combined pathology of the eye and the organs of the dentoalveolar system is known: neuralgia with pain radiating into the eye, vasomotor disorders accompanied by conjunctival hyperemia, hypo- and hypersecretion phenomena, tear fluid and saliva, motor disorders, eye movements, neurotrophic lesions of the dentoalveolar system, cornea, sclera, uveal tract, retina, optic nerve, orbit.

Changes in the eye often occur with such dental diseases as caries, periodontitis, periostitis, abscesses, gangrene, periodontitis, granulomas. With dental phanulems and chronic periodontal inflammation, end extremities of the trigeminal and sympathetic nerves are irritated, which causes a pathological reflex action on the eye and other organs. The centers of pathological irritation can arise after treatment of depulled, sealed or covered with metal crowns teeth. There are cases of development of paralysis of accommodation of odontogenic origin.

The appearance of flickering, dark and light spots, asterisks, strips or fog in front of the eyes, decreased vision of different duration in some cases can be explained by reflex vascular reactions originating from dental foci.

Teething can lead to blepharospasm and conjunctival hyperemia.

Odontogenic infection can cause the development of thrombophlebitis and inflammation of the facial veins, often on the side of the caries of the upper teeth. Caries, periodontitis, abscesses, periostitis, osteomyelitis, periodontal disease, and fascula cause various changes in the eye. Sometimes the infection passes into neighboring paranasal cavities, and then affects the eye.

The cause of inflammatory diseases such as orbital cellulite, osteoperiostitis and subperiosteal abscesses of the orbit can also serve as erysipelas, furuncles and abscesses of the facial and head skin, various inflammatory diseases of the dentoalveolar system - acute and chronic perecentientes, mandibular fascial jaws, cellulitis and abscesses of the maxillofacial area and neck.

In infants, the most common cause of cellulitis is the inflammation of the upper jaw. After hematogenous osteomyelitis of the upper jaw, as a rule, defects of the lower orbital margin of the orbit with scarring of the eyelids are formed.

Acute inflammation of the orbit should be differentiated from hematogenous osteomyelitis of the upper jaw, chronic osteomyelitis of the upper jaw - from dacryocystitis, abscess of the infraorbital margin - from cellulitis of the lacrimal sac.

Malignant tumors of the paranasal sinuses, both primary and secondary (sprouting from the nasopharynx), tumors of the upper jaw of the hard and soft palate penetrate into the orbit. Thus the ophthalmologist can find out the first signs: on an eyeground as a result of compression of an optic nerve and vessels stagnant phenomena appear, there are an exophthalmus and a diplopia, and the earliest symptom is the edema of the eyelids. Especially in the mornings. With tumors originating from the main sinus, persistent headache, axial exophthalmos, decreased visual acuity, on the fundus of the eye - stagnant disc of the optic nerve.

It is possible to develop combined ophthalmic and maxillofacial tumors. The most common are hemangiomas, lymphangiomas, dermoids. These tumors can be located under the muscles of the bottom of the mouth, under the tongue, in the tongue and the root of the nose.

Congenital cleft of upper lip and palate, hypoplasia of enamel can be combined with congenital cataracts. Against the background of tetany, there is often a layered cataract and a layered distribution of enamel in the teeth.

Bilateral, often pronounced exophthalmos can be caused by underdevelopment of the upper jaw and orbit. With craniocerebral exostoses, a Mongoloid type of face, astigmatism, nystagmus, subluxation of the lens, deformation of the skull, open bite, paralysis of the cranial nerves, etc. Can be observed.

Behcet's disease. The Turkish dermatologist N. Behcet (1937) combined in one syndrome recurrent hypopion-iridocyclitis, aphthous stomatitis, ulceration of genital organs and skin lesions.

Men get sick more often and mostly at the age of 20-30. Very rarely the disease can begin in childhood.

The disease occurs suddenly, occurs in the form of seizures, which last from several weeks to several months and then recur for a long period of time - up to 25 years. Within a year, as a rule, there are 4-5 exacerbations, both eyes are affected, sometimes simultaneously, more often at different times.

The presence of all the symptoms is noted in about 1/3 _{of the} patients, more often individual symptoms manifest themselves at intervals of several months or even years. This makes it difficult to diagnose in time.

The duration of the incubation period is not established. The disease rarely begins with eye symptoms, bowl - with malaise and fever, the appearance of aft on the mucous membrane of the mouth and tongue, then there is ulceration of the genital organs.

Aphids are painful and have the form of whitish-yellowish spots, surrounded by a red rim of different sizes. More often several aphids are formed and very rarely single. Aphs disappear without leaving traces.

Aphthous stomatitis more often than other symptoms coincides with exacerbation of hypopion-iridocyclitis. Ulceration of the genital organs is manifested by small superficial ulcers, the formation of papules or vesicles, which then ulcerate. After their disappearance, pigmentation or scarring remains. At different times from the onset of the disease develops hypopion-iridocyclitis, which at each relapse is more severe. Patients noted a decrease in vision, the moisture of the anterior chamber becomes turbid, then hypopion, the iris becomes hyperemic, and turbidity of various intensities forms in the vitreous body. Hypopion first resolves quickly, as well as opacities of the vitreous. As a result of repeated attacks, posterior synechia is formed, exudate is formed in the pupil area, intraocular pressure is increased, complicated cataracts and persistent opacification of the vitreous humor develop. The process usually ends in blindness.

The disease sometimes begins with exudative chorioretinitis, neuroretinitis, periarteritis with retinal and vitreous hemorrhage, retrobulbar neuritis, papillitis, optic nerve atrophy, degenerative retinal changes. The results of a fluorescence-angiographic study indicate that in Behcet's disease there is a generalized lesion of the vascular system of the eye.

Pathological changes on the fundus are a factor determining a poor prognosis for vision in Behcet's disease.

In rare cases, the disease is accompanied by conjunctivitis and superficial keratitis with recurrent ulceration of the cornea or the presence of stromal infiltrates.

Skin lesions are manifested in the form of folliculitis, furuncles, erythema nodosum, erosive ectodermia, pyoderma.

Other symptoms are described: tra-hebronchitis, thrombophlebitis and thrombosis of the veins of the lower limbs, joint diseases like rheumatoid polyarthritis, tonsillitis, orchitis, and damage to the nervous system in the form of meningoencephalitis.

It should be noted that pain and swelling in the affected joints, i.e., arthropathy, may be the first symptom of Behcet's disease.

Diagnosis is based on a complex of clinical signs.

Behcet's disease is differentiated from sarcoidosis, encephalitis, Crohn's disease, Reiter's syndromes and Stevens-Johnson and other similar clinical illnesses.

Effective treatment is not, as well as the conventional system of treatment.

Applied treatment - broad-spectrum antibiotics, sulfanilamide preparations, calcium chloride, transfusion of odnogruppnoy blood, plasma fractional doses, globulin, corticosteroids under the conjunctiva retrobulbarno and inwards, instillation of atropine, autohemotherapy, ultrasound and dehydrating therapy, etc. - gives only a temporary improvement.

Currently, the treatment is supplemented with immunosuppressants, immunomodulators.

Sjögren's syndrome. Clinical symptoms of the disease are lesions of lacrimal and salivary glands, upper respiratory tract and gastrointestinal tract, arising against the background of deforming polyarthritis. The disease develops slowly, chronic course with exacerbations and remissions.

Complaints of patients are reduced to a feeling of rubbing, dryness, burning in the eyes, difficulty opening the eyes in the morning, photophobia, clouding, lack of tears in crying, poor eyesight and pain in the eye. In an objective study, there may be a slight hyperemia and loosening of the conjunctiva of the eyelids, a viscous discharge from the conjunctival cavity in the form of thin grayish elastic threads (mucus and deleted epithelial cells).

The cornea loses its shine, is thinned. On its surface there are grayish threads, after the removal of which there can be erosions, and subsequently develops its turbidity with ingrowth of vessels, the process ends with a xerosis. The sensitivity of the cornea does not change. With the help of the sample of Schirmer No. 1, a decrease in the function of the lacrimal glands is revealed (from 3-5 mm to 0).

After a while, after the appearance of the eye pathology, changes in the mucous membrane of the mouth and tongue are noted. Saliva becomes viscous, resulting in difficulty in speech, act of chewing and swallowing. Food has to be washed down with water. After a while, dryness develops due to a lack of saliva (sialopenia), and in a later period, a drop of thick yellowish saliva can be squeezed out of the hole of the stenococcus duct (parotid duct) with great difficulty. Later parotid glands are enlarged, which is sometimes mistakenly regarded as a symptom of mumps. The mucous membrane of the oral cavity and the red border of the lips become dry, erosions and cracks appear on the tongue. Dryness extends to the mucous membrane of the pharynx, esophagus, stomach, larynx, trachea, etc., since nasopharyngeal, buccal, gastric, tracheobronchial and other glands are involved in the process. Develop gastritis and colitis, there is hoarseness, sometimes a dry cough. Rarely affects the mucous membrane of the urethra, rectum and anal opening.

As a result of a decrease in the secretion of sweat and sebaceous glands, dry skin appears, hyperkeratosis, hyperpigmentation, hair loss can occur.

Most patients have arthropathies in the form of chronic deforming polyarthritis, subfebrile temperature, acceleration of ESR, normo- and hypochromic anemia, first leukocytosis, then leukopenia, albuminoglobulin shift, liver dysfunction, cardiovascular and genitourinary system disorders, neurological disorders.

Not all symptoms occur simultaneously, but the dryness of the conjunctiva and the cornea, the mucous membrane of the mouth and nose are permanent signs of this syndrome. The course of the disease is chronic. Always amazed both eyes.

According to modern ideas, the disease refers to collagenosis, a group of autoimmune diseases. For the diagnosis, the following procedure for performing the salivary gland function research is suggested: cytological examination of secretions, radiosialography, radiometric examination of saliva, scanning, contrast radiographic examination of glands and complete ophthalmological examination with the study of the functional state of the lacrimal glands.

Treatment is symptomatic: vitamin therapy, immuno-depressants, 5% solution of pilocarpine, subcutaneous injection of 0.5% galantamine solution, topical instillation of artificial tears, corticosteroids, lysozyme, peach and sea buckthorn oil, laser stimulation of parotid salivary and lacrimal glands .

Syndrome Stevens-Johnson. Characteristic signs of the disease are erosive inflammation of the mucous membranes of most natural openings, polymorphic rashes on the skin, feverish condition. The dominant symptom is the damage to the mucous membranes of the mouth, nasopharynx, eyes and genital organs.

The disease is more common in children and adolescents, but can occur at any age. Relapses occur in the spring and autumn. The disease is associated with focal infection, drug allergy, autoimmune processes. It often begins with the onset of headache, malaise and chills, fever to 38-39 ° C, depression or irritability, joint pain. Later, a polymorphous rash appears on the skin of the face, trunk, extremities. This is preceded by severe damage to the mucous membranes of the mouth, nasopharynx, eyes and genital organs. On the mucous membranes of the necks, gums, tonsils, throat, palate, tongue and lips, pronounced hyperemia and edema are noted with the formation of rapidly bursting blisters. Bubbles, merging, turn into continuous bleeding erosion. The tongue is enlarged and covered with a mucopurulent coating, which causes severe soreness, salivation, difficulty in speaking and eating. The lymph nodes are enlarged, especially the cervical ones.

Eye diseases are observed in all patients. Affection of the conjunctiva is manifested in the form of catarrhal, purulent or membranous conjunctivitis. Eyelids are edematous, hyperemic, glued together with abundant purulent-bloody exudate. Catarrhal conjunctivitis ends safely, leaving no consequences. With purulent conjunctivitis due to the attachment of a secondary infection, the cornea is involved in the process, surface or deep ulceration occurs, followed by scarring and sometimes perforation, resulting in partial or complete blindness. Membranous conjunctivitis is accompanied by necrosis of the conjunctiva and ends with scarring. Consequences are trichiasis, eyelid twisting, xerosis, simbelfaron and even ankiloblepharon. The ocular manifestations of this syndrome are not limited to conjunctivitis. Cases of iritis, episcleritis, dacryocystitis and even panophthalmitis are also described.

Patients are mistakenly diagnosed with measles, foot and mouth disease, trachoma, eye diphtheria, pemphigus, and smallpox.

Treatment - broad-spectrum antibiotics combined with sulfanilamide preparations, vitamins, corticosteroids, desensitizing agents, blood transfusion, immune serum. Locally used corticosteroids in the form of drops and subconjunctival injections, vitamin drops, with dryness - an artificial tear. With trichiasis, eyelid twist, xerosis, surgical treatment is indicated.

Syndrome nosoresnichnogo (nazotsiliarnogo) nerve (Charlene syndrome) - a complex of symptoms caused by the neuralgia of the nosocarillary (nasociliary) nerve - the largest branch of the first branch of the trigeminal nerve. Long ciliary nerves that go to the eyeball depart from it.

When the nosoremonic nerve irritates in the zone of its innervation, sensitivity changes (pain sensations), impaired secretion (lacrimation, increased secretory function of the nasal mucosa) and trophic disorders (in the skin and cornea) are noted.

The disease is associated with hypertrophy of the middle nasal cone, curvature of the nasal septum, adenoids in the nasopharynx, polyps, sinusitis, facial trauma.

The syndrome is manifested by sudden attacks of acute pain in the eye, around it, corresponding to the half of the head, blepharospasm, lacrimation, pains and profuse secretion from the nostrils on the side of the lesion. The attack of pain can last from 10-60 minutes to several days and even weeks. If the cause of neuralgia is not eliminated, then surface, ulcerative or neurotrophic keratitis, iritis, or iridocyclitis develop.

Treatment consists in elimination of the main cause of the disease. Subjective sensations are temporarily removed by lubricating the nasal mucosa with a 5% cocaine solution with adrenaline. Apply antibiotics, tranquilizers, painkillers, hypnotics, ganglioblokatory.

The syndrome should be differentiated from the defeat of the pterygoid and other facial neuralgia.

The syndrome of the winged nodule (Slyuder's syndrome) is a complex of symptoms caused by the neuralgia of the pterygoid node.

The pterygopalon is the formation of the parasympathetic nervous system. It contains multipolar cells and has three roots: sensitive, parasympathetic and sympathetic. Branches of the winged nerve innervate the lacrimal gland, the mucous membrane of the palate, the nasal mucosa, the posterior cells of the latticed bone and the sinuses of the maxillary and basic bones.

At the beginning of the disease, the patient has sharp shooting pain at the base of the nose, around and behind the eye, in the eye, in the upper and lower jaw, in the teeth. Pain radiates to the temple, ear, neck, shoulder, forearm and hand. The most intense pain in the area of the orbit, the root of the nose and the mastoid process. Duration of pain from several hours and days to several weeks.

At the time of the attack, the patient also complains of a burning sensation in the nose, sneezing attacks, runny nose, watery eyes, drooling, dizziness, nausea, asthma attacks and taste distortion.

On the part of the eyes, sharp photophobia, blepharospasm, lachrymation, upper eyelid edema, conjunctival hyperemia, midi-az or miosis, sometimes a short increase in intraocular pressure (IOP) occur. The disease can last for a long time, sometimes months and even years. In the interictal period, there is often a dull pain in the area of the upper jaw, the root of the nose, the orbit, and the edema of the affected half of the face may remain.

Neuralgia of the pterygoid node is associated with perifocal infection of the paranasal sinuses and oral cavity, infection in various parts of the head (purulent otitis, cerebral arachnoiditis), with nose injuries, hypertrophy of the shells and curvature of the nasal septum, peritonsillar abscesses, allergies.

The cause may also be tumor tumors.

In contrast to the syndrome of the nasocyli nerve, there is no anatomical change in the anterior segment of the eyeball when the pterygoid node is affected. Increased sensitivity of the nasal mucosa concentrates in the posterior nasal cavity. Differentiate also with other facial neuralgia.

During an attack, cocaine blockade is recommended in the area of the pterygopalon. Treatment should be directed primarily at eliminating the underlying cause of the disease.

Assign painkillers and protivostoevye funds, corticosteroids, anti-infective therapy, ganglioblokatory, cholinolytic drugs and physiotherapy procedures, biogenic stimulants.

Ciliary node syndrome (Hageman-Pochtman syndrome) occurs with inflammation of the ciliary unit located behind the eyeball (12-20 mm) between the beginning of the external rectus muscle and the optic nerve. From the ciliary unit to the eye 4-6 short cilp nerves depart.

The disease appears suddenly with pains in the head and depth of the orbit, which give teeth and teeth in the jaw. Pain can increase with movement of the eyeball and pressure on it. They can irradiate into the corresponding half of the head. Duration of pain from several days to several weeks.

Patients with unilateral mydriasis with the right round pupil shape, absence of pupillary reactions to light and convergence, weakness or paralysis of accommodation, corneal hypoxaemia, epithelial edema and a transient increase in ophthalmotonus are noted in patients. Rarely does optic neuritis develop. The syndrome is usually one-sided. Usually it passes in 2-3 days, sometimes in a week and later. The longest is the paralysis or the paresis of accommodation, which is sometimes the only evidence of the process being transferred. Relapses are possible.

The causes of the disease are inflammation in the paranasal sinuses, teeth, infectious diseases, trauma or contusion of the orbit.

Treatment: sanation of the paranasal sinuses, the oral cavity, ganglionic blockades, corticosteroids, vitamin and pyrotherapy, dimedrol, novocaine retrobulbarno, topical quinine with morphine, vitamin drops.

Marcus-Gunn syndrome. Paradoxical movements of the eyelids are a one-sided ptosis that disappears when the mouth is opened and the jaw moves in the opposite direction. If the mouth opens more, the eye gap may become wider. When chewing ptosis decreases. The syndrome can be congenital and acquired, more often observed in men. With age, it can become less pronounced.

With the acquired disease, paradoxical movements of the eyelids appear after trauma, tooth extraction, facial nerve injury, brain concussion, encephalitis, and trauma. It is assumed that there is an abnormal connection between the trigeminal and oculomotor nerves or the nuclei of these nerves. Sometimes this syndrome is considered as a result of violations of corticobulbar bonds.

There are accompanying changes in the organ of vision and the body as a whole (paralytic strabismus on the side of ptosis, epilepsy with rare convulsive seizures, etc.). Treatment is mainly surgical - elimination of ptosis.

The syndrome of Martin Ama is a syndrome. Reverse Marcus-Gunn syndrome, - the lower eyelid is lowered when the mouth is opened. Ptosis also appears during chewing. The development of paradoxical synkinetic movements is preceded by peripheral paralysis of the facial nerve.

Mikulich disease is a symptom complex that is characterized by a slowly progressing symmetrical, often significant increase in lachrymal and salivary glands, by shifting the eyeballs downward and inside and protruding them forward. Eye movements are limited, sometimes there is diplopia. The skin of the eyelids is stretched, can be cyanotic, enlarged veins are visible in it, and hemorrhages are noted in the thickness of the eyelids. The conjunctiva is hyperemic. On the fundus there are sometimes perivasculitis, hemorrhages, stagnant disc or neuritis. The disease develops slowly, for several years. It begins more often at the age of 20-30 years with the gradually increasing swelling of the salivary and then lacrimal glands, sometimes the process spreads even to the small glands of the oral cavity and larynx. Swollen large glands are mobile, elastic, painless, with a smooth surface. Suppuration of glands never occurs. Lymph nodes are involved in the process. Pathological changes are manifested in the form of lymphomatosis, less often granulomatosis of lacrimal and salivary glands. Treatment depends on the alleged etiology of the disease. In all cases, the use of arsenic and a solution of potassium iodide inside is indicated.

The disease is differentiated from the chronic productive parenchymal inflammation of the salivary gland, salivary stone disease, salivary and lacrimal gland tumors, Sjögren's syndrome.

The Sturge-Beber-Crabbe syndrome is an encephalotrigeminal syndrome characterized by a combination of cutaneous and cerebral angiomatosis with ocular manifestations. Etiology is a congenital neuroectodermal dysplasia. Cutaneous angiomatosis can be congenital or develops in early childhood in the form of angiomas of the face, often located on one side of the face along the first and second branches of the trigeminal nerve. The coloration of the foci in infancy is pink, then becomes bluish-red. Angiomatosis of facial skin often extends to the skin of the eyelids, conjunctiva and sclera. Angioma can develop in the choroid, sometimes a retinal detachment, respectively, localization of the angioma occurs. As a rule, the syndrome is accompanied by glaucoma, which occurs with a slight hydrophthalmic. Symptoms of brain damage are manifested in the form of mental retardation, clonic convulsions, epileptiform seizures, recurrent hemiparesis or hemiplegia. Possible hemangiomas in internal organs. Endocrine disorders are also noted: acromegaly, obesity.

Treatment - X-ray therapy, sclerosing therapy, surgical treatment of cutaneous angiomas, treatment of glaucoma.

The prognosis for life is usually unfavorable because of severe neurological complications.

Cranio-facial dysostosis (Cruson's disease). The main symptom is a bilateral, often significant exophthalmus, due to underdevelopment of the upper jaw and orbit.

Also there are divergent strabismus, an extension of the nose root area, hypertelorism. On the fundus there are congestive discs of optic nerves with subsequent secondary atrophy due to narrowing of the optical channel or increased intracranial pressure due to synostosis of most cranial sutures. Observe the Mongoloid type of the eyes, astigmatism, nystagmus, congenital subluxations of the lens, hydrophthalmic, cataracts. Of the other symptoms, there are deformities of the skull type of the tower, the beak-like nose, short upper lip, epileptic seizures, impaired sense of smell and hearing, mild mental retardation. Cruson's disease is sometimes combined with an open bite, syndactyly brushes and feet.

The disease is regarded as a family-inherited anomaly of the skull. Treatment - surgical bone plastic.

Mandibulofacial dysostosis (Franceschetti's disease) is a family-hereditary syndrome characterized by a variety of maxillofacial anomalies in various combinations. From the side of the eyes oblique "antimongoloid" eye slits (bilateral omission of the outer corner of the eye gap), eyelid colobals, epubulbar dermoid, paresis of oculomotor muscles, rarely microphthalmus, congenital cataracts, vascular cord, optic nerve column are noted.

From the side of the maxillofacial system there is hypoplasia of the bones of the face, which leads to a significant asymmetry of the face, a sharp underdevelopment of the teeth.

Often there is aplasia of the ears, hyperplasia of the frontal sinuses, splitting of the bones of the face and deformation of the skeleton. Sometimes there is an increase in the tongue, absence of the parotid gland, hydrocephalus, heart damage, etc. Along with the typical forms of the syndrome, there are also atypical ones, in which there are only a part of the symptoms.

Meyer-Schwickerat-Grüterich-Weieres syndrome (near-digital-digital dysplasia) - combined lesions of the eyes, face, teeth, fingers, hands, feet. Eye symptoms - epicanthus, narrow eye slits, ptosis, bilateral microphthalmia, anomaly of the iris in the form of anterior leaf hypoplasia, congenital glaucoma. On the part of the teeth - generalized dysplasia of the enamel with brown staining of the microdenity and oligodentia. A face with a small nose, hypoplasia of the wings of the nose and a broad bridge of nose. From limb abnormalities should be noted the change of the skin between the fingers, the square appearance of the middle phalanx of the little finger, hypoplasia, or the complete absence of middle phalanges of several fingers, nail dystrophy or their absence. There may also be microcephaly, nose changes, hypotrichosis, and skin pigmentation deficiency.

Rieger's syndrome is a legacy ectomeodermal dysgenesis of the iris and cornea, combined with tooth-jaw changes. From the side of the eye there may be a megalocorrhoea or a microcornea, a flat cornea, the remains of a mesenchymal tissue in the corner of the anterior chamber, marginal splices of the posterior surface of the cornea with the anterior surface of the iris, deformity of the pupil, atrophy of the iris with the formation of through defects, glaucoma. Possible congenital cataract, coloboma of the iris and choroid, strabismus, dermoid cysts near the limb, abnormalities of refraction of a high degree.

Of the common manifestations there are a wide nose bridge, a hypoplasia of the upper jaw, cleft palate, oligodentia, a conical shape of the front teeth, dysplasia of tooth enamel, hydrocephalus, malformations of the heart, kidneys, spine. Some patients have short stature due to a deficiency of growth hormone.

Type of inheritance is autosomal dominant.

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