Eye Diphtheria
Last reviewed: 23.04.2024
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[Causes and epidemiology of eye diphtheria
The causative agent of diphtheria is Leffler's wand that secretes exotoxin. The source of infection is a sick person or a carrier. Currently, the main source of infection are bacterial carriers, which can be healthy people. Leffler's wand is excreted from the body of a patient or carrier with pharyngeal and nasal mucus. The transmission path is airborne.
Pathogenesis of diphtheria of the eye
The causative agent, having penetrated the body, remains in place of the entrance gates (zev, upper respiratory tract, conjunctiva), causing necrosis of the mucosa with the formation of fibrinous films tightly welded to the underlying tissues. Exotoxin, secreted by the rod, causes both local and general signs of the disease, absorbed into the blood, it damages various organs.
Symptoms of diphtheria of the eye
The incubation period is from 2 to 10 days. Children are more often ill 2-10 years. Clinically, several forms of the disease are distinguished: diphtheria of throat, larynx, nose, eyes, combined forms. Diphtheria of the eye refers to rare forms and is mostly combined with the diphtheria of the upper respiratory tract. Very rarely is there a primary independent diphtheritic lesion of the skin of the eyelids and the mucous membrane of the eyes (Figure 15).
Diphtheria of the skin of the eyelids arises after injury or in the presence of diphtheria of pharynx, nose, and eye mucosa. It is characterized by hyperemia of the skin of the eyelids and the appearance of transparent vesicles. Bubbles quickly burst and in their place remains grayish scab, which gradually increases and turns into a painless ulcer. The outcome is cicatricial changes, leading in a number of cases to deformation of the eyelids.
Diphtheria conjunctivitis occurs more often than the skin of the eyelids and can clinically manifest itself in various forms: diphtheritic, croupous and catarrhal.
The most severe is the diphtheritic form. It begins with a sharp edema, densification and hyperemia of the eyelids, especially the upper one. The eyelids are so dense that they can not be turned out. Detachable from the conjunctival cavity is insignificant, mucopurulent. After 1-3 days the eyelids become softer, the amount of detachable increases. Characteristic of the appearance of films dirty gray color, tightly welded to the underlying tissue, on the mucous cartilage of the eyelids, transitional folds, in the intercostal space, on the skin of the eyelids, sometimes on the mucous membrane of the eyeball. When you try to remove them, a bleeding and ulcerated surface is exposed. 7-10 days pass from the appearance of films to their independent rejection. During the period of rejection of the films, the separated becomes purely purulent. In the outcome of the disease on the mucous membrane, stellate scars form. Sometimes the fusion of the eyelids with the eyeball develops (simbelfaron). There may be a twisting of the eyelids, trichiasis. One of the most serious complications of diphtheria conjunctivitis is the appearance of corneal ulcers due to disruption of its trophism, the impact of diphtheria toxin, the layering of pyogenic infection. In some cases panophthalmitis may develop, followed by wrinkling of the eyeball. According to EI Kovalevsky (1970), this form of the disease occurs in 6% of cases of diphtheria of the mucous membrane of the eye.
Significantly more often there is a croupiform form (80%). With croupous form, inflammatory phenomena are less pronounced. Films are formed mainly on the mucous membrane of the eyelids, rarely - transitional folds. They are tender, greyish-dirty, superficial, easily removed, exposing a slightly bleeding surface. In place of films, scarring remains only in rare cases. The cornea, as a rule, is not involved in the process. The outcome is favorable.
The most easy is the catarrhal form of diphtheria conjunctivitis, which is observed in 14% of cases. With this form of films there is no, only congestion and puffiness of the conjunctiva of different intensity are noted. General phenomena are not very pronounced.
The diagnosis of conjunctival diphtheria is based on the general and local clinical picture, the data of bacteriological examination of smears from the mucous membrane of the eye, nasopharynx and an epidemiological anamnesis.
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Differential diagnosis of eye diphtheria
The disease must be distinguished from a filmy pneumococcal, diphtheria-like form of adenoviral conjunctivitis and epidemic conjunctivitis of Koch-Weeks. The first is characterized by catarrh of the upper respiratory tract or pneumonia, the presence of pneumococci in the separable conjunctival cavity. Diphtheria-like form of adenovirus conjunctivitis in a number of cases also occurs with the formation of films and clinically resembles a diphtheria or croupous form of the diphtheria of the eye, but unlike the latter, the patient develops upper respiratory tract catarrh, there is an increase and soreness of pre-premature lymph nodes; mainly infants and young children. Films with diphtheria-like form of adenoviral conjunctivitis are gray, tender, easily removed. Detachable is very poor, mucopurulent and does not contain Leffler's sticks.
The epidemic Koha-Wicks conjunctivitis is more common in areas with a hot climate. Films of yellow-brown color. Characterized by pronounced chemosis of the mucosa, subconjunctival hemorrhages, hyaline mucosal regeneration, respectively, the open eye gap. When bacteriological examination, Koch-Wicks sticks are found.
It should be noted that with diphtheria, complications can occur from the "side of the organ of vision." These are, first of all, toxic lesions of the oculomotor nerves, leading to paralysis of accommodation, ptosis, the development of strabismus (usually convergent), as a result of paresis or paralysis of the abduction nerve. When paralysis of the facial nerve is observed lagophthalmos. Toxic diphtheritic optic neuritis in children is rare.
When diagnosing diphtheria of any localization, the leading role belongs to bacteriological research, which is carried out in bacteriological laboratories. Usually, mucus is examined from the pharynx, nose, separated from the conjunctival cavity, etc. The material should be delivered to the laboratory no later than 3 hours after taking. Bacteriological study (staining smears with aniline dye) is used only as a preliminary method. It is not sufficiently informative because of the frequent presence of a xerosis rod in the conjunctive cavity, which is morphologically similar to a diphtheria rod.
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Treatment of diphtheria of the eye
The patient with diphtheria of the eye is sent by special transport to the infectious hospital. Treatment begins with the immediate introduction of antidiphtheria antitoxic serum according to the method of Bezredki. The amount of serum administered depends on the localization of the process and the severity of the disease. With localized diphtheria of the eye, as well as pharynx and nose, 10 000-15 000 AE (for a course of up to 30 000-40 000 AE) are administered, with the diffused diphtheria the doses are increased. Along with the serum, antibiotics of the tetracycline series, erythromycin in the dose levels for 5-7 days are prescribed. Disintoxication therapy (hemodez, polyglucin), vitamin therapy (vitamins C, group B) are shown. Prior to the application of local eye treatment, it is necessary to take a detachable from the conjunctival cavity, from the surface of the film for bacteriological examination. Local treatment of the eyes consists in frequent washing of the eyes with warm disinfectant solutions, instillation of solutions of antibiotics, laying ophthalmic ointments with antibiotics of the tetracycline series over the eyelids. Depending on the condition of the cornea, midriatics or myotics are prescribed.
If a diphtheria is suspected, the patient is hospitalized in the diagnostic department of the infectious hospital, where the examination is conducted and the diagnosis is clarified. The cabinet, where the patient was taken diphtheria, is subject to special disinfection.
Prevention of diphtheria of the eye
Prevention of diphtheria of the eye consists in isolation, timely and correct treatment of patients with diphtheria of the upper respiratory tract, active immunization, early detection of bacterial carriers and their treatment.
The prognosis for diphtheria of the eye is serious because of frequent complications from the cornea.