Tenonite

Tenon capsule is a dense fibrous barrier that separates the fatty body of the eye socket from the eyeball. Inflammation of this capsule is called "tenonitis": a similar disease is polyethiologic and, as a rule, secondary - that is, caused by an inflammatory or allergic process in other tissues and organs.

Epidemiology

Inflammatory processes affecting the organs of vision are considered one of the most serious problems in clinical ophthalmology, because the inflammatory reaction can cause dangerous and often irreversible disturbances in the eye tissues.

According to medical statistics, inflammation of various eye tissues is the most common ophthalmopathology. According to some reports, 80% of patients are temporarily incapacitated, and in 10% of cases the disease leads to a complete loss of vision.

Tenonitis does not occupy a leading position among the frequent infectious lesions of the organs of vision: leading places belong to conjunctivitis (about 67%), blepharitis (about 22%), keratitis (5%), iridocyclitis, choroiditis. Therefore, the disease can be safely attributed to the category of relatively rare eye pathologies, as occurs tenonitis less than 1% of cases.

[1], [2], [3]

Causes of the tenonite

One of the most common causes of the development of tenonitis is the presence of an inflammatory reaction in other parts of the organ of vision. Thus, tenonitis becomes a secondary disease. Inflammation can go from such pathological foci:

• corneal ulcers;
• anterior uveitis (iridocyclitis);
• inflammation of the inner shells of the eyeball (endophthalmitis);
• inflammation of all shells of the eyeball (panophthalmitis).

Not so often, but still possible development of tenonitis due to acute respiratory viral infection, scarlet fever, erysipelas, mumps. Infectious agent is beta-hemolytic streptococcus group A, influenza virus.

Serous tenonitis can form as a consequence of syphilis or chicken pox.

Purulent tenonitis develops with hematogenous or lymphogenic bacterial metastases.

Medicine describes cases of development of pathology in patients who are in the active phase of the rheumatic process, or suffering from collagenoses.

Tenonitis can become a complication after surgical operations in patients with cataracts, strabismus, phacoemulsification, and also after penetrating damage to the organs of vision.

[4], [5], [6]

Risk factors

The risk factors that accelerate the development of tenonite can be:

• state, accompanied by a decrease in immunity;
• constant use of contact lenses;
• dry eye syndrome;
• craniocerebral, eye trauma;
• the state of vitamin deficiency in the body;
• allergic processes (spring catarrh, pollinosis, etc.);
• metabolic disorders, endocrine pathologies (obesity, diabetes, etc.);
• chronic systemic pathologies (rheumatoid arthritis, gout, etc.).

[7], [8], [9], [10], [11],

Pathogenesis

The eyeball is placed in such a specific structure as the tenon capsule. Thanks to this structure, the apple is movable and fixed in the center. At the site where the cornea is attached to the sclera, the capsule is adjacent to the conjunctival stroma. The sclera and the capsule are united by Tenon space, which allows free rotation of the apple. On the back surface, the capsule is attached to the sclera by means of connective tissue fibers.

Tenon capsule has its own system of ligament apparatus, which consists of fascial leaves and processes. For the equilibrium function of oblique ocular musculature, the Lockwood ligament is responsible, which, as it were, is woven into the capsule. The eyeball rotates at a certain amplitude: if this amplitude increases, then both the eyeball and the capsule are displaced simultaneously.

The tenon bursa forms the so-called episcleral (supravaginal) space - a system of cavities in loose episcleral tissue.

Through the capsule to the eyeball there lie the eye nerves and muscle fibers. Its anterior segment is attached to the apple, and the posterior part is adhered to the fatty tissue. With a network of ciliary nerve fibers and arterial vessels, the Tenon capsule is in tight contact with the optic nerve.

In front of the bursa, straight eye muscles penetrate, giving the muscular shell a helical appearance.

Due to the peculiarities of the structural organization, any inflammatory or allergic process affecting closely located tissues can become one of the causes of the development of tenonitis - be it a bacterial or viral infection, a trauma. Against the background of a weakened immune system, inflammation spreads to nearby structures.

[12], [13], [14]

Symptoms of the tenonite

By the nature of the clinical course, the serous and purulent form of tenonitis is isolated. If the lesion is extensive, then the inflammatory reaction can spread throughout the tenon space: when a small area is affected, they speak of a local tenonite.

The disease is acute or subacute. The acute onset is accompanied by patients' complaints about the feeling of squeezing out the eyeball, a marked pain in the affected eye, which is amplified by movement. Soreness gives to the frontal and superciliary zone. As a rule, only one of the organs of sight is affected.

On the second or third day after the first signs of tenonitis appeared, the stage of marked clinical symptoms begins. The feeling of extrusion is replaced by exophthalmos. The motor ability of the eyeball is severely limited, diplopia may occur. In the area of the orbital conjunctiva and eyelids, there is swelling, while no pathological discharge, like lachrymation, is observed.

Patients complain of severe photophobia. The general condition with tenonitis is disturbed, but insignificantly - this is an important diagnostic sign, indicating the absence of general intoxication of the body.

Stages

Tenonitis can have several inflammatory stages:

1. The alterative stage at which initial tissue damage occurs.
2. Exudative stage, accompanied by accumulation of fluid in the Tenon space.
3. Proliferative stage (or reparative).

Acute tenonitis lasts, as a rule, from several hours to several days.

Subacute tenonitis can last several weeks.

[15], [16], [17], [18], [19],

Forms

Distinguish tenonitis of allergic etiology (serous inflammation) and metastatic (purulent) tenonitis. The process can be acute or subacute, which is determined by the corresponding clinical picture.

• Serous tenonitis is accompanied by conjunctival chemosis and a slight exophthalmos. This type of disease is more favorable; Clinical symptomatology is observed for several days, after which the patient's condition improves. The quality of visual function, as a rule, does not suffer.
• Purulent tenonitis is the most unfavorable form of the disease, which is often accompanied by perforation of the conjunctiva in the zone of attachment of the ocular musculature. Purulent lesions can be complicated by cyclitha, iridocyclitis, optic nerve damage.

Autoimmune tononite

The human organs of vision are reliably protected by immunity from infection. However, sometimes the components of immunity themselves are capable of stimulating the development of an inflammatory reaction. His cellular memory is present in the eye for a long time, and causes a relapse of the inflammatory process with the next contact with the pathogen.

In addition, immunity is also activated during molecular mimicry, when certain bacteria masquerade as body structures. This feature can have, for example, chlamydia.

The influence of external factors sometimes triggers painful autoimmune reactions that cause damage to organs and systems.

Inflammatory eye diseases are often accompanied by autoimmune pathologies in the human body. Sometimes, tenonitis can be the first sign of a disease. However, more often it appears after other systemic manifestations.

Autoimmune tenonitis has its own characteristics:

1. the disease has a predominantly acute course;
2. there is a bilateral defeat, in contrast to bacterial inflammation (the eyes can be affected not simultaneously, but after a while).

Most often, autoimmune tenonitis is combined with damage to the skin, joints, lungs.

[20], [21]

Complications and consequences

Timely treatment, which is prescribed at the initial stage of development of tenonitis, can prevent an unfavorable outcome of the disease. In some cases, long-term consequences may occur as a limitation of the motor ability of the eyeball, optic nerve atrophy, amblyopia.

Against the background of a progressive and widespread purulent inflammatory process, panophthalmitis, meningitis, cerebral abscess, and generalized sepsis, threatening the death of the patient, may occur.

Virtually all negative consequences and complications can be avoided, provided that you seek medical help in a timely manner and follow all medical recommendations.

[22], [23], [24]

Diagnostics of the tenonite

Anyone, even the most experienced medical specialist, can prescribe correct and effective treatment only after receiving the results of a comprehensive diagnosis. To make the diagnosis - in particular, tenonitis - correct, the doctor will necessarily examine the affected eye with the help of an ophthalmoscope and a slit lamp, check the visual function, and measure the intraocular pressure. To identify an infectious agent, several relevant laboratory tests should be carried out.

In case of suspicion of tenonitis the following diagnostic measures may be most popular:

• Lab tests:

1. PCR analysis of scraping taken from the conjunctiva and the cornea;
2. PCR blood test to determine the quality and quantity of the pathogen of tenonitis;
3. bakposov eye eye with the definition of the sensitivity of the pathogen to antibiotic therapy;
4. allergic tests;
5. microscopic examination to exclude fungal disease or demodectic disease.

• Instrumental diagnostics:

1. computed tomography (performed CT of the orbits, which is the receipt of a layered image of the cavity of the eye socket in three projections);
2. ultrasound examination in B-mode (provides for the reception of echoes reflected from the eye structures);
3. visometry (quality control of visual function);
4. tonometry (measurement of intraocular pressure).

During the external examination, a small exophthalmos, eyelid swelling and reddening of the conjunctiva are found. The degree of exophthalmos is the first or the second.

With a difference in the indices of the height of the standing of the eyeballs, more than 2 mm is spoken of as a one-way process.

When probing the projection zone of the pathological focus, painful aggravation is observed. The image obtained during computer tomography, indicates the presence of liquid in the Tenon space.

Ultrasound examination helps to determine the nature of the exudate:

• serous fluid prone to spontaneous resorption;
• the purulent content gradually increases in volume, after which it breaks into the conjunctival cavity.

The quality of the visual function for vasimetry usually corresponds to the reference parameters. With purulent tenonitis, intraocular pressure may increase.

[25]

Differential diagnosis

Differential diagnostics makes it possible to distinguish tenonitis from the myositis of the external musculature of the eyeball, as well as from the episclete and scleritis.

With myositis, pronounced exophthalmos are observed, with clear photophobia and sequelae.

Epicleritis, scleritis, tenonitis - these diseases require a special diagnostic approach due to the common clinical picture. Distinctive features are:

• severe reddening of the conjunctiva of the orbit;
• presence of symptoms of inflammation on the external connective tissue ocular membrane;
• photophobia.

If there is an eye phlegmon, then there are also signs of general intoxication: fever, headache, general deterioration.

[26], [27], [28]

Treatment of the tenonite

Treatment of the disease can be different, depending on the type of tenonitis, as well as on the individual characteristics of the patient. If serous tenonitis developed as a result of an active form of rheumatism, then it is mandatory to administer glucocorticosteroid preparations. The method of administration, as a rule, is selected subconjunctival or retrobulbar.

In the proven infectious origin of tenonitis, injecting antibiotic therapy with a wide spectrum of activity is mandatory.

Surgical treatment is used in purulent tenonitis. The operation involves general anesthesia, autopsy and further installation of drainage in Tenon space. After the operation, systemic antibiotic therapy is prescribed.

Subacute flow can be treated with physiotherapy procedures. Standardly used UHF-therapy, diathermy, dry warming. With rheumatic tenonitis, electrophoresis with glucocorticosteroid preparations is shown.

In addition to general treatment, immunostimulants can be prescribed.

Medicinal treatment

The first thing the treatment is directed at eliminating the causal disease, which led to the development of tenonitis. Further, the pathology is directly treated, depending on its shape.

• Serous tenonitis:

1. instillations of corticosteroids (suspension 0.5-2.5% Hydrocortisone, solution 0.3% Prednisolone, 0.1% dexamethasone solution);
2. Sofredeks are drops for the eyes.

• Purulent tenonitis:

1. intramuscular injection of benzylpenicillin in a dosage of 300 thousand units up to 4 times a day;
2. orally Sulfapyridazine 500 mg to 4 times a day with a further decrease in the frequency of admission up to 2 times a day;
3. orally Ampiox 250 mg, Oxacillin 250 mg, Metacyclin h / 300 mg, or Ampicillin 250 mg;
4. orally Indomethacin to 0.025 g, or Butadion to 0.15 g three times a day.

To avoid side effects in the treatment of corticosteroids, the withdrawal of drugs is carried out gradually, for several days.

Antibiotic therapy usually lasts 7-10 days, after which it is necessary to re-pass tests to clarify the dynamics of the infectious process. Prolonged use of antibiotics is not recommended.

The intake of non-steroidal anti-inflammatory drugs can be accompanied by disorders of the digestive system, so this treatment is often supplemented with drugs that protect the gastric mucosa from damage.

Vitamins

The best way to get all the necessary vitamins is a varied and nutritious diet, with the predominance of plant products. If you can not diversify your diet for various reasons (for example, with diseases of the digestive system), then the doctor can prescribe tableted multivitamin preparations that will help, in particular, with tenonitis. If you trust the reviews, then the most effective are the following vitamin complexes:

• Ophthalmo is a special combination of vitamins and minerals to support the function of the eye. The composition of the drug includes 8 vitamin and 6 mineral components.
• Doppelherz with lutein - contains a number of vitamins, as well as lutein and zeaxanthin. This drug can be taken only by adult patients.
• Super Optics is an effective combination of B-group vitamins, minerals and trace elements, polyunsaturated and monounsaturated fatty acids and amino acids. This complex is designed to improve vision in people after 40 years.
• Vitrum vizhn is a complex of vitamins and minerals with plant components: the preparation is represented by zeaxatin, lutein and anthocyanosides of blueberries.

One of the listed drugs is taken according to the instructions. It is not necessary to take two or more multivitamin complexes at once, since such an approach can lead to an overdose of vitamins.

Physiotherapeutic treatment

The treatment scheme often includes the appointment of physiotherapy procedures. Significantly improve the state of local thermal effects.

• Diathermy is a method that involves the action of alternating current with parameters of 1 MHz, up to 3 A. The procedure helps to increase blood circulation in tissues, improve trophic and reduce pain. Do not use diathermy with purulent tenonitis.
• UHF-therapy implies the impact of an alternating electric field of ultra-high frequency, deeply penetrating into tissues. The method has anti-inflammatory, vasodilating, analgesic, anti-edematous and bacteriostatic effect.

Heat therapy, electrophoresis, diadynamic therapy, ultrasound and massage are shown. In accordance with the appointment of a doctor, treatment begins with thermal procedures followed by electrophoresis sessions.

At the regression stage, a cautious massage of the affected eye with therapeutic ointments is practiced.

Alternative treatment

Tenonitis is a rather specific disease, and not every folk healer knows how to deal with it correctly. However, alternative recipes for getting rid of tenonite still exist. True, use them is recommended only against the background of general medical treatment, which is prescribed by the doctor.

• With tenonitis, lotions with croton broth and honey are effective. To prepare a decoction of 1 tbsp. L. Plants pour 200 ml of hot water and stand on low heat for about five minutes. Next, the product is filtered and 1 tsp is added. Honey. Wet the cotton pad in the medicine and apply to the affected eye for 10 minutes.
• Make lotions based on fresh cucumber juice, boiled water and baking soda, in equal proportions. The lotions are kept on the affected eye for 10 minutes.
• Grind 10 grams of althea rhizome, pour 1 liter of boiling water and insist in the thermos for an hour. The infusion is filtered through several layers of gauze and used to wash the eye three times a day.

It should be noted: if the condition worsens during treatment, it is necessary to consult a doctor.

[29], [30], [31]

Herbal Treatment

• With severe symptoms of tenonitis before going to sleep, apply to the affected eye wadded disks, impregnated with a warm broth from dill seeds. The procedure lasts about ten minutes, and the total duration of treatment is two weeks.
• Take the leaves of ordinary burdock, rinse with running water, scroll through the meat grinder and squeeze the juice. The juice is cleaned through several layers of gauze and drips into the affected eye one drop every morning and in the evening. Duration of treatment is one week.
• Select sprouted potatoes, remove from it sprouts - one tablespoon of such sprouts is needed. Raw materials are poured into 200 ml of vodka, insist for a week. Drink 1 tsp. Three times a day after meals.
• Take equal amounts of blueberries and dogrose. Sleep in a thermos 3 tbsp. L. Raw materials, pour 600 ml of boiling water, close and leave overnight. The next morning, strain and drink 150 ml 4 times a day for half an hour before meals.
• Take 3 tbsp. L. Chemist's chamomile, pour 200 ml of boiling water, insist for about an hour, filter. Use the infusion to rinse the affected eye, several times a day.

Homeopathy

The undoubted advantage of homeopathic drugs is the impossibility of causing harm to the patient: due to small dilutions, such drugs practically do not cause side effects and overdose.

The following preparations are used for tenonitis in dilutions of C3, C6.

• Aconite - in the acute period of tenonite take 5-8 granules (or drops) every half hour.
• Belladonna - in the acute period is used similarly to Aconite.
• Mercury is prescribed for 6-8 granules (or drops) up to 4 times a day. The drug can be combined with the Belladonna.
• Gepar sulfur is prescribed for 4-5 drops twice a day (the drug is especially recommended for purulent tenonitis).
• Arsenic take 6-8 drops in the morning and evening. You can alternate every other day with Gepar Sulfur.

Before you decide on any of these drugs, you must first get a consultation with a specialist in homeopathy: dosage adjustment can not be ruled out depending on the constitutional characteristics of the patient suffering from tenonitis.

Prevention

The basis of any prevention is hygiene, which includes, among other things, organs of vision. If you do not follow the hygiene rules that are available for everyone, then the infection will have a much greater chance of penetrating into the tissues and giving a boost to the development of the inflammatory process. Therefore, to monitor the purity of the face and eyes - especially those who use contact lenses, it is necessary.

Those who work at a computer for a long time should periodically do special and uncomplicated visual gymnastics. It consists of such exercises as the rotation of the eyeballs, the translation of the view into the distance and close, upward and downward. To improve local circulation, you can also rub your ears, whiskey and neck.

The general state of health is greatly influenced by lifestyle and nutrition. In case of violations related to these factors, immunity is weakened, therefore, when creating favorable conditions for infection, tenonitis will develop more rapidly.

• It is necessary to eat well and fully.
• You should forget about smoking, alcohol and other bad habits.
• It is advisable to move more, more often to be outdoors.

And one more important moment of prevention is the prevention of eye injuries. When working with different mechanisms, dust, paints, wear protective goggles, in order to prevent foreign substances from entering the organs of vision.

[32],

Forecast

The quality of the prognosis depends on the timeliness of the diagnosis of tenonitis, as well as on the usefulness of the treatment. Patients who have been diagnosed with this type of diagnosis should visit an ophthalmologist twice a year for follow-up examinations.

If a patient has frequent relapses, then he is prescribed a therapeutic correction - a second treatment course.

The pathology also affects the quality of the prognosis. The most favorable outcome is usually subacute serous tenonitis: possibly even elimination of the disease without subsequent organic disorders. As for purulent tenonitis, the outcome depends on how timely the diagnosis was. With early detection and adequate treatment of the disease, the prognosis is positive.

[33]