Fungal infection of the eyelids

Massive granuloma-like, with a tendency to ulceration and the formation of fistulas by a knot that can be taken for suppurating chalazion, aspergillosis of the eyelid manifests itself.

Similar to aspergillosis on clinical grounds, nodes are sometimes observed with a localized lymphatic form of the sporotrichosis of the eyelids. However, sporotrichosis usually forms under the skin of the ciliary edge of the affected eyelid (subcutaneous form) slowly increasing inflammatory nodules. Fusing, they permeate with fistulous moves, ulcerate and then, according to N. Heidenreich (1975), resemble gummies or collibacative tuberculosis. Regional lymph nodes are enlarged, but painless. The course of the disease is chronic. Diseases of the eyes are almost always preceded by the siorotrichosis of the mucous membrane of the mouth, where the fungi are brought from plants on which they saprophyte. Using grass blades instead of toothpicks, their snacking or chewing leads to such a mycosis.

Eyebrows and eyelashes are prone to favus disease (scab ), which usually develops in patients with favus of the scalp and, much less often, as a disease only in the eyelids. Against the background of hyperemic skin in the eyebrows and the ciliary edge of the eyelids, small vesicles and pustules appear, followed by the formation of yellowish saucer-like crusts - scutes (scutes). In the center of such a crust is a hair or a cilium, thin, brittle, covered with bloom. When you try to remove scutum, the skin under it bleeds, and after healing there are scars; on the eyelids, true, barely noticeable. Scots, like the yellowish points preceding them, consist of fungal masses.

The surface trichophytosis (ringworm), caused by anthropophilic species of the trichophytons, appears mainly on their smooth skin with pinkish rounded foci ("plaques"), the edges of which are raised by a roller covered with knots, pustules and crusts ("curb"), and the center is pale and flaky. The disease is more frequent acute; rational treatment of its foci can be eliminated in 9-12 days. In chronic course, long-term therapy is required. Ciliated edges of the age of trichophytosis are very rarely affected. In the literature, only a few cases of "trichophytic purulent blepharitis" are described. Possible trichophytosis of the eyebrow area with damage to their hair.

With a deep trichophytosis of the eyelids, caused by zoophilic trichophytons, the infiltrative-suppuration process develops in the form of follicular abscesses. N. Heidenreich describes them as granulation-like soft, red, crusted and fistulous passages that leave scars after healing.

Trichophytosis often affects school-age children, who are affected by the scalp, smooth skin, nails. Among patients with chronic trichophytosis, 80% are women. Trichophytosis of the eyelids, as a rule, develops against the background of a common lesion. Features of its clinical picture, the identification of the pathogen, often detected by microscopy of hair, especially gun, positive reaction with trihofitin facilitate the recognition of the disease.

Very severe lesions of the eyelids are caused by radiant fungi of actinomycetes. The process is more often secondary, spreading into the eye area from the oral cavity (carious teeth). The pathological focus captures not only the eyelids, but also the forehead, the temple, and the edema extends to the entire half of the face. Against the background of the edema, more pronounced at the outer corner of the eye fissure, a large granuloma forms, the suppuration of which leads to the appearance of fistulas with a thick yellowish granules (drusen of the fungus) with thick purulent discharge. Without treatment, the healing granulomas are replaced by new ones. The process can spread to orbit, or, conversely, from the orbit passes to the eyelids.

In addition to direct infection with fungi, allergic processes caused by these irritants are possible on the skin of the eyelids. As E. Fier (1966) points out, fungal allergies are suspected of eyelid diseases, which are difficult to cure antibacterial and other therapies. The likelihood of allergy increases in patients with foci of chronic fungal infection. It was noted above that the allergic nature of the age-related lesion of the fungus confirms its rapid (even without local therapy) cure after the elimination of fungal foci. These diseases are manifested in the form of fungal-allergic blepharoconjunctivitis or eczema of the eyelids. The first disease has no noticeable symptoms that would distinguish it from banal blepharitis; the conjunctiva is more often interested. Fungal-allergic eczema of the eyelid is more often observed in women, and its initial foci, according to E. Fier, are mycosis of the vagina. Less frequently, the foci are the fungus, sometimes "interdigital itching", chronic mycoses of legs and nails hiding under the dentures and bridges of teeth in the mouth. Clinically, such eczema is characterized by puffiness of the eyelids, hyperemia, peeling, itching, brownish-red skin coloration. Patients have positive samples with fungal antigens. The disease often causes fungi of the genus Candida, sometimes trichophytons.

In the literature, individual observations of the development of blastomycosis, mucormycosis, rhinosporidosis, and other fungal lesions have also been described.

Fungal diseases of the tear ducts are more often manifested by canaliculitis, which occurs with hyperemia of the conjunctiva in the region of the lacrimal canals, by disturbances of the lachrymation, and secretions from the canal of pus. The content in the last grains or crumbs is suspiciously puffy, the tubule widening at some point, the formation of a chalazion or barley resembling from the outside, and when extracting a gray or yellowish calculus as large as rice grains, almost always indicates fungal damage, as evidenced by laboratory research.

Concrements form aspergillas, penicillas, trichophytons, actinomycetes and other fungi.

The introduction of fungi into the lacrimal sac leads to its chronic inflammation. For the diagnosis of fungal dacryocystitis, a systematic examination of the contents of the bag or material obtained by dacryocystorhinostomy or extirpation of the label coming through the lacrimal pathways is required.

It is possible that the fungal infection is one of the causes of recurrence of dacryocystitis after its surgical treatment.

Fungal conjunctivitis, apparently, is more often seen than is diagnosed, as often occur against the background of mycosis of the eyelids or cornea and in such cases are evaluated as concomitant irritation of the conjunctiva. Only more pronounced hyperemia and edema of the conjunctiva, the detection in it of particles similar to the grains or infarcts of meibomian glands of inclusions, or similar to granulations of growths, as well as the ineffectiveness of antibacterial and other therapies make one think of mycosis of the conjunctiva. Studies of concrements and granulations, less often smears and scrapes, in such patients fungi can be found.

The noted changes are characteristic of sporotrichosis, rhinosporidosis, actinomycosis, conjunctivitis coccidioidosis, whereas penicillas cause the formation of ulcers with a greenish-yellow coating (Pennicillium viridans) on its surface, floccate-like formations can be observed in coccidioidosis, and pseudomembranous conjunctivitis is characteristic for candidiasis, aspergillosis and other fungi. In some cases, the fungal conjunctivitis that occurs with the formation of nodes is accompanied by a pronounced reaction of the lymph nodes, causing diseases similar to the Parino syndrome, where the lymph nodes can be inflated, and fungi can be contained in the pus. As a bilateral blepharoconjunctivitis with small erosions and ulcers of the conjunctiva and cornea, and sometimes with concrements ("plugs") in the lacrimal canals, cephalosporiosis of the conjunctiva proceeds. Candida albicans, less often penicillas, aspergillas and mucoras, producing antigens in the out-of-focus foci, cause the development of fungal allergic conjunctivitis.

[1], [2], [3]

Risk factors

Infection with specific infectious mycoses, including especially dangerous fungal infections (histoplasmosis, blastomycosis, moldy fungal infections), accompanied by severe sensitization. Fungal lesions of the eyes are often found in various situations, accompanied by suppression of cellular immunity.

[4], [5]

Pathogenesis

Surface and deep palpebricosis can be caused essentially by any pathogenic and conditionally pathogenic for human fungi, with eyelids often transfer to conjunctiva and the eyeball , penetrate into the orbit, although it is possible to reverse their spread. More often than other mycoses, there are lesions of the age of Candida albicans. In the eye area, this yeast-like fungus is carried from the soil, transmitted from person to person or comes from the primary foci of candidomycosis in the cavities of the mouth, nose, and conjunctiva. With infection and reduced resistance of the body, a disease occurs that is manifested by inflammatory hyperemia and edema of the eyelid skin, sometimes with a pasty edema. Against the background of hyperemia and edema, small pustules are formed, and in the thickness of the eyelids reddish-brown nodes similar to barley or chalazion are formed, prone to ulceration. More often such nodes are observed in patients in whom mycosis was preceded by a prolonged receipt of antibiotics. In the purulent contents of the nodes, an agent is found.

[6], [7], [8]

Symptoms of the fungal infection of the eyelids

Common common mycoses are described, the entrance gates for which the conjunctiva served.

Actinomycosis, the most common of fungal eye lesions, causes radiant fungi of actinomycetes, close in their properties to anaerobic bacteria. Actinomycetes are widely distributed in nature: in the air, on plants and in humans on the skin, mucous membranes, in caries and intestines.

Defeat of the skin of the eyelids can be primary, exogenous and secondary as a result of metastasis of the fungus into the skin from foci in the internal organs. Actinomycosis of the eyelids is characterized by the appearance of dense, painless nodules, further deep infiltrates, surrounded by a skin of a paid (woody) consistency over a certain length of time. Nodules soften in the center and are opened, on the infiltrates there are fistulous orifices, from which pus, containing the filament of the fungus, is secreted. Fistulas are long-term non-healing.

Aspergillosis causes mold fungus, often asymptomatic on healthy skin and mucous membranes. According to the clinical course, aspergillosis resembles tuberculosis.

Blastomycosis. The causative agents of blastomycosis are various yeast-like fungi that live in the soil, in the places of nesting pigeons, in sheds, stables. They are present on the skin and mucous membranes, in urine and feces of patients with this mycosis of humans and animals. The clinic is dominated by deep systemic lesions of the organ of vision - usually secondary phenomena.

The lesion can be isolated or combined with a skin candidiasis. On the skin of the eyelids there are papules, erosions, ulcers, the surface is moist, slightly wet, the sores are covered with a white or yellowish coating. An itch disturbs. Papules and ulcers sometimes spread over the face. The disease can be accompanied by deformation of the edges of the eyelids and eyelid twists. The course is often long, chronic.

Histoplasmosis is a systemic deep mycosis that mainly affects the reticuloendothelial tissue, in the cells of which small yeast-like elements of the fungus-mycoplasma accumulate.

Candidamycosis causes yeast-like fungi that are found on fruits, vegetables, fruits and other products in stagnant waters, on the skin and in the gastrointestinal tract of both healthy and sick people and animals. Eye damage can be isolated or combined with candidiasis of the skin, mucous membranes, internal organs (especially the digestive tract and lungs) or with generalized candidiasis. Combined lesions are possible - microbial and fungal.

Mucorosis causes fungi, widespread in the environment, often found on vegetables, fruits, hay, cotton. Mucous membranes of the mouth, respiratory tract, genital organs, digestive tract are more often affected. The defeat of the orbit and, more rarely, the cornea is secondary.

Rhinosporidosis is a rarely encountered deep mycosis, the causative agent of which has been little studied. The disease manifests itself in polynomial and polynucleus-ulcerous formations on the mucous membrane of the nose, nasopharynx, conjunctiva, eyelid, in a lacrimal sac.

Sporotrichosis causes filamentous fungi - sporotrichum. The source of infection is soil, some plants, grass, as well as sick people and animals. This is a deep, chronic mycosis that affects primarily the skin, subcutaneous tissue, often eyelids and conjunctiva. Characteristic is the damage to the skin of the eyelids in the form of dense, painless, slowly growing nodes. The skin above them is purple. Over time, the nodes soften, fistula is formed, of which yellow-gray pus is separated.

[9], [10], [11]

Diagnostics of the fungal infection of the eyelids

Diagnosis requires isolation of the pathogen.

[12], [13], [14]

Treatment of the fungal infection of the eyelids

Candidomycosis of the eyelids is treated with the lubrication of the foci with brilliant green, the administration of nystatin or levorin, the application of them topically in the form of ointments, creams, lotions on the eye bases. In a conjunctival bag instilled solutions of nystatin, amphotericin B.

Treatment of aspergillosis of the eyelids is carried out locally and intravenously with amphotericin B, amphoglucamine is administered internally, and locally fungicidal ointments.

In case of sporotrichosis, the best effect is produced by iodine preparations, in particular potassium iodide, administered orally 3-6 g daily for 4-5 months. Nystatin, levorin, and amphotericin B were also tested with positive results.

When phavus is effective griseofulvin, appointed inward. The skin in the eyebrows and eyelashes area is smeared with 0.5-1% ointment of copper sulfate or 1% with yellow mercury ointment, or in the morning they are lubricated with 3-5% alcohol solution of iodine, and at night they apply and lightly rub the ointments.

For the treatment of trichophytosis of the eyelids, griseofulvin is administered orally at a rate of 15 mg per 1 kg of body weight, of course, in the absence of contraindications. The drug is given daily until the first negative result of the study of fungus hair and scales, then the patient receives the same daily dose every other day and 2 more weeks after 2 days for the third. At the same time, local iodide therapies: foci are lubricated with 5% tincture of iodine, and in the evening with ointments containing sulfur. Recommended lotions from 0.25% and 0.5% solution of silver nitrate, a solution of ethacridine lactate (rivanol) 1: 1000. Eyebrows should be sheared, and eyelashes epilated. In connection with the possibility of stratification of pyogenic flora at the beginning of treatment for 5-7 days, sulfonamides are used.

Actinomycosis of the eyelids, in contrast to other fungal diseases, is treated with the most common antibiotics and sulfonamides. Parenterally, penicillin is prescribed in high doses for 6 weeks or more, or tetracycline, erythromycin, broad-spectrum antibiotics that give the best effect. Solutions of these same agents wash the cavities of abscesses. Sulfanilamidy appointed instead of antibiotics with insufficient effectiveness of the latter. Inside, it is recommended to take potassium iodide. The peculiarities of therapy confirm the validity of attribution of lesions by actinomycetes not to true, but to pseudomycosis.

In the treatment of fungal-allergic instances, the main thing is the sanation of the out-of-focus foci of mycosis, with indications - the fight against secondary infection, the appointment of common desensitizing agents, specific desensitization with fungal antigens.

Fungal canal canals are quickly cured by dissection of affected tubules along their length and removal of fungal masses (scraping). Less often, additional stamping of the dissected tubule with an alcohol solution of iodine or silver nitrate is required.