Angular conjunctivitis is an inflammation of the conjunctiva of the eye, the causative agent of which is diplobacillus Morax-Axenfeld. The clinical picture of the disease includes itching and burning in the ocular region, redness of the eyes and eyelids, blurred vision. To confirm the diagnosis, special diagnostic panels, analysis with monoclonal antibodies, biomicroscopy, visometry, cytological examination are used. Therapeutic tactics are reduced to the appointment of zinc sulfate, antibacterial drugs, immunostimulants and nonsteroidal anti-inflammatory drugs.
Angular conjunctivitis was first described in 1896 by two scientists – French and German ophthalmologists V. Morax and K. Axenfeld, who studied the morphology of the diplobacillus and the symptoms of its damage to the membranes of the eyeball. According to statistics, the share of diplobacillar inflammation of the conjunctiva accounts for 5-7% of the total number of all bacterial conjunctivitis. About 78% of patients suffer from a chronic or recurrent form of pathology. The disease is mainly diagnosed in middle-aged and elderly people. Men and women suffer with the same frequency.
Detailed studies in the field of clinical ophthalmology have made it possible to exclude the staphylococcal and streptococcal nature of the disease. At the moment, it is reliably known that the causative agent of angular conjunctivitis is the Morax-Axenfeld wand. Moraxella lacunata is a non–fermenting aerobic gram-negative diplobacillus that lives on mucous membranes. Compared with other representatives of the genus moraxell, this microorganism has more aggressiveness, affects the outer shell of the eye, less often – the epithelium of the paranasal sinuses and endocardium. Bacillus belongs to the number of conditionally pathogenic microorganisms, angular conjunctivitis is observed in persons with reduced immunological reactivity. The bacterium is resistant to adverse environmental conditions, can exist for a long time at temperatures from -10 to 55 ° C. Optimal conditions for growth occur at a temperature of 30-37 ° C.
The main way of transmission of the disease is contact and household. Infection is realized through the use of personal items. You can also get infected with a handshake, because when a sick person wipes his eyes, secretions from the conjunctival cavity containing microorganisms fall on his hands. Progressive necrosis of conjunctival tissue with subsequent transition to the cornea plays a significant role in the mechanism of pathology development. It is the destructive type of inflammation that causes the further formation of deep ulcerative defects.
Symptoms of angular conjunctivitis
The diplobacillar form of the disease is characterized by a cyclical course. The duration of the incubation period is on average 4 days. The lesion of the eyes is always symmetrical, the severity of clinical symptoms increases in the evening. The first signs of the disease are severe burning and itching in the eye socket. During the peak period, there are complaints of a feeling of pain in the eyes, pain in the periorbital region. The pain syndrome increases with blinking. Hyperemia of the orbital and palpebral conjunctiva is visually determined in the area of the medial, rarely lateral corners.
Foamy mucus is released from the conjunctival cavity in a small volume, the consistency of which becomes viscous after 24-72 hours. Pathological secretions accumulate in the corners of the eye slit. A slight deterioration of vision is determined. Patients note the appearance of a “veil” or “fog” in front of their eyes. Over time, dense waxy crusts form in the medial corners of the eyes. Maceration of the skin in the periorbital zone is observed. Painful cracks form on the skin of the eyelids. The disease is characterized by frequent relapses, there is a high probability of chronization.
The spread of infection to the cornea leads to the development of marginal keratitis, which is accompanied by the formation of infiltrates and deep ulcers. A common complication is inflammation of the eyelids. Less often, the nasolacrimal canal is involved in the pathological process with the subsequent occurrence of dacryocystitis. The formation of cracks on the skin of the palpebral zone causes the appearance of dense scarring that limits the mobility of the eyelids. With hematogenic dissemination of pathogenic microflora, the inner lining of the heart is affected. Severe course of endocarditis leads to progressive valvular destruction and embolism.
To confirm the diplococcal etiology of angular conjunctivitis, special commercial panels are used, which allow obtaining the result of a comprehensive analysis of generally recognized tests (agar corrosion, hemolysis, oxidation and fermentation, nitrate reduction). Monoclonal antibodies are used to detect type-specific proteins of the outer membrane. Assign the following instrumental diagnostic methods:
- Examination of the anterior segment of the eye. Biomicroscopy of the eyeball reveals vascular injection and edema, more pronounced at the medial angle. Clusters of viscous secretions in the inner corners of the eye are visualized. With concomitant corneal lesions, single infiltrates and ulceration foci are visible.
- Visometry. With isolated diplococcal conjunctivitis, visual acuity decreases slightly. When the process spreads to the cornea, visual dysfunction increases. In some cases, additional computer keratometry is required.
- Cytological examination of a smear from the conjunctiva. For the analysis, a scraping or smear-print from the conjunctival surface is used. Diplobacilli have the form of short sticks arranged in pairs or small chains. Changes in the cellular composition of the epithelial layer correspond to a bacterial lesion.
Treatment of angular conjunctivitis
Pathology is difficult to treat. Upon admission of a patient with suspected angular conjunctivitis, broad-spectrum antibiotics are empirically prescribed before determining the etiology of the disease. There is a need for the use of zinc-based etiotropic drugs within 1-2 weeks after the disappearance of all symptoms of the disease. Conservative therapy includes:
- Antiseptic agents. In the complex treatment of angular conjunctivitis, the leading role is given to a solution of zinc sulfate. Instillation of eye drops is carried out 4-6 times a day for 1-1.5 months. After the symptoms are eliminated, the drug is instilled for another 7-10 days. The edges of the eyelids are carefully treated with zinc ointment.
- Antibacterial drugs. The individual treatment regimen is selected taking into account the results of the antibiotic resistance test. The Morax-Axenfeld bacterium is sensitive to macrolides, tetracyclines and aminoglycosides. In the absence of an effect from the prescribed therapy, reserve preparations are used – fluoroquinolones and combined antibacterial agents.
- Nonsteroidal anti-inflammatory drugs. To reduce the severity of inflammation, instillations of 0.1% diclofenac sodium solution are used. The average duration of the course is 5-7 days. With simultaneous corneal damage, NSAIDs are administered for at least 10-14 days. In severe pathology, glucocorticosteroids are additionally prescribed.
- Immunostimulants. Immunomodulatory agents are indicated for the chronic course of the disease or frequent relapses. Biologically active peptides and thymus preparations are recommended. If conjunctivitis occurs against the background of an immunodeficiency condition, interferons and interleukins are included in the treatment program.
Prognosis and prevention
The outcome of pathology directly depends on the adequacy and timeliness of treatment. If all the doctor’s recommendations are followed, a full recovery is possible. At the same time, most patients have relapses with a transition to a chronic form. Specific preventive measures have not been developed. Non-specific prevention is aimed at compliance with the rules of personal hygiene. You should wash or treat your hands with antiseptic solutions before touching the periorbital zone. It is necessary to strengthen the immune system, normalize sleep and wakefulness, and pay due attention to the diet.