Edema with syphilis
With syphilis in different periods of its courseaffects the cardiovascular, central nervous system and other organs, including the eye. There are changes in the skin of the eyelids and conjunctiva. The cornea, the vascular tract of the eye and the retina are affected more often.
Consequences of congenital chorioretinitis havea characteristic ophthalmoscopic picture: on the periphery of the fundus a lot of small grayish-white foci alternating with small pigmented lumps. They give the eye-bottom a specific appearance: as if it was sprinkled with salt and pepper. Retinal vessels are narrow, the optic disc is pale. There are also atypical forms, when in the peripheral part of the fundus there are only pigmented foci or, on the contrary, large white foci bordered with a pigment in the form of a ring. Occasionally, the outbreaks reach the central department. In the white foci, in addition to the pigment, the remnants of the empty choroid vessels are visible.
With acquired syphilis, the choroid and the retina are affected in the second and third periods of the disease.
Diffuse and focal forms are distinguishedsyphilitic chorioretinitis. Acquired syphilis is characterized by diffuse chorioretinitis. One of the first signs of the diffuse form of syphilitic chorioretinitis is a gentle opacification of the posterior part of the vitreous humor. The disc of the optic nerve is pink, its borders are not quite clear, the retina is edematic. Sometimes, against the background of a swollen retina, pinkish or light gray small foci without sharp boundaries about the size are visible. half the disc of the optic nerve. Outbreaks are located in or around the area of the yellow spot. The retinal vessels over the foci pass unchanged. Then, changes occur in the pigment epithelium, pigment flakes are formed in the inner and middle layers of the retina. As a result of the displacement of the pigment, a diffuse discoloration of the choroid is detected, and atrophy of the choroid vessels is visible against this background.
The disc of the optic nerve becomes pale,gets a gray tinge, its boundaries are indistinct. Vessels of the retina are narrow. A typical atrophy of the optic nerve develops. Vision sharply decreases. Choroiditis is often combined with iridocyclitis.
Disseminated chorioretinitis in syphilis is difficult to distinguish from disseminated chorioretinitis of another etiology. Serological reactions are important.
A specific treatment is provided by the venereologist. Locally used drugs that dilate the pupil, corticosteroids in droplets and subconjunctival. In addition, use drugs that improve the metabolism of the retina.
Syphilitic inflammation in the brain is accompanied byunilateral mydriasis and accommodation paralysis, there is a picture of the congestive optic nerve disc, and then neuritis and paralysis of the oculomotor nerve develop. A characteristic symptom is homonymous hemianopsia.
In dorsal with one of the earliest symptomsis the absence of pupillary response to light with a preserved response to convergence (Argyll Robertson's symptom). Later, atrophy of the optic nerves develops, leading to a complete loss of vision.
For treatment, corticosteroids are administered orallyscheme, as well as topically in the form of instillations of 0.1% dexamethasone solution, 0.5% hydrocortisone ointment and subconjunctival injections of 0.4% dexamethasone solution at 0.3 ml every other day. Assign desensitizing agents, angioprotectors, vitamins. It is recommended to take indomethacin to 0.025 g 2-3 times a day. Locally - instillation of 3% potassium iodide solution or electrophoresis of a 0.1% solution of lidase. Parabulbarno is also recommended for the introduction of broad-spectrum antibiotics (gentamicin, etc.). Ultrasound is used to resolve hemorrhages, according to indications, laser coagulation of the affected veins of the retina is performed.