Kerato conjunctival xerosis yak likuvati. Horny conjunctival xerosis (diagnostics, clinics, lykuvannya)

30-08-2012, 15:04

to describe

Їх look at a glance from the analysis of zagalnyh for SSD key signs.

Global Clinical Signs of Dry Eye Syndrome

I will show you how to do it, the SSD of a different ethological affiliation can be contradicted in different forms for the severe clinical forms, but itself -

• in the lungs,
• middle grade of gravity,
• important
• and especially important.

Horny conjunctival xerosis in mild form characterized by the obvious microscopic signs of ailments in ailments, since before that they develop on aphids in a compensatory incremental production. The insult to the surroundings and often serve as the cause of pardon diagnostics, but the doctor leads far in the direction of the right cause of the apparent pathology.

As a rule, in the eyes of the pupils, in the main, on lacrimation It’s okay to do it when the unwelcoming factors of the world’s environment are injected into the eye. They do not have a lot of fun and not in the power of the SSD to improve, and not to change the height of the lower and upper tears, but in some cases - to the extent of Tears.

When there are microscopic signs of developing horns-conjunctival xerosis, then the stench of the blisters appeared in 154 ailments (Table 4 and 5).

Table 4. Sub'-active signs of dry eye syndrome, which are contrary to light (I), moderate (II), important and especially important (III) forms and frequency of occurrence (in%; n = 811).

Table 5. Indicative signs of the dry eye syndrome, which is contrary to the lungs (I), moderate severity (II), important and especially important (III) forms and the frequency of their occurrence (in%; n = 811).

For a short differentiation of representations of stigmas, they were respected for the specific, Tobto are characteristic only for SSD, i indirect, Scho start to see if the eyes become ill.

When looking at the ailments, I especially respect the slides of the beasts, viciously, for the emergence of specific stigmata STS both sub'active, so і objective character... It is even more characteristic, as we have established, a negative reaction of the ailments to the zakopuvannya in the conjunctival emptying whole indifferent day drops (0.25% razchin levomycetin, 0.1% razchin dexamethasone and in.). Vona є inherited an opinion in the assessment of the acceptance of the letter and the issue. Zakopuvannya, however, in a new lust for the grateful specks, for example, 20% of the range of sulfacyl sodium, supervises the appearance of sudden swelling pains.

It is very specific, it is a little bit thin with mild xerosis, microscopic signs of SJS serve typically seen from conjunctival emptying... When toilets, there is a lot of viscosity in the eyes of thin mucus threads, it is heavy to be carried by the ailments. Prior to the speech, the appearance of such a vision is indicative of those who, in the conjunctiva of the cells of Bechera's cells, still retain their function.

Krym of specific microscopic signs, in ailments with mild horny-conjunctival xerosis, one hour at a time indirect symptoms... Unimportant to those who stink at the same time and when there are a number of eyes that are ill, they still need to be respected if patients are mature enough to develop STS. With all the manifestation of one of these symptoms, which are not explained by the other reasons for the local nature, in the same way, a straightforward situation is being carried out.

The main part of the table presented in the table contains all the sub-active symptoms of illness. Among them, the most close to specific microscopic signs of horny-conjunctival xerosis a symptom of bad tolerance to vіtru, Conditioned food (especially with victorian fan heaters), dima and I can. Often, spending a short hour on a sick person in a "smoky" environment will lead to a sharp development of a new healthy discomfort, which can take a long time for a change in the situation. There are fewer characteristics of the skarg of patients with such a pathology for the death until the evening of the healthy age and the number of guests, since before that they were already bound because of the sharpness of the other key manifestations of SSD.

Prior to the change in disease by indirect signs of DES, it was also diagnosed and diagnosed in 21.8% of such ailments. included in the sl_znu plyvka These are small breasts to be slipped off, surplus of epithelial threads, bulbs and small microchastins. The stench swims at the lazy pudding, the lukewarm menus and the lower conjunctival zodiac, redeeming on the food of the horns with the blinking collapses of the capital. All included is kindly in the light of the lamp. However, the process of obstruction of the cold water is not strictly pathognomonic for the SSD, so as it is one of the most important healthy peopleі in children with ailments with chronic conjunctivitis and blepharoconjunctivitis.

Clinical interruption of horny-conjunctival xerosis the middle stage of severity begins, as a rule, the microscopic signs of horny-conjunctival xerosis, as a rule, are described. However, the frequency of the appearance and the steps of the turnover can be easily transformed in case of mild xerosis. In addition, the ailments of the given group are already grateful during the day reflexively With the obvious signs of scarg and active symptoms, and there are clear signs of a deficiency of synovial production (Div. Table 4). Dawn, in such ailments it is easy to change, because there is an increase in the daytime near both sides of the capital of the men (div. Table 5). A whole characteristic symptom appears in the process of biomicroscopy of the anterior view of the eye, altogether obov'yazkovo from the arch of the eye. A short time of the day borrow a loan, the conjunctiva has grown and darkened, "napovza" to the wilderness of the capital. The slid means that 29.5% of patients have skarg when they see "dryness" in their eyes.

Among the nonspecific microscopic signs of corneal conjunctival xerosis of the visible degree of severity, which appear when looking at the organ of the eye (div. Table 5), with special respect to merit bulbar conjunctiva with the "crawl" її to the wilderness of the lower povіk (so the titles of conjunctіvochalazіs) and "blatant" hyperemes. With the blinking collapses of the capital, the part of the changing conjunctiva often shrinks through the adhesion at once with the lower curl.

Important horny-conjunctival xerosis To develop most often in three key forms - "nitric" keratitis, "dry" keratoconjunctivitis and recurrent microerosis.

"Nitchastі" keratitis characterized by statements on the horns of single, and often of many epithelial growths of threads, fixed with one end to the epithelium of the horn (Fig. 16).

Small. 16."Nitchastі" keratitis in a patient with SS.

Vilny end of such a "thread" to wager on horny eyes, when superimposed on horny syndrome, ale, as a rule, without fiery symptoms of conjunctiva. In some blinking places of the century, the walls grow large, so that the patient can see such "threads" from the eye. At the їkh mіsci, erosive mailing lists are set up, self-hosted for 2-3 dB. Naturally, "filamentous" keratitis is superfluous and already described as microscopic signs of horny-conjunctival xerosis (div. Table 4-5), which occur in such ailments in the future.

"Dry" keratoconjunctivitis, The order of signs of "filamentous" keratitis and microscopic signs of xerosis, manifest itself swelling of horns and conjunctiva and an ignition-degenerative character... At the same time, changes in the relief of the surface of the horns at the viglyadi saucer-shaped epithelialized or non-nutritive gagged, sub-epithelial, clouded, "filamentous" steps, the filamentous stages, are discouraged. Vona is drawn into the ranks of vipadkiv as well as blisk, becoming dark and short. Most often, the zone of superficial perilimbal vascularization is expanding. Bulbar conjunctiva of darkness, spontaneous "blasphemy" hyperemia and embryo near the provinces. When you are small, you will be flooded with capitals, wandering around the apple in the big world, not in healthy people. The reason for this manifestation is the "fierceness" of the bulbar and tarsal conjunctiva, in this chi іnshіy world of the lethargic veil. Perebіg incapacitation chronic, with frequent sharpening and remissions.

recurrent microerosis are characterized by periodic occurrences of surface microdefects in the feed line. However, it is unimportant on a small area, such eroses can be reached (up to 5 dB or more), they are often eaten. A characteristic "horny" syndrome, which changes with trivial discomfort after the end of the episode of erosion. However, even after 2-3 months., And once before, get sick and start to relapse.

Especially important horny conjunctival xerosis to develop a weakness in ailments with more or less frequent non-micanisation of intramural schilines in cases of lagophthalmos of a growing genesis, or because of a shortness in the organism of Vitamin A.

Keratitis is caused by non-micania of intramural spine to reach a good dermal practitioner, and that does not require a report description. It is necessary to deprive the mother of the uvaz, but in the weakened ailments it is you can speed up the development of the twist with the offensive perforation of the horn (div. fig. 19).

Small. 19. The name of the sick D., who is suffering from autoimmune ophthalmopathy (explained in the text).

Xerophthalmia on the ground with rotated avitaminosis A develop in different classy forms. On this day, the pathology is typical, mainly, for residents, especially children, who live in the provinces of the Great Patriotic War, as well as in some regions of Africa, Near Descent and Latin America. However, the appearance of ailments with such gross manifestations of full-time xerosis is possible, in principle, in our land. The urgency of this problem is related to the high mortality rate of such ailments, which can reach 35% -60% of the number of all types of xerophthalmia. At the same time, according to the data of the VOOZ, from the number of children, they saw close 25% to get lost in sleep, 50% -60% - to occasionally sleep and only in 15% -20% healthy functions do not get bogged down in the fake. Symptoms of xerophthalmia develop when there is vitamin A in the blood plasma lower than 10mkg / 100ml and low reserves of it in the oven... In patogenezі danoї patologії lezhit nedorozvinennya yak epіtelіalnih so smut, i kelihopodіbnih klіtin kon'yunktivi, diferentsіyuvannya yakih in normі regulyuyut metabolіti vіtamіnu A. rezultatі zmenshuєtsya Quantity povnotsіnnih kelihopodіbnih klіtin i rozvivaєtsya luskata metaplasia of epіtelіyu away keratinіzatsіya kon'yunktivi. The description of the main nosological forms of autonomous xerophthalmia is induced lower.

conjunctival xerosis I show myself the appearance of a normal glossy blisk of bulbar conjunctivi, like a call to a nagaduє visk or a dry farb. On the surface, if the child is not crying, I do not have to wet myself with the drops of xerosis at the viglyad "pischanikh milin for an hour". Smells are found in the most beautiful bends dysfunction of the cells of the conjunctiva... At the far advanced stage of conjunctival xerosis, the milk grows with a dark papillary calyx, it is provocative and elasticity (Fig. 17).

Small. 17. Diffuse conjunctival xerosis full-time apple(According to the type of "shagreen shkiri") in a sick person, who is suffering from A.

In such vipads on the bulbar conjunctiva, vertical folds of the riser step are established (more noticeable in the lower half). Most significant changes in the boundaries of the open school. A characteristic, albeit non-viscous, manifestation of swollen conjunctival xerosis is the manifestation of the so-called Iskersky-Bito plaques (Iskersky K.K., 1860; Bitot G., 1863). The stench is silver-gray "nalipki" with a piney surface, Pіdnyatі above the іvnem of the conjunctiva (Fig. 18).

Small. eighteen. Xerotic plaque of Iskersky-Bito on the bulbar conjunctiva of the patient's eyes with a small swelling in the body of A.

The big-mensh plaques are easy to see, they are stunning in front of a xerotic conjunctiva with a short surface. The plaques are visible on the bulbar conjunctiva, often at once on both eyes from the frontal side, closer to the edge of the internal slit, so that there, de "erase" the ruins of the capital of the border. Most often, the plaque is nagadu oval with a horizontal horizontal axis, and inodі її is thrown out in the vertical folds of the conjunctiva. Varto mean scho Iskersky-Bito plaques characteristic not only for conjunctival xerosis in children who develop on the ground deficiency in vitamin A. Voni also develop in older adults with dry eye syndrome, and later will appear lower.

Parenchymal xerosis of hornivka There is a special need for the conjunctival. The surface of the horn is swollen, shaggy appearance and intricate blisk and tactile sensitivity. The growth of the filtration of the stroma stroma grows to the point of being cloudy, often in the lower parts of the bluish-milky viglyad. In some cases, an aseptic hypopyon is present in the anterior chamber.

Xerotic flyback It is seen as an acute corneal bend by the concomitant signs of xerosis of the horns and the appearance of an ignition reaction (if it did not come with an infection). With a large ruined stroma, descemetocele is not a bar;

keratomalacia is a shvidkoplinny rozrіdzhu necrosis okremikh spherіv or navіt all comrade horns, yaka "tanya", transformed into a kalamut draglista masu svitlo-zhovtoy koloru. After settling in the defect, the inner shell of the intramuscular apple grows, endophthalmitis develops. Rice-like keratomalacia є weak flare reaction to cob stages process. Have children early vik keratomalacia develops especially quickly, and sometimes it occurs when there are characteristic xerotic changes of the conjunctiva.

The order of the already discernible signs of illness, with a lack of vitamins A, are also spared and so called. Secondary symptoms: hemeralopia and so called xerophthalmia full-time(Bili and zhovtі zlivnі vognischa, roztasovani in comrade sits, the color of which changes to red-brown).

In such a rank, in greatness of its own (mabut, behind a vignette of vipadkiv of a swollen xerosis) key picture SSD characterized by a great number of nonspecific symptoms... If only signs, pathognomonic for this pathology, come into the background. To that, only a retinal analysis of all the clinical manifestations of corneal arteries-conjunctival xerosis allows such ailing correct diagnosis and immediately acknowledge your love.

Clinical characteristics of nosological forms of the dry eye syndrome

Demonstrate the MTRs in a classy way, next to the first for all the indications of the signs and symptoms in the symptomatology and clinical interruption of the STS, which is vicious ethiological factors... So, syndromic horny-conjunctival xerosis, accumulation of organisms, endocrine and immune disorders, develop in general, Manifesting themselves with a spat of periodically wobbling and weakly swirling sub-active distributions of a nonspecific character. At the end of the cycle, such ailments first grow up to the oculist, as a rule, even through a few months, or to find the rocky results of the actual diagnosis of the first manifestations of the SSD. perebіg sickness In a large number of cases, they are accompanied by periodic sharpening and remissions, which may be tied to the same dynamism of the main ailment, which was triggered by the SSD.

The clinic of symptomatic horny-conjunctival xerosis is the first for all by the nature and intensity of the flow of the vicious factor... The reasons for the fault, as a rule, are not specific diagnostic problems, but the symptomatology of xerosis of such a genesis appears to be similar. In general, due to a vignette of trachoma, conjunctival pemphigus and rotated lagophthalmos, overwhelming illnesses in such patients are all more hospitable, but not in the middle group of ailments.

Especially in a series of pathogenetic forms of symptomatic xerosis of the loan SSD, injected into the eye of exogenous podraznikiv... Yogo klinichni manifest, as a rule, nonspecific and are characterized, in the main, by sub'active discomfort of the adult stage, with the appearance of dim active manifestations. At the same time, there is a clear link of such symptoms with an inflow of an exogenous adolescent.

The peculiarities of the clinical transition of the main nosological forms of SJS (in the order of the decrease of their significance) are discernible.

Expansion of nosological form to the dry eye syndrome

Naybilsh yaskravo "xerotic" symptomatology is prevalent in ailments with S'egren's syndrome(Sjogren). They do not care for those who have a "peak" for the pathology of a seizure at the 60-year age, around the conditions of the dam fall were recorded by us and in 30-40-year-old patients. Diagnosis of an important illness to be blinded by a rheumatologist, to be based on the consultative signs of an ophthalmologist (the level of decrease in oral hygiene, symptoms of "dry" keratoconjunctivitis) and dentist sluggish vines according to the abnormal results of the biopsies of malikh sluchny vines). Providing laboratory support for the diagnosis of S'egren's syndrome, including the re-adjustment of rheumatoid factor titer in the blood (from 1: 320 and more) or antinuclear antibodies (from 1: 320).

Famous for the international classification (1986), S'egren's syndrome pіdrozdіlyayut on the first, characterized by the named criteria, and second. In the last resort, signs of the primary syndrome are confronted with the clinically evolving systemic discomforts: rheumatoid arthritis, Systemic chervonia vovchak, polymyositis, scleroderma or bilar cyrosis.

In the pathogenesis of full-time manifestations of this pathology, the main role of the loss of mucin and mucin production, It should lead to an increase in the vaporization of pre-corneal lacrimation and significant weakening on the whole ground of the disease.

Yak biovolі vinyk pathological process already in 2-3 months swells the maximum turn. A typical manifestation of xerosis in such ailments є"Dry" keratocon'junctivitis, before the "filamentous" keratitis with swelling of pain syndrome and a practically new "set" of microscopic signs of horny-conjunctival xerosis. Most often in cases of severe fear and pain, such patients are relieved of the power of being healthy for a robot. At the same hour, the deyak is inconceivable in the presence of sub-active manifestations of ill-health of this disease, often even more skeptical than the skepticism of such ailments. The particularity of clinical manifestations of SJS in ailments with S'egren's syndrome is followed by mothers on the basis of their regularity and medical examination.

Yak rule getting sick is nasty to act on intensive therapyі I have a strength to frequent zagostreniye. Compensation for S'egren's syndrome to systemic signs of corticosteroid drugs will often reduce the size of the eyes in such ailments, if not in all cases it will allow them to become more likely to have recurrences of SJS.

Indicators of functional adolescence of patients with S'egren's syndrome are characterized by significant decreases (or more often during the day) in the stability of the lacrimal fluid (from 21.1 ± 2.0 s to 3.1 ± 1.2 s), as well as the values ​​of the main refractive index at 3.3.5 mm. ± 0.8 mm і from 11.8 ± 3.1 mm to 3.5 ± 0.9 mm), based on an additional test-male from Alcon.

SSD of climacteric genesis(Women) develop 55 years of age, often on the pathological climax, in postmenopausal women. Win to become the main part (up to 28.2%) of the middle nosological forms of SSD.

In the pathogenesis of SJS lie so ranks extragenic estrogen deficiency It is possible to develop on aphids and to reduce mucin viroblast by Becher's clitins. As a result, the stability of the pre-threshold lacrimation breaks down and the clinical picture of the SSD develops.

Zahvoryuvannya maє admittedly friendly clientele perebig and are characterized by a great number of rapidly evolving sub-active microscopic signs of horny-conjunctival xerosis on the smallest active symptomatology, including some of the contrasts on the same hypertension. It is necessary to arrange and quickly speed up the diagnosis of SJS in such ailments, such as a trivial hour and unsuccessfully to go to the "chronic conjunctivitis" unclear ethology», Not acceptable for SSD therapy.

As a rule, it is easy to get sick with instillations of drugs "piece sluzi".

3 functional doors merit for respect is a slight decrease in the stability of pre-corneal lacrimation (from 21.1 ± 2.0 s to 7.6 ± 0.3 s) with unchanged indicators of the values ​​of the main components of production.

Dal for significant in the structure of nosological forms of SSDs are so called "Full-time office"і "In-person monitoring»Syndrome. It smells as a result of the inflow on the pre-threshold flush, as well as the computer monitors and conjunctiva of such artifical factors, such as the air conditioning or the heat-ventilators, the electric motors

For the most intelligent reasons, for syndromes, for the most common manifestations of the most frequent reasons, learn from people singing professions(Operator of a different profile). The pathogenesis of the hypothetical syndromes is based on the decrease in the stability of the pre-corneal lacrimal fluid (from 21.1 ± 2.0 s to 4-8 s) on the basis of normal indices of lytic production.

The clinical picture of skin syndromes is characterized by clear sub-active symptomatology and in some minor observational manifestations. Zokrem, such patients travel

• Feeling the obviousness at the tables " outside body»,
• periodic "intramural discomfort",
• intolerance to dim, conditioned and difficult food,
• shvidka zorova stomatomy
• і vinikak bazhannya "close your eyes".

One s common reasons the destruction of the stability of the cold water, which is bathing in the rest of the rock of all the greater relevance, є keratorefractive surgery(Photorefractive keratectomy, laser keratomylosis in situ - Lazik, anterior radial keratotomy, etc.). Some of them have a factor that is ear and mechanical (radial refraction keratotomy), in some - promenevim (photorefractive keratectomy), in some of them there is a combination of lazy As a result, the function of the new epithelial membrane will be destroyed, and it is impossible to produce it until the stability of the slice is broken. In the principle, the process of destabilization and bi-buty compensations for the reflex enhancement of the production of mucin and baby balls of the pre-corneal lacrimation. However, through the end of the sensitive nerve fibers of the horn break down the afferentation process, The staff of the child should be asked for the diagnosis of the dry eye syndrome.

Based on the results of our efforts to watch for 56 ailments, as they underwent developmental keratorefraction operations, it was established that 95% of them had higher rates in 1-2 months. when it is involved in spostering the clinical and functional signs of the predicted syndrome. I will show you dosvid, rewrite the feed you cannot serve in a clear view of the evidence of the residual normalization of the deteriorated function of the pre-corneal lacrimation. Stretching the offensive 2-4 rock_v? in 37% of patients undergoing radial keratotomy, and in 46% of patients with Lasik, there was a significant decrease in the stability of the lateral flow and a decrease in the basic production of blood.

Need to see what? in 80% of the more mature patients with dry eye syndrome, the development of keratorefractive surgeries, their subjective development, including specific signs mali mіsce shche to їkh vikonannya Protest the stench was shed, for it wasn’t mentioned, for it wasn’t booted by the surgeon.

Another reason for the development of symptoms of "dry eye" for the same pathogenetic mechanism to serve no update of the epithelial membrane of the horn after the transferred adenovirus keratocon'junctivitis or herpetic keratitis. It’s a trivial hour for many ailments to see the "alien body" in the assessment and in the renewal of good health, especially when robots with monitors of computer systems. In the process of the patient's active follow-up, respect for the patient is one of the few reasons why he / she will be able to use too many subtypes, as masking the microscopic symptoms of SSS, as a rule, to serve as a stimulus until the continuation of the opposition. Tim is more, in such patients, there are more indirect signs of horny-conjunctival xerosis (tearing, "blinking" hyperemia of the conjunctiva, etc.). At the same hour, we have a habit of such ailments with the preparation of "piece slides", we will acquire a sub-active symptom complex, and I will also shorten the mill of their horns.

Sometimes nosological forms of "dry eye" syndrome are very common

Zagvoryuvannya, about how you go in this section of the book, reach out to practical doctors, So it’s not easy to start in CLINIC PRACTICE... However, the pitoma of the vaga in the structure of the SJS is not very high, and the symptoms of horny-conjunctival xerosis in a large world are the nature of the pathological process, which is the wake of the SJS.

Lagophthalmos in the form of cicatricial shortening is characterized by a higher incidence of scarg ailments on the side of the horn, as in important cases it can wriggle into swelling keratitis. In the pathogenesis of the development of their DES, the main role is to establish accelerated vaporization of thinned pre-corneal lacrimation after the expansion of unprotected capitals, the zone of full-time apple is exhibited. Until then, the stability of the cold water will break down and through the inability of the ruins of the capital, to smooth it over the apple.

Functional signs of SSG in such patients, to serve a low value of the stability of the lagging pudding (8.9 ± 0.6 s, the replacement of 21.1 ± 2.0 s) with an acceptable normal performance sleep production.

In the clinical picture of horny-conjunctival xerosis in such ailments they get over their nonspecific microscopic signs(Div. Table 4 and 5). Perebіg SSD іdpovіdaє rotation and dynamism wіklicіv yogo lagophthalmos. When a surgical correction of cicatricial lagophthalmos occurs, all manifestations develop SS, as a rule, they know.

Clinical signs of SSD in patients with paralytic Lagophthalmos lie down at the level of the facial nerve... So, as soon as it became lower than the opening of the great stone nerve, to avenge the secretory lagging fibers (Div. Fig. 4), then the pathogenesis and symptomatology of SS is not very common to be seen as such in cicatricial Lagophthalmos. However, in case of large lesions of the facial nerve, the SDS class becomes heavier through a regular, low decrease in the main (from 11.5 ± 2.7 mm to 2.9 ± 0.7 mm) and reflex (from 11.8 ± 3.1 mm to 1.2 ± 0.3 mm) production. In cychids up to swelling sub-active microscopic signs of horny-conjunctival xerosis, keratitis often occurs due to non-microscopic symptoms of intrauterine dissection. At the same hour, with a positive dynamism from the side of the facial nerve of the first, as a rule, reflexive tears are renewed.

Symptomatic SSD, Which develops in ailments with pathological thyroid gland, I also have my own specialties. So, in case of thyrotoxic ophthalmopathy, a large number of them are susceptible to the erasure of little congestion of sub-active microscopic signs of mild xerosis (often the appearance of “foreign body” in general), on the other ... In the pathogenesis of SSDs of the general genesis, it is mainly the vaporation of the thinned pre-corneal lacrimal plexus that has been increased, as the area of ​​the apple on the background of exophthalmos is expanded. The variability of the sign of xerosis in such patients lies in the magnitude of the exophthalmus and the level of compensation of the main illness.

Kilka bilsh is characterized by clinical symptoms of horny-conjunctival xerosis in ailments with autoimmune ophthalmopathy... Primitively, the very sub-active symptoms of SJS often rattle such ailments for the first time to turn to a drug. Pathogenesis and turnover of clinical manifestations of SJS in the presence of a stage of autoimmune ophthalmopathy [Sandul GA, 1991].

on Stage I of becoming ill On the other hand, in the pathogenesis of SSS, there may be a value of exophthalmus in the power of the deterioration of the stability of the lacrimal tissue. Clinical interruption of SJS in such ailments is characterized by the development of microscopic signs of mild xerosis with recurrent reflex lacrimation.

Have sick people II stage autoimmune ophthalmopathy, which is characterized by a change in the size and on the cob fibrosis of soft tissues, to prevent a change in reflex lucidosis in the case of fibrous overgrowth of lacrimation. However, the change in exophthalmus in such ailments has a lot of normalization of the stability of the tear and minimal manifestation of horny conjunctival xerosis.

Nabagato mensh friendly clientele perebig SSD powerfully we are sick III stage autoimmune ophthalmopathy. High step exophthalmos і progressive fibrosis of retrobulbar cells і, you can, sl_znykh zoloz in such ailments, there is an intense sub-active symptomatology, the appearance of active microscopic signs of xerosis.

pathogenesis of SS in such ailments of dressings due to significant reductions in tear production and one-hour damage to the stability of tear production on the ground, deficiency in tear production and swollen exophthalmos.

With a further progressing exophthalmos on aphids, "deficiencies" of the table often develop keratitis, which in important cases can quickly end with a sharp horn and, nav, perforated horn.

In fig. 19 shows a photograph of the sick D., who is suffering from an important autoimmune ophthalmopathy in the stage of fibrosis. The patient enrolled in the clinic of ophthalmology of the Viy'skovo-Medical Academy even after perforating the fibrous capsules of both apples on the ground of the progressive lack of capital. Ophthalmologists and endocrinologists, with active systemic and muscular injections of corticosteroid drugs, are deprived of spilnye zusillami ophthalmologists and endocrinologists. Pislya vikonannya post-lane blepharophysiology, and in the end - and decompression ochnytsi (Monakhov B.V., Sandul G.A. and in.)

Slid, really, mean, scho in a timely manner we are ill with autoimmune ophthalmopathy, as a rule, allowing us to get more important things faster.

With functional provision of patients at stage I restructuring slightly adjusting the main rakhunok and reflex sleep production on the basis of a decrease in the stability of the sludge (from 21.1 ± 2.0 s to 6-8 s). At stage II autoimmune ophthalmopathy is indicated by a tendency to normalization of all functional indicators, and on III- the order of the decrease in the stability of the lacrimal flow up to 5-7 s, the rate of the main (from 11.5 ± 2.7 mm to 6-8 mm) and reflex (from 11.8 ± 3.1 mm to 4-6 mm) tear production was diagnosed. The number of deterioration has grown in the world of the general progress of autoimmune ophthalmopathy.

Clinical manifestation of symptomatic SJS However, having developed on the ground of pathological changes on the surface of the horn and conjunctiva, in most of its nonspecific, are also characterized by well-discernible microscopic signs and without an average connection with the main pathological process in the assessment. In the pathogenesis of such stagnation, there is a significant deterioration in the formation of full-thickness stable pre-corneal lavage on the changed surface of the corrugation. In addition, we will give the same functional impairment in such ailments, in addition to the decrease in the stability of the slush (from 21.1 ± 2.0 s to 6-7 s and lower).

With the help of the pathogenesis, the development of symptomatic SJS ob'ednan to reach a large group of nosological forms. The number of signs

• keratoconus,
• cicatricial cicatrices due to postponed injuries and surgeries,
• epithelial forms of corneal dystrophy,
• Changes in the surface of the corrugation due to the transfer of keratitis and the first stage.

Difficult critical interruption horny-conjunctival xerosis is characterized by disease and malnutrition, which is supervised at once as a lack of lymphatic production, as well as damage caused by tears on the surface of the intramural apple. The order of the already discernible "dry" paralytic Lagophthalmos and autoimmune ophthalmopathy in the third stage, then one can guess about the opioid ailments of the eyes and intramural pemphigosis.

The sufferers from the IV stage of the opiate ailments of the eyes, Tobto in the stage of cicatrices and degenerative dystrophies (Volkov V.V., 1972), in the main, prevailing microscopic signs of horny-conjunctival xerosis over the microscopic sub-active symptomatology. In the clinical picture, the symptoms of SJS are masked by intense cicatricial and dystrophic symptoms of the cornea, conjunctiva and symptoms, which are vicious without a median factor.

The functional signs of SDS in such patients are characterized by one-hour significant decrease in the stability of the lacrimal puff (from 21.1 ± 2.0 s to 3-5 s) and the basic lactic acid production (from 11.5 ± 2.7 mm to 4-6 mm). When there is a whole reflexive tear production, as a rule, it will not break.

Similar to the appearance of the food, show the MTR by the value in sick people with Pemphigus conjunctivi... The process of becoming ill is characterized by an important, altogether stable clinical interruption of the SSD. Inflated conjunctival cicatrix, deformity of the cicatrix and serum corrugation (Fig. 20)

Small. twenty. Deformity of conjunctival emptying and corneal conjunctival xerosis in a sick person with pemphigus.

supravodzhuyutsya in such ailments with sub-active manifestations, even less with less intensity, less with S'egren's syndrome. Apparently, the stench and it is easier to compensate for the muscular therapy.

When looking at such ailments on the conjunctiva of the cartilage of the column, especially the lower one, it is possible to see dilyanka leukoplaki, Which are the epithelial cells of the conjunctiva. The stench is easy to pick up plaques white color, Oval shape, size from 1 to 10 mm (middle, 4.1 x 2.3 mm) with a larger diameter parallel to the edge of the table. The plaques are like bi-welded from the conjunctiva, so that you don’t want to be bothered by the fluorescein gap - sodium.

At the sight of the sufferers from the sickness of the eyes, from the sick people with the very eyes Pemphigus reflex production of tears is significantly reduced(З 11.8 ± 3.1mm to 4-6 mm).

Similar to the appearance of appearances, the supernatural full-time pseudo-pemphigoid, Viklikaniy we trivialize zasosuvannyam deyakim ochnih krapel. Tse finish ridkisne ill spostering at patients who are sick to allergic reactions. To that and the very illusion of being looked at, as an extreme manifestation of drug allergy. Provokuvati medication pseudo-pemphigoid can be pilocarpine, adrenaline, fenilephrine and a number of toxic preservatives for intramural drops.

Іnshі, slyly, і інші key forms SSD. However, the stench does not seem to have any particular specifics and does not look at it here.

At the same time, the picture of SSD in bagatokh vypadki is characterized by the presence of pathognomonic for a new sign, in the diagnosis of this disease the main meaning is to swell functional probes... The aftermath of the clinical and functional presentation of such ailments is discerned in the offensive section of the book.

Statute from the book:

8827 0

Dry eye syndrome (SDS) is a complex of signs of a clinically swollen abnormal latent horny abnormalities-conjunctival xerosis, enveloped in trivial damage to the stability of the mucous membrane, with a thin ball covering the front surface.

Epidemiology

Classification

For the relocation of the SSD buv:
■ lightweight;
■ average gravity;
■ important and especially important.

Ethiology

Growth of the incidence of SSD in the remaining rock of zooming is increasingly widespread in keratorefractive surgical operations, in accordance with the contact correction, as well as the increased frequency of "diagnosis" of young people.

pathogenesis

As a result of a series of processes in the pre-threshold lacrimal process, a change is formed; At the scene of such razriviv on horns, dry dies are set, the mucin ball is added to the cake, in the end of its service is the morphological basis of the clinical manifestations of the SSD.

Clinical signs and symptoms

Sub'active symptoms (first 3 signs of pathognomonic for SJS):
■ disgusting tolerance to winters, conditioned meals, dim, etc .;
■ seeing dryness in the assessment;
■ painful reaction to the instillation in the conjunctival emptying of indifferent intramural drips;
■ the acceptance of foreign body, printing and printing in the assessment;
■ svitlobojazn;
■ tearing (signs of characteristics for easy form SSD in the cob stage).

Active symptoms (with biomicroscopic pre-detection of the anterior superficial apple; first 4 signs of pathognomonic for SJS):
■ a change in the number of days at the edge of the country due to late men;
■ degenerative changes in cornea and bulbar conjunctiva in the boundaries of intracritical intracranial dissection;
■ belting of epithelial threads on horns;
■ more and more rupture of the tarsal and bulbar conjunctiva with abnormal lower povika;
■ sings on horny microerosis;
■ local embryo bulbar conjunctivi with the transition to the willow edge of the capital;
■ the appearance of conjunctival vidokremlyuvanny in the viglyadі of mucous threads;
■ the presence of the inclusion, which will prevent the slipping of water.

With a light SSD, the hour of breaking the pre-corneal lagging of the warehouse is 8.3 ± 1.3 s, with a medium-hard one - 5.5 ± 1.2 s, with an important one - 2.1 ± 1.3 s.

The manifestation of deyakykh from ob'ktivnyh signs of horny-conjunctival xerosis to say goodbye to vicorian barvniks. It is often found that 0.2% of sodium fluorescein is produced with the help of a small amount of wine, so that it allows the farthing of a bottle of hornet, to add to the food. However, with this help, it is possible to evolve the cells of the conjunctiva and horns, which have become aware of degeneration. Quite a few additions іnshy barvnik, 1% of Bengali horny varieties, which are included in the pre-liminal tears. Yogo stasis permits the appearance of more subtle epithelial changes, which are evidently not only in horns, but in bulbar conjunctiva, but also in conjunctiva in vilny regions of the population. With a vikorystanny of 3%, the size of lissamic green can be achieved with a shorter contrast of farbuvannya diamonds and a change in teasing, which is not linked to a diagnostic procedure.

The appearance of cob, and more obvious signs of SSD, as well as the presence of pathognomonic symptoms for SSD, with the presence of sub-active signs of being ill, to serve as indicated before the setting of such functional tests, such as (in this end):

■ assessment of the stability of the pre-corneal lacrimal fluid (Norn's test). Look obtezhuvanogo go down. After pulling the upper tip, the lens flares up in the middle of 12 hours with one spot of 0.2% of sodium fluorescein, when the second is turned on through the eyepieces of the flush lamp, it appears behind the surface of the flash ... Seconds start at that moment, if a defect appears, it fixes in size, or if there is a radial head. We can talk about the importantly significant deterioration of the stability of the cold water, if the hour is within 10 seconds;

■ Pre-admission of over-the-counter products of Slaznoy Ridini (Schirmer's test). Likar zgina is a working end (up to 5 mm) of a special test-woman from a filter paper before a cut of 40-45 ° and helps for a lower head in the last third full-time line of both eyes. When a part of the skin is bent, it is guilty of reaching the bottom of the lower crypt of the conjunctiva, not sticking out the horns, but bending over to the edge of the capital. Then the license can ask the ailing one to close his eyes. After 5 minutes, the vityaguy of the smuggle and the vimiryu will get the rest of the salted part (as soon as possible). The result of the test is positive when the test is less than 15 mm.

Differential diagnosis

General principle of lіkuvannya

If necessary, additional vicorious treatment of LZ of the other groups: metabolic, anti-allergic, antiapaline and other groups.

For the duration of the day, the obturation of the lacrimal nozzles with polydimensional plugs-obturators is shown, either invasively, including surgical treatment.

Hydroxypropylmethylcellulose, 0.6% solution, in the conjunctival emptying for 1 drop 3-4 r / day, which is a trivial hour (the multiplicity of the introduction can be increased up to 6 r / add the input from the dynamics of the sub-active output. Chergov's instillation drug to serve as an update to discomfort, to stop it before the introduction)
±
(If necessary, frequent (more than 4 times per day) administered hydroxypropylmethylcellulose)
Carbomer 974 / polyvinyl alcohol, gel, in the conjunctival emptying 2-3 r / day, mostly or Polyacrylic acid, 0.3% gel, in the conjunctival emptying 2-3 r / day, during a trivial hour.

Therefore, with the consumption of frequent administration of drugs of low viscosity, the transfer is given to gel forms, and if it is necessary in frequent administration of residuals - obturation of the tear-removing paths. In case of decreased production, as well as ineffectiveness drug therapy a stretch of 1 ms shows obturation of lacrimal points or tubules.

In case of an important SS, the instillation of gel preparations of "piece slides" is shown in combination with the addition of preparations in low viscosity and for the stagnation of full-time mastication (LZ, who give a reparative effect):

Carbomer 974 / polyvinyl alcohol, gel, in the conjunctival emptying 2-3 r / day, mostly or Polyacrylic acid, 0.3% gel, in the conjunctival emptying 2-3 r / day, during a trivial hour
+
Hydroxypropylmethylcellulose, 0.6% solution, in conjunctival emptying, 1 drop 3-4 r / day, which is a trivial hour renewal of discomfort, reduction in advance)
+
Full-time ointment base (vaseline and lanolin in equal proportions) in conjunctival microscope 1 r / day at night, when a trivial hour or Dexpanthenol, 5% ointment, in conjunctival microbes 1 r / day for three hours dializate from the blood of dairy calves, 20% gel, in the conjunctival bear 1 r / day at night, for a trivial hour.

With degenerative changes in the epithelium of the horny, or the conjunctiva of the LZ, which produce a reparative effect, stagnate more often (the triviality of therapy starts individually):

Dexpanthenol, 5% ointment, in the conjunctival microscope 3-4 r / day or deproteinization dializate
from the blood of dairy calves, 20% gel, in the conjunctival bear 3-4 r / day or Taurine, 4% o solution, in the conjunctival bear 1 dribble 3-4 r / day. The triviality of therapy begins individually in the number of cases of renewal of the booklet.

Cromogliceic acid, 2% solution, in the conjunctival microscope, 1 dots 2-3 r / day or Lodoxamid, 0.1% solution, in the conjunctival microshock, 1 dots 2 3 r / day
+
Azelastine, 0.05% solution, in the conjunctival bear 1 drops 3 4 times per day.

Diclofenac, 0.1% solution, in the conjunctival microscope 1 dots 3-4 times per day, 1-3 months or Indomethacin, 0.1% solution, in the conjunctival microshocks, 1 drops 3- 4 r / day, 1-3 days.

Folding and branching efficiency

Graves and unprimed signs

Evaluation of the efficiency of treatment

The criterion for the polypsy is to serve on the basis of any part of the knowledge of the active and sub-active symptoms of illness.

forecast

Winikє xerosis of the eyes as a result of tricky razdratuvannya, injuries or opіku shell. Pathology is manifested by severe dryness, pain and fear of light. With ophthalmoscopy, there are cases with twists and turns, and without the necessary treatment, they can provoke the establishment of a great number of scars and clouded eyes. Tse provokuє to waste time and invalidization of the patient.

Zvoryuvannya wiklican with lack of production of tears.

cause development

To provoke xerosis of the conjunctiva and horns can be infused on the body of people such as:

• failure of Vitamin A in the body;
• opik;
• injury;
• trachoma;
• surgical visibility of the slushy zolozi;
• autoimmune disease;
• vegetative dysfunction nervous system;
• chronic exchange of ailments;
• razdratuvannya;
• hormonal imbalance;
• dovgostrokovo flowing fired;
• traumatic brain injury;
• infusion of bacterial or viral infections;
• lousy portability of contact lines;
• vikova neuroendocrine evolution;
• snakes on the anterior segment of the eye;
• kurinnya and pouring in a cigarette dim on the inside of an apple;
• taking medications.

Xerosis є severe dryness of the eye and vinik as a result of the deterioration of the products of the sleepy birth. The price is summed up by the decrease in the stability of the pre-corneal slush. The process of winnings as a result of the destruction of the debate, the warehouse and the production of goods, as well as other things that make the young bureaucrats careless. All the same, overwhelming dryness and damage to the organ.

see pathology

Xerophthalmia maє takі klinіchnі form:

• Recurrent microerosis, which is characterized by periods of sharpening and subsiding, showing minor changes in intramural apple.
• Recurrent macroerosis with abnormal lesions of the horn structure.
• Dryness, with any pathology, also expands to the conjunctiva.
• Filamentous with bends overgrowths of the resulting fabric.

Main symptoms

Xerophthalmia wiklikє development in a patient of such key manifestations of ailments:

• pechinnya eyes;
• lacrimation;
• fear of fear;
• head beel;
• zamorochennya;
• the ruin of the zalny camp;
• the bastards self-respect;
• a decrease in the sensitivity of the eye to podraznikiv;
• nudota;
• pochervoninnya slizovoy;
• seeing a side object in the assessment;
• swelling;
• not completely close the full-time schilini.

For the help of ophthalmoscopy, there will be a change in the progression of the conjunctiva, it will become dry and dull-white will begin to appear on the surface. Do not miss the start of the eye, and at the end of the day there will be one erosive start. With a trivial interruption of the disease and during the day of the necessary treatment, the patient may be depleted as a result of severe scarring of the membranes of the eye.

How can diagnostics be carried out?

Xerosis can be diagnosed for the presence of symptoms in the patient, characteristic of the pathology of symptoms. To confirm the diagnosis, it is necessary to carry out an ophthalmoscopy; It is also necessary to create a laboratory and biochemical analysis of blood for the detection of a possible concomitant pathology. An ultrasound of an intramural apple is performed, as well as vimir gostroti zoru. With worn contact lines, it is necessary to have a tear drop, which is a tearing of a tear along the edge of the lower belt.

Xerophthalmia, or xerosis, I call the drying of the mucous membrane of the eye. The appearance of xerophthalmia can be caused by a number of reasons.

Tse zzvychay tse tied with the coming reasons:

• We are trivial with a m_ssevim pozhkodzhuyu flow.
• Zagalny zhavoryuvannym.

In the first group of factors in the formation of scarring of the conjunctiva, summarized:

• Trachoma, opikami, diphtheria, pemphigoid meager. The stench is repaired in the form of intermingling small dalyanoks, step by step involved in the pathological process of all fabrics of the conjunctiva and horns.
• Ectropion and Lagophthalmos, which become the cause of an unreasonable prejudice by the capitals of the surface of the apple.

pathological changes with the development of xerophthalmia, the head rank is found in the hospital, which step-by-step has begun nagaduvati epidermis shkiri. The secretion of the slime is leaning back, the new ball is found - granulation and horny. Because of the cause of the winy, the compensatory strengthening of the robotic meibomian vines, in conjunction with the chim, the dry surface of the conjunctiva, and more often to be covered with a fat secret, and the loss of the health of the mucous membrane for the additional snake. During the development of the process, the high growth of a stick of xerosis (non-pathogenic microflori of conjunctival emptying) is indicated, I want the names of saprophyte from the cymbal disease of the causal link.

It is necessary to be aware that in case of xerophthalmia, damage to the robotic device cannot be detected. Poisonousness is not to be found in the inheritance of extirpation (vividness) of tears, so as the conjunctiva is good enough to be effectively moistened with a lucid secret. Ale, if the secretory function of the conjunctiva itself is decreasing, xerophthalmia can occur in that number and with normal or to see a high viscous lacrimal line of eyes.

To the other group of men, xerophthalmia, there is a deficiency in the ranks of fatty vitamins. A pathological process, with a whole lot of people to achieve a simple form, supervise the day and night, and help to make it easier for children, often for lads. The conjunctiva with the development of xerophthalmia absorbs its insight, becomes dry. On the surface of the mucous membrane there are small tricky, short beaches, and also internal sides rogivki. Play pokriti pinistic visions, yak do not waver with sloozoy (so-called beaches of Iskersky-Bito). It’s the beaches to be set up through the excess secretory line of meibomies, like when you get morgan, you’ll be beaten, and at the same time you’re not going to go down the slopes and sit on the winners, shyunks. Some changes in children are typical for summer months, moreover, it is not necessary to tie it to non-rational food. Similar mild forms of xerophthalmia, which are supervised by a certain period of time, also rarely appear in children with a pink appearance, and it is not easy to get along with keratomalacia or necrosis of the horn.

Having returned to Moskovska Ochnu Klinika, the skin patient can be a songwriter, that for the results of the treatment there will be one of the most beautiful Russian factions. The excellence in the right vibration, it’s crazy, to give the reputation of the client and thousands of family members. Most successful possession for diagnostics and illnesses of eyes INDIVIDUAL PIDHID before the problems of the skin patient - the guarantee of high results in the treatment in the Moscow Ochniy Clinic. We carry out diagnostics and treatment in children older than 4 years and older.

Torn down mehanіzmu funktsіonuvannya slіznoї plіvki mozhut stosuvatisya whether yakogo Yogo Lanka: slezoproduktsіn, rozpodіlu JV on poverhnі Yabluko full-time, the structure of the skin її ball, shvidkostі viparovuvannya rіdini, іntensivnostі protsesіv vіdscheplennya vіdmerlih klіtin epіtelіyu rogіvki i, navіt, vіdtoku slozi of kon'yunktivalnoї porozhnini.

Great value at the same time nadayut the intensity of the vaporization of the joint venture. A taste of a number of processes є the acceleration of the establishment of non-wet cake with the corneal food, so that the stability of the precorneal joint venture is destroyed. Naturally, when the trivial hour of unstableness is lost, the joint venture is not victorious in the world of its functions and due to the development of a number of pathological symptoms characteristic of the "dry eye" syndrome.

In such a rank, the SSD can be significant, as a complex sign of a swollen or pricked against corneal abnormalities-conjunctival xerosis, as well as on the ground a tricky damage to the stability of the precorneal joint. broken up by us CLINICAL CLASSIFICATION The SDS is presented in Table 1. In all types of SSDs during the course of the period, fallen as a result of the etiology of the xerotic process, up to one of the two key groups: syndromic abo

symptomatic. For syndromal reckoning on the risk of xerosis, accumulation of decreased secretory functions of mucous and mucous membranes on the ground of any systemic disease. Symptomatic SJS develops as a result of "psychotic" tissue of the anterior view of the eye due to the causes of the local nature of the abnormal avitaminoza A.

Table 1

Clinical classification of horny-conjunctival xerosis type of dry eye syndrome

With the guidance of a viscera, the value of vapors, until the first group is guilty of being guilty of a neurotic syndrome, with manifestations of a juvenile and cholovy climax, autoimmune diseases of a vegetative secretion, a syndrome of a syndrome Rile-Dey), deyakyh deyentsephalicheskikh razladiv and іnshih subdivny stanіv (div.

Dodatok 1). For tribute to R.I. Fox (1994), with STD dressings also ciliy row systemic illnesses: Infiltrative processes (lymphoma, amyloidosis, hemochromatosis, sarcoidosis), Infectious diseases(Syndrome of diffusional infiltrative lymphadenopathy, viral infections of human immunodeficiency virus, hepatitis B and C, syphilis, tuberculosis), as well as the autoimmune process of transplantation cystic brain... slid

obviously, S'egren's syndrome is traditionally associated with a large number of patients in our country with SSDs, taking a modest part in the out-of-town structures of this pathology. One of the reasons for the decrease in the secretion of lacrimal vines and kelikho-like clitins of the conjunctiva, which is still very important, is to serve and the chronic exchange of ailments (Gamus D., et al., 1994). In some cases, thyrotoxic and autoimmune ophthalmopathy is associated with it, which is often diagnosed by us in patients with SS, who are recruited from regions with radioactive infections of the muscle. However, the specific mechanism of recognition of the deterioration in such patients is still not invisible.

In etіologії symptomatic SSc provіdnu role vіdіgrayut virazhenі anatomіchnі torn down ochnoї lokalіzatsії: nepovne zmikannya i (ABO) nadmіrne rozkrittya ochnoї schіlini on gruntі rumen abo paralіtichnogo lagophthalmos, ekzoftalm rіznogo genesis endokrinnoї (thyrotoxic autoіmunnoї i) ophthalmopathy and takozh buphthalmos. The group also includes SSS vypads, deformations of congestion trophies, deformations of the surface of the congenital apple, or of a bulging character (keratoconus, pterigium, symblepharon), and cicatricial infections of the congenital congestions junctivi). Xerosis can also develop as a result of the functional disability of the lacrimal disease due to the transferred dacryoadenitis, the extirpation in the connection due to the malignant puffiness, the recurrent alacrimony of the deceased pharmacological preparations for zapuvannya actions of them into the conjunctival empty space (div. dodatok 2).

Rise of a decrease in the production of tears and mucins is also caused by damaged innervations of tears (with lesions of the facial nerve, rosy sclerosisі ін.) і in the case of instability in the body of vitamins A.

(For example, with meibomian blepharitis). Nareshty, in the group of ailments it is necessary to include and patients, for which titles the transient SSD is stimulated by permanent or time-consuming joint ventures by the callous art-physical factors. Before them are dim, zmig, condition of the povitrya (so the titles of "office-eye syndrome": Sommer HJ. Et al., 1994). electromagnetism from monitors of computer or television systems, ultraviolet optimization (according to Michalos P., et al.; 1994), exchange with X, = 100-280 nm, often glide at the slightest), cosmetic and, especially, contact lines.

Guidance is a reversal of reasons that lie in the basis of the development of the SSD, to inform about those who are given a problem of very great practical significance. So, for the tribute of R. Marquardtu F.N. Wenz, dating back to 1980, SJS is developed in the skin third patient, who has gone to the ophthalmologist. Our previous years (born in 1988-1996) revealed the manifestation of functional and clinical signs of ill health in all patients with damaged health problems, herbalism, 65.2%, health problems, 65.2% chronic conjunctivitis and blepharoconjunctivitis of the developmental etiology, in 90.0% - with chronic dacryocystitis, and in 65.7% - with the so-called reflex lupus. In Fig. 7 graphically representations of the spectrum and frequency of the population of the main nosological forms, which can be attributed to the SJS, in the case of our patients there are 486 such patients. It can be seen from the graph that the most nutritious car in the structure of this pathology is dysfunction of Becher's lobes of a climacteric genesis (in females), an ailment of the eye, lagophthalmus of a disease of ethology, as well as the middle of transient breakdowns of stable conditions

The pathogenesis of SJS is not one-day behind the recent data. Name the win of the three main representations key types... The first among them is the reduction in the production of the agricultural components of the joint venture with the use of inheritance, which is sounded by the inheritance. Zokrem,

Reducing the production of low-level production until the reduction of the production of a small ball of the joint venture, and the rapid secretion of mucinous or lipidiv - until the vitrification of the same number of balls. You can also get a good combination of different types of food. As a result of the joint venture in this world, it consumes its virtue.

Small. 7. Kіlkіsna structure of nosological forms of SSD, diagnosed) 500 severe ailments.

1 - S'egren's syndrome; "2 dysfunction of Becher's valleys on the ground of clinical syndrome; 3 symptoms of congenital pain; 4 lagophthalmus of the disease; 5 endocrine ophthalmopathy; 6 the duration of the lacrimal hallucination of the disease; , viklicanii instillations of beta-adrenergic blockers; 10 - transient SS, viklicanii trivial instillations of corticosteroids; 11-transient SS, stimulation by unpleasant factors of the outer middle; 12 - transient SS, transient vascular diseases. ethology.

We'll get more details on the day of the missed ones. The stench is made before the offensive: 1 - it is not uncommon to make a spicy ball of the joint venture to "get angry" with mucins in the most "spilling" zones of the horn (often - in

the addition of edible epithelial cells) and until the non-wet surfaces of the surface are covered (div. fig. 6); 2 - local mucin deficiency, porous deterioration of the wettability of the cortex. At the whole miscellaneous joint venture, "smoothed" in front of the front blinking arms, the hydrophobic epithelial membrane is immediately opened up; 3 - the change in the production of wine is made with a lot of intensification of the boiling of a small ball of the joint venture.

Problems of vaporization from conjunctival emptying in case of SSD in foreign literature in the rest of the rock comes more and more respect. Data from A. Heiligenhaus und and. (1995), in 78% of patients with SJS horny-conjunctival xerosis was found to be overly associated with adrenaline vapors, and only in 8% - with isolated deficiency of locomotion. At the same time, the value of the analyzed indicator is to be found in the norm, to lie down straight ahead (Table 2).

Table 2

Degree of vaporization of the lacrimal origin in the area of ​​the crusty surface of the apple

(According to Tsubota K .., 1994; revised).

However, the most significant is the problem of swelling in patients with a deficiency in the secretion of lazy birth. So, with a decrease in fluid production from 12 µl / s to 0.12 µl / s, only for a rakhunok normal vaporization (0.094 µl / s), up to 78% are consumed. If you want to change the vaporization of the rare components, it will decrease compensatory

lipid secretion increase) to 0.057 μl / xv, then up to 47.5% of the volume is consumed in the whole range, which is in the conjunctival emptying (Fig. 8). For normal women, the indicator does not exceed 10% (Tsubota K .. 1994). In order to promote the stability of the joint venture in such ailments, K. Tsubotan K.N akamori (1995) recommend that you give the patients a slight feel for the wrinkle and, if possible, normalize the frequency of blinking collapses.

Small. 8. Spіvіdnoshennya indicesіvnі prodіnіy і vаvіvannya tіlіy іdiny in normі (а) і in ailments with a syndrome of "dry eye" (b) (according to Tsubota K., 1994; s revised).

Decreasing the secretion of one of the components of the joint venture stimulates compensatory enhancement of the production of the other structural elements. In the bag, it is necessary to produce up to the development of reflex lacrimation, or lazy separation at the eyes of the threads, it is heavy to be carried by the ailments. Hyperproducts of lipids are manifested in the affirmations on the tables (often at the most recent adhesions of the capital) with a characteristic bile of "pinks", which is sooner a cosmetic shortcoming.

Lower than the representations, the list of nosological forms of intramural pathology (in the order of the decrease in frequency), can be attributed to the first pathogenetic type of SSD, then ecib, with deficiency

products of the main components of the joint venture. I am going to give you a reason to show the possibility of becoming ill in some of the most important options:

1. We consider the changes in the production of drugs due to one of the onset reasons:

The appearance of an abnormally low lacrimal clot (due to extirpation during the development of a swelling, aphrodisiac abnormalities or a hypoplasia of a clot (aphrodisiac alacrimia, Bonnevie-Ulrich syndrome), an old woman is abnormally thin;

Destruction of the innervations of lacrimal vines (reduction of secretory "lacrimal" fibers for an hour of operative insertion on the scleral cyst, cryopidnebine fossa, ochnits, crushed of laxative fibers by the lump, collapse of the laxity of blood cells

Dysfunction of lazy formation of the transferred dacryoadenitis;

Pharmacological rotting of the disease.

Recessive complex dysfunction of the autonomic nervous system (Riley-Day syndrome);

2. On the lowering of mucin secretion on the ground of dysfunction of Becher's conjunctival lobes of climacheric genesis, deficiency in vitamins A or multiforme erythema (Stevens-Johnson syndrome).

3. Defective products of lipids (meibomia blepharitis due to decreased products of lipids).

4. Combined form (Sjogren's syndrome).

Another pathogenetic type of development of the SSD is due to the decrease in the stability of the precorneal joint venture due to side causes - lagophthalmos or pathology of the epithelial membrane, on the "full-thickness" joint venture it is easy to break, or it does not form. It is not included, however, at the same time, there is also a decrease in the secretion of mucin in the epithelial cells of the conjunctiva and horn. A similar situation, waking up, is seen in ailments with lucid metaplasia of the conjunctival epithelium (in the application of lack of vitamins A, already a prey). smoothing of the villi

the anterior membrane of the diet, a decrease in the amount of mucopolysaccharides by the epithelial cells of the mucopolisaccharide is a lot of thinning of the mucin ball of the joint venture and the destruction of the interaction of mucins with the small ball of the joint venture, the production of such a decrease.

Fig. 9. Scheme of the destruction of the structure of the lacrimal water in ailments with lucid metaplasia of the epithelium of the conjunctiva (according to TsengS.C.G., 1987). a-norm; b-luskata metaplasia of conjunctival epithelium.

1.2 і 3 days, watery and mucinous balls SP;

4 glucoprotein the membrane of the epithelial cell, covered with glucocorticosteroids, which reduce the pressure in the water of the mucin.

In addition, with the scars of the horns and the symblepharon, the congruence of the close-to-the-surface apple and the symptoms will break down, even though with the blinking ruffs of the century, it is no longer possible to see the normal "smoothing" of the slack.

Clinical options for pathological damage, typical for SSD of genesis, are induced (in the order of frequency decrease) lower:

1. Lagophthalmus of the disease genesis (scarring in the shortened column; paresis or paralysis of the facial nerve; autoimmune ophthalmopathy

(1-2 (infiltrative and transition to fibrosis) stage); thyrotoxic ophthalmopathy; exophthalmos

post-traumatic nature; "Nichny" and "narcotic" not so much as a povik.

2. Pathological changes on the surface of the cornea and conjunctiva (scarring genesis; symblepharon; true and papillous pterygium; epitheliopathic genesis).