Eye tuberculosis: possible causes, symptoms, prevention and treatment

Despite the achievements of modern medicine, tuberculosis annually takes the lives of about 3 million people on the planet. This disease can affect not only the lungs of a person, but also many of its other organs and systems. Eye tuberculosis refers to infectious diseases that are difficult to diagnose and completely cure. Especially dangerous is the development of this ailment in children, since in the absence of adequate and timely therapy, it can lead to meningitis, sepsis and other serious complications.

Causes of the disease

If the human immunity works in a normal mode, the ingestion of mycobacteria does not necessarily lead to the development of tuberculosis. With the help of protective forces, foreign microbes can be defeated by special cells that prevent infection from spreading. But with weak work of the immune system, a large number of pathogenic bacteria and the presence of adverse indirect factors, the likelihood that tuberculosis of the eye will still develop is very high.

Factors that contribute to the development of the disease:

• Unbalanced diet and vitamin deficiency;
• Adverse housing and labor conditions;
• Inadequate human presence in the open air and sun;
• Psychoemotional stress, stress;
• Lack of sleep and rest;
• bad habits;
• Presence of chronic inflammation in the body;
• Severe diseases of the immune system.

Classification

The defeat of the eyes with tuberculosis can be of different severity depending on the form of the disease. The treatment options and the prognosis of the disease depend on this. There are 4 options for the development of the disease:

• Tuberculosis of the mucous membranes;
• Pathological changes in the eye muscles, eyelashes, tear apparatus, conjunctiva or eyelids;
• Secondary painful changes in the eyes of tuberculosis of the central nervous system or lungs;
• Infectious-allergic lesions of the eye apparatus.

In the first two cases we are talking about the primary infection of mycobacteria and their reproduction directly in the tissues of the eye. Such pathologies are less common than the forms of the disease associated with allergies or the primary focus of tuberculosis in other organs. In these cases, ophthalmic symptoms can sometimes be ignored because of a pronounced underlying symptomatology. But this can be fraught with loss of vision in the future, so it is important to recognize them in time and begin treatment.

Symptoms of primary tuberculosis of the eye and its adnexa

Some diseases due to the lack of specific signs are difficult to recognize at an early stage. One of these ailments is eye tuberculosis, the symptoms of which are similar to many ophthalmic diseases. They may differ depending on the location of the infection.

When the primary infection with tuberculosis and its development in the eyesight of the patient first symptoms are characteristic of the usual conjunctivitis: redness of the vessels, eyelid swelling, lacrimation. But along with this, lymphatic compaction is formed inside the eye, which increases in size and eventually can lead to an abscess without treatment.

Tuberculosis of the adnexa of the eye (eg, eyelids or lacrimal ducts) is rare. At the same time on the skin and mucous membrane there are inflamed tubercles, the tissues of which eventually become dead and inflamed. This can lead to a reversal of the upper and lower eyelid, as well as causing cicatricial changes in the skin.

Tuberculosis of the eye: symptoms, the first signs in the allergic nature of the disease and secondary damage

With infectious-allergic tuberculosis the symptoms are sharply expressed, and they practically do not have an incubation period. Both eyes are usually involved in the pathological process, although manifestations can be more pronounced on one side. The duration of the acute period ranges from several days to two months. For this form of the disease, there are such signs of eye tuberculosis :

• Lacrimation;
• Inflammation of the mucosa;
• Itching and burning;
• photophobia;
• Soreness.

If unpleasant symptoms in the eye area are caused by primary tuberculosis of the brain or spinal cord, then, as a rule, they are only a supplement to the general neurologic symptoms. In these patients, the posterior part of the choroid is most often affected, where foci of inflammation (granuloma) with lymphoid tissue appear. Clinically, this is manifested by decreased visual acuity and blurred vision. The disease can develop rapidly or progressively.

How to identify the disease?

Diagnosis of eye tuberculosis is complicated by the absence of specific symptoms, since its manifestations are similar to other ophthalmic diseases. The inability to take a sample of tissues for analysis for the presence of mycobacteria also makes it difficult to diagnose. In the presence of complaints indicating a possible tuberculosis, it is desirable for a patient to undergo a series of such examinations as directed by a doctor:

• Determination of acuity and visual fields;
• Measurement of intraocular pressure;
• Examination of the fundus ;
• Ultrasound of the eye ;
• Angiography of the retina;
• A test with tuberculin;
• Diagnostic treatment with antituberculous drugs.

In addition, the patient must necessarily do radiography of the thoracic cavity and tomography of the mediastinum, as it is often in it with allergic tuberculosis of the eye that inflammatory foci are often found. To understand the general condition of the body, the patient can also be assigned clinical blood and urine tests.

Ways of infection

Eye tuberculosis can occur due to the spread of the infection by blood or direct contact with the pathogen from the external environment. Hematogenous transmission pathway is possible if the body has a primary focus of the disease. The variants of getting mycobacteria from the outside world to a healthy person are as follows:

• Airborne pathway (during a conversation, coughing or prolonged stay in the same room with a patient);
• Contact-household way (when using contaminated household items);
• Fecal-oral mechanism (when bacteria get into food or water).

Mycobacteria can keep pathogenic activity for years in dark dusty premises, so when inhaled by such air in a person with weakened immunity, the risk of infection is high. Sometimes the disease is transmitted through the blood, if the integrity of the skin is damaged or vertically (from mother to child). But most often the transmission of infection is associated with the presence of mycobacteria in the air.

Features of the course of the disease in childhood

Since the immunity of the child does not work as active as in an adult, any serious illness is a serious danger for him. Tuberculosis of the eyes in children is most often allergic or is a secondary manifestation of the active pulmonary process. In itself, the primary manifestation of this infection in the organs of vision is extremely rare.

Given the tendency to generalize the pathological process, treatment of tuberculosis should always include inpatient treatment until full recovery. At the same time, the ability to regenerate in affected tissues is higher in childhood, therefore the child always has the chances of a successful cure without subsequent relapses and complications.

Surgery

Effective therapy should include antibacterial drugs of general action, even if it is an extrapulmonary form of the disease that affects one particular organ. For example, tuberculosis of the eye, the symptoms of which are most often concentrated in this area, should still be treated with the help of an integrated scheme.

When surgical pathologies appear, in some cases, an emergency surgery is possible in order to save a person's vision. In this case, it should be carried out in parallel with antibiotic therapy. But if there is no acute need, in order to avoid complications, it is better to perform it after the complete completion of the course of therapeutic treatment.

Eye tuberculosis: treatment without surgery

Complex treatment of the disease involves the use of antibiotics, chemotherapy and immunomodulators. In addition, drugs are prescribed for symptomatic relief of the patient's condition depending on the clinical picture. All antituberculosis drugs can be conditionally divided into 3 classes according to the severity of the action:

• Potent drugs (Isoniazid, Rifampicin);
• Medications of medium strength (Kanamycin, Streptomycin, Prothionamide);
• Medicines with a moderate therapeutic effect ("Paraminosalicylic acid", "Tioacetazon").

The mode of their reception and dosage should be selected by the phthisiatrician, taking into account the peculiarities of the pathological process in each individual case. With severe hemorrhages in the retina, before using these drugs, it is necessary to carry out a therapy that normalizes the condition of the blood vessels of the eye. Until the patient is stabilized, he is shown hospital treatment.

Prevention

Preventing eye tuberculosis is much easier than treating it. For specific prevention, there is a BCG vaccine that protects the human body from all forms of this insidious disease. It is recommended to introduce it to children after birth in order to form active immunity.

For non-specific prevention of tuberculosis it is important to comply with such rules:

• lead a healthy lifestyle;
• To eat rationally;
• Regularly conduct wet cleaning in the apartment and carefully wipe the dust;
• Spend enough time outdoors;
• Engage in gymnastics or any uncomplicated sport for the recovery of the body;
• Normal rest and sleep;
• Once a year to undergo a fluorography (from the age of 15).

With any strange symptoms, you need to consult a doctor without delay, because in the case of tuberculosis it can help to maintain health, normal vision and a full life.