Horioidit

Horioidit is an inflammation of the choroid. When horioidit usually involved in the process and the retina (horioretinit).
Most often the infection penetrates into the vascular shell eyes hematogenous route. About half of the cases of horioidit have tubercular origin, and the process can take many forms (disseminated horioidit, diffuse horioidit, solitary tubercul). Syphilitic horioidit happens in congenital or acquired syphilis. Focal Central horioidit observed with toxoplasmosis.
Patients complain of the occurrence of haze in the eye, decrease of visual acuity (often, but not a permanent sign of horioidit). Ophthalmoscope study finds when horioidit exudative yellowish-white lesions, accompanied by swelling of the retina.
The process horioidit usually ends with a partial atrophy of the choroid and retina with redistribution of pigment in the zone of inflammation. In the treatment, as a rule, the forecast for favorable view; only when the Central horioretinit, exciting area of yellow spots are irreversible visual impairment.
Treatment stationary, General and local depending on the etiology of the disease (antibiotics, sulfanilamides, symptomatic treatment).
Cm. also Pigmentosa, Uveitis.

Horioidit (chorioiditis) - an inflammatory disease of the rear Department of vascular tract eye - choroid - or actually the choroid.
The etiology and pathogenesis. Almost all horioidit are hematogenic metastatic infectious diseases. Features anatomical structure and extremely abundant and extensive vascular network of the choroid create very favorable conditions for the emergence of hematogenous inflammatory focus (see Uveitis). Pathogens horioidit can be the most various pathogenic microorganisms, recorded by the flow of blood in the vasculature of the choroid. Horioidit occurs when tuberculosis, syphilis, toxoplasmosis and a number of other common infectious and viral diseases. Clinical and Ophthalmoscope paintings such horioidit, despite the similarity of their pathogenesis, have a number of features that allows in some cases to establish the etiology of horioidit even if you erased forms or long ended infectious diseases.
Pathological anatomy. Because of the close ties of the choroid with primary, svetovosprinimayuschee part of the eye is the retina, any outbreak of horioidit immediately cause reactive inflammation in the retina that always manifests those or other disabilities. If horioidit is not too rapidly, the reaction of the retina may be limited to a small hyperemia, nabukalu and edema. The resulting visual disturbances are transient in nature; as soon as there comes a certain weakening of horioidit, all symptoms of irritation of the retina disappear and vision is restored. In more severe and long-current horioidit reaction on the part of the retina is expressed much sharper. It is not limited to already hyperemia and swelling, and manifested infiltration and partial collapse of the pigment epithelium cells. When Ophthalmoscope study of such patients even in the relative weakening of the inflammatory process in the choroid visible single or multiple foci light pink or yellowish with fuzzy boundaries. About the deep location of these lesions can be judged from the fact that the retinal vessels pass over them continuously, often forming at the edges of the light curve, indicating the existence of a bulging retinal tissue above centers. Already in the early stages of development horioidit themselves foci and around them are separate clusters of small pigment dust. In more severe long-term recurrent horioidit on the edges of lesions appear more massive pigment glybki; at the same time, the foci become almost white and clearer contribute. All these Ophthalmoscope changes suggest rougher destructive changes of pigment epithelium cells and about moving their pigment into infiltrative fabric, and also about coming scarring, leading to the gradual replacement of the inflammatory infiltrate the newly formed connective tissue. Such changes, exciting as the choroid, and the deep layers of the retina, there are often irreversible. Then we can talk about a mixed process - horioretinit, although as pathological and clinical differences between one and another process is quite conditional. The most important subjective sign of the defeat of the retina when horioidit is that of functional visual disorders lose their remitting nature and become when horioretinit persistent. Remitting inflammatory process in choroidal hearth does not lead to the restoration of view and to the disappearance of paracentral cattle.
The clinical picture. The most common and severe, often leading patients to long-term disability, or even blindness, are horioidit tubercular etiology. Depending on the age and General immune status of patients with active inflammatory process in the choroid can take various forms. In infected TB children at the time of dissemination during miliary tuberculosis or TB meningitis sometimes appear rash miliary tuberculosis bumps in the choroid. In the fundus immediately, there are many small light gray rounded foci with fuzzy boundaries (prosperous, table, Fig. 1). Retinal vessels sometimes bent at the edge of the foci, otherwise they are not changed; sometimes there is swelling of the retina and optic nerve papilla. The resulting functional disorders may not always be identified because of the severe General condition of the children. The emergence of miliary bumps in the choroid is seen as a symptom of deteriorating General forecast of the disease.
More often tuberculosis horioidit occurs at the age of 20-30 years in people is practically healthy for TB. Many of them only with careful survey't install tuberculosis infection in children.
X-ray examination of the thorax find only a small scar on - the remains of a long-postponed primary complex, sometimes barely discernible. Only a dramatically positive tuberculin skin tests can help diagnose, mainly based on the data ophthalmoscopy. Ophthalmoscope picture has some characteristic features. Typical disseminated tuberculosis horioidit affects primarily periyakulam region, which are characterized by repeated eruptions are usually small, not merging between a light-yellow poor pigment foci with fuzzy boundaries (printing. table, Fig. 2). Simultaneously with fresh foci are marked and old white with a rim of pigment clumps (printing. table, Fig. 3). At the moment of explosion retin centers around becomes dull, edematous, to distinguish different foci is not always possible. At the time of remission, when edema and hyperemia of the retina reduced, all of them again visible. Often appear retinal hemorrhages or exudates, further reduces the visual acuity.
Sometimes in the choroid occurs isolated tuberculosis granuloma - solitary tubercul of the choroid, reaching a size three diameters nipple optic nerve and greater (printing. table, Fig. 5).



horioidit
Fig. 1. Miliary tuberculosis horioidit. Fig. 2. Disseminated tuberculosis horioidit. Fig. 3. Old cicatrizing chorioretinal pockets. Fig. 4. Syphilitic horioretinit. Fig. 5. Solitary tubercul of the choroid. Fig. 6. Chorioretinal hearth with toxoplasmosis.

Situated first in premakosamai area, such tubercul soon capture the macular region, greatly reducing vision. The presence of inflammation in the environmental retina and in the nipple of the optic nerve to differentiate tuberculosis granuloma of the choroid from the tumor.
Syphilis chorioretinal centers are usually located initially in the periphery of the fundus (in case of congenital syphilis in children) and can be a long time not to cause any visual disturbances. For syphilis of horioidit and chorioretinitis characteristic more abundant pigmentation and expressed a tendency foci merge with each other, forming intricate winding shape (printing. table, Fig. 4).
When brucellosis, flu, recurrent fever and other common infections horioidit is rare. In most cases it is only one component of diffuse inflammation of all vascular tract.
Several similar to solitary tuberculosis picture sometimes give diseases of the choroid toxoplasmose etiology (printing. table, Fig. 6).
Treatment. It is based on a specific therapy (TB, protevoepilepticescoe and others). While conducting the General and local desensitizing antiallergic treatment, what is it used for calcium (inside calcium gluconate 0.5 g; intravenous 10% solution of calcium chloride to 10 ml; calcium-iontophoresis by eye Bourguignon)and diphenhydramine, suprastin, pipolfen and others Appointed restorative treatment and appropriate gently. In severe horioidit tubercular etiology shown climatotherapy. Early initiated and vigorously treatment of horioidit leads to the elimination of inflammatory phenomena, and to resolution of infiltrates with no education lasting Scar changes, greatly reducing visual function.