Fungal lesions of the eye: causes, symptoms, diagnosis, treatment

Lesions of the organ of vision of a fungal infection are known for more than 100 years. For a long time this pathology was considered very rare, the fungus species dangerous for the eyes were counted in units, the publications about the diseases caused by them were predominantly casuistic. However, since the 1950s, reports of such diseases have become more frequent. Often, a significant number of observations are given, previously unknown fungal eye lesions are described, and new fungal flora are called for by ophthalmologists, clinic, diagnosis and prophylaxis are specified, more effective methods for treatment of ophthalmic infections are suggested.

Currently, up to 50 species of fungi are considered pathogenic for the organ of vision. The most important of them are yeast-like, molds, dermatophytes, etc.

In most patients with ophthalmic infections, fungi are introduced into the eye tissues from the environment or are brought in from mycotic foci on the skin and mucous membranes of other parts of the body, less often from these and deeper sources by hematogenous way. Exogenous infection with fungi usually causes mycosis of the appendages and anterior part of the eyeball. Endogenous skid often causes severe intraocular processes.

Great importance in the inoculation of the fungal infection in the tissues of the eyelids, conjunctiva and the eyeball has the damage of the latter, more often minor abrasions and erosion, superficial foreign bodies of the conjunctiva and the cornea, especially the derivatives of the plant world. For example, of the 33 FMs observed, Polack et al. (1971) of patients with keratomycosis only 4 had no eye damage in the anamnesis. Inside the eyes fungi penetrate with perforating wounds. Most often ophthalmic diseases affect rural residents, workers of grain elevators, granaries, mills, cotton gins, weaving mills, feed shops, cattle breeders, etc.

Fungal diseases appear more easily and are worse, especially in early childhood, with the weakening of the body due to common infections, eating disorders, metabolic disorders. For such patients pathogenic become even the most harmless fungi - human saprophytes.

Unlike infectious diseases of the eyes of bacterial and viral genesis in fungal diseases, drug therapy is ineffective. All authors of one of the important causes of fungal eye disease growth in recent decades unanimously recognize the widespread, not always rational, local and general use of antibiotics and corticosteroids for the treatment of a wide variety of human diseases.

The validity of this opinion is confirmed by clinical observations and experimental studies. Thus, N.V. Nema in co-authorship. (1968), after monthly treatment of conjunctivitis, found a previously lacking fungal flora in the conjunctival sac in 41.2% of patients treated with hydrocortisone and in 28.7% of patients receiving tetracycline. Similar data are given by L. Nollimson et al. (1972) for betamethasone and neomycin. According to I. I. Merkulov, antibiotics disrupt the antagonistic relationship between bacteria and fungi in favor of the latter, and corticosteroids reduce the protective capacity of tissues. In addition, some fungi, in particular Candida albicans and Aspergillus niger, grow better and become more pathogenic in the presence of corticosteroids. The growth of fungi, especially Candida albicans, is also promoted by B vitamins.

The noted features of fungal infection are characteristic not only of eye processes; they are manifested in many other localizations of mycoses. Nevertheless, for ophthalmologists it is important that the organ of vision does not represent exceptions to the general patterns of damage to human fungi. If the eye inflammatory disease developed in the eyes of the patient with eye inflammation against the background of mycosis of other parts of the body, the disease was preceded by even a minor trauma, according to the conditions of life and work the patient could become infected with fungal infection, and the attempt to treat antibiotics, sulfonamides, corticosteroids was unsuccessful To suspect an ophthalmomycosis. In cases where the clinical picture of eye disease "is characteristic of fungal damage, the above factors are additional data. However, in order to establish an accurate diagnosis of ocular mycosis, it is necessary to isolate the fungal culture, determine its type, confirm that it was this pathogen that caused the eye disease in this patient, the sensitivity of the isolated culture to antimycotic agents. Quick and unambiguous answers to the questions you ask can not always be obtained. In general practice, the etiology of eye disease is often estimated as mycological only on the basis of anamnestic data, a clinical picture of the ocular process, the detection of the out-of-focus foci of mycosis and trial treatment with antimycotics. Naturally, with this approach, some ophthalmic diseases, especially when they are layered into viral and bacterial diseases of the eye, remain unrecognized. To laboratory mycological studies with suspicions of ophthalmic infections it is desirable to resort as often as possible.

Despite the variety of pathogens and manifestations of fungal lesions of the eye, their clinic is characterized by some common qualities. Thus, the incubation period from the time of the introduction of the fungal infection until the appearance of the first signs of the eye disease ranges from 10 hours to 3 weeks. Symptoms tend to develop slowly, and the process is often chronic, with no tendency to spontaneous remission. There are always external manifestations of inflammation expressed in different degrees: hyperemia, purulent discharge, infiltration and ulceration of tissues, delayed repair of defects. A number of fungal invasions of the eye are inherent in the formation of nodes like granulomas in the skin of the eyelids, conjunctiva, orbit, the vascular tract, their suppuration with the appearance of fistulas, skin bridges, the presence of fungus in the separated granules from the mycelium, the formation of concretions in the lacrimal ducts and glands of the conjunctiva, their yellowish or grayish-yellow coloration, etc. At the same time, most of the fungal infections of the eye are characterized by individual differences, depending on the type of fungus, localization and prevalence of the lesion, before estvovavshego mycosis tissue condition, general health, reactivity, even hereditary predisposition to fungal diseases. The first group of signs facilitates the general diagnosis of mycosis eye, the second helps to suspect a certain type of fungus, which is important when choosing methods and means of treatment.

Histologically, in the preparations and sections of the eyes affected by fungal tissue, violations of the integrity of the epithelium and the perforation of its cells, nonspecific granulomas from leukocytes, lymphocytes, histiocytes, epithelioid and other cells, pskrobio.ch and dystrophic changes around such granulomas are determined. With the help of special stains (Gridly, Gomori, etc.) in such preparations, as well as in scrapings with ulcers of the conjunctiva and the cornea, mycelium and spores of the pathogen are often found. Some species of fungi, for example Candida albicans, cause only leukocyte and eosinophilic infiltration of membranes and suppuration of internal; environments of the eyeball.

Fungal pathology of the eye and its auxiliary apparatus is determined not only by the direct introduction of pathogens into their tissues. Often develops as an allergic reaction to fungal allergens, coming from distant from the eye mycotic foci. With persistent, years of non-curing eye processes, such foci are found under the crowns and bridges of teeth in the mouth, in the interdigital folds of the legs, in the vagina. Sometimes the cause of the allergy was onychomycosis. A sharply expressed reaction to trichophytosis (skin test) and rapid recovery of eyes to eliminate ectopic foci are strong evidence of the allergic nature of this pathology.

[1], [2], [3]

Treatment of fungal diseases of the organ of vision

Treatment of human fungal diseases as a whole is currently carried out primarily by special antimycotics, the arsenal of which is significant, and the effectiveness is quite high. Timely begun and conducted by purposefully chosen in accordance with the clinical data and features of isolated cultures of pathogens, therapy is most successful. More often than not other means of such therapy in general mycology resort to antifungal antibiotics: nystatin, active against yeast-like and mold fungi, amphotericin B and amphoglocamine affecting coccidioidosis causative agents, cryptococcosis, blastomycosis, molds and other fungi, levorin affecting the fungi of the genus Candida, griseofulvin, effective in epidermophytia, trichophytosis, microsporia. Among the other fungicides active on fungi, decamine and decamethoxin, useful in candidomycosis, nitrofurilene, nitrofran, esulan, amikazol, and ointments "Tsinkundan" are used, mainly in dermatology. "Undecin" and a number of other drugs.

Assigning general treatment with fungicidal drugs should be strictly guided by the said manual, since many of these drugs, especially amphotericin B, griseofulvin, etc., are highly toxic. To their appointment there are many contraindications, they require compliance with a number of conditions of their application. Eye forms of fugistatikov for topical application are: eye drops (0.25%, 0.5% and 1%) and eye ointment (0.5%) amphoteric B, eye drops (1% and 2.5%) and ophthalmic ointment (2.5%) levorin, eye drops (1%), injectable solution for conjunctivitis (1-2.5%)) and ophthalmic ointment (5%) of nystatin. Injection solutions for amphotericin B conjunctiva (0.015 g in 0.2 ml of water), eye drops of grisamine (0.5%) and dekamine (0.1%) are listed in the reference book on ophthalmology, published in 1967. Using the data in these handbooks are prescribed, ophthalmologists have the opportunity to supplement the general treatment of ophthalmic infections with the local administration of the most effective antifungal agents, sometimes limited only to local treatment, and also use these funds to sanitize the conjunctival cavity from fungal flora. Successfully tested in ophthalmology, electrophoresis of antifungal agents.

When treating certain types of fungal infection of the organ of vision, the drugs of iodine, aniline dyes, disinfectants used for a long time have not lost value. Often good results are provided by surgical interventions from simple scraping of foci and opening of abscesses to keratoplasty and vitreoectomy.