An eyesore for a man

It is not difficult to guess why the name of the scar on the cornea - an eyesore - became a figurative expression, because the phraseologism "like an eyesore" is used when it comes to something that is very disturbing and annoying.

The medical definition of a dense white spot on the anterior transparent part of the eye is corneal leucoma. What does leikoma mean? In Greek, leukos is “white,” and cornea is the Latin name for the cornea.

According to ICD-10 in the class of ophthalmologic diseases, the code of this pathology is H17.0 (in the section - Scars and corneal opacities).

Epidemiology

The most common causes of corneal opacity were eye injury (50.6%), retinal disease (15.5%), measles (9.5%), and congenital etiology (5.5%). [1]The prevalence of leucoma of the cornea is about 0.03%. [2] The prevalence of visual impairment and blindness among patients with corneal opacity was 46.2% and 19.2%, respectively. [3]

Causes of the eyesore

Corneal leucoma often occurs with keratitis and corneal wound due to a variety of factors, such as physical, chemical, and congenital. Opacity of the cornea leads to cosmetic problems. If the scar is in the area of the visual axis, it can lead to loss of vision and even functional blindness. 

In the list, which includes the most frequent and possible causes of eyesore, ophthalmologists have listed: [4]

• eye damage - mechanical injury, thermal or chemical  burns of the cornea ;
• corneal inflammation -  keratitis of  any etiology, which, in turn, can lead to the formation of  corneal ulcers, healing with scarring of its underlying tissue (stroma);
• corneal dryness (xerophthalmia);
• injury to the cornea during abnormal growth of eyelashes (trichiasis);
• congenital disease (in infants) with gonorrhea or diffuse parenchymal keratitis associated with congenital syphilis;
• intraepithelial neoplasia of the conjunctiva or cornea, retinoblastoma;
• genetically determined  corneal dystrophy (degradation) ;
• hereditary  metabolic disorders with corneal lesions ;
• infectious diseases (measles). [5]

Risk factors

All of the above reasons simultaneously apply to the risk factors for eyesore.

For example, severe penetrating damage to the eye, leading to rupture of the cornea, require emergency surgical intervention: the eye can be saved, but postoperative scar formation leads to progressive corneal opacification, and after a while a white thorn is formed on the eye.

By the way, it should be borne in mind that visual impairment in advanced cases of beta-carotene (vitamin A) deficiency may be manifested by clouding of the cornea. [6], [7]

Alternation of the cornea with its subsequent inflammation may be caused by lagophthalmos (incomplete closure of the century) in patients with facial nerve palsy, blepharism (rapid blinking in nervous tic or Tourette syndrome) or, conversely, a decrease in the frequency of blinks, for example, Parkinson's disease, glaucoma. [8]

It remains to add an increased risk of the development of infectious inflammation of the cornea when wearing unsterilized contact lenses, the presence of a hereditary factor (if there were cases of corneal leucoma formation in the genus), [9]as well as age (morphological changes in the corneal structure of the cornea are degenerative).

Pathogenesis

The structure of the corneal stroma is formed by collagen fibrillar protein fibers and sulfated glycosaminoglycans, represented by type I keratan sulfate (the content of which is much higher compared to cartilage tissue) and high molecular weight keratan sulfate proteins (proteoglycans) with a high content of leucine: keratocan, lumicane, and the isostroma. Together, they make the cornea strong enough, optimally elastic and absolutely transparent. In addition, the extracellular matrix of the  cornea  contains adhesive glycoproteins: several laminin isoforms and fibronectin, which hold together all the elements of the stratum corneum. 

The apical region of the stroma - Bowman's membrane - is a dense, cell-free layer between the stroma itself and the horny epithelium, consisting mainly of tightly woven collagen fibrils. So, the pathogenesis of scar formation on the cornea is associated with damage to this particular membrane, since alterations that do not affect it do not leave scars during healing. [10]

The fibronectin produced by keratocytes of the cornea and keratoepithelin synthesized by the cells of its epithelium and stroma fibroblasts promote the adhesion of microfibrils of collagen and sulfated glycosaminoglycans to accelerate the repair of damaged corneal tissues. Formation of eyesore is the result of the accumulation of excess protein fibers throughout the middle and anterior stroma. [11]

In addition, an important role in the disturbance of the remodeling processes of the damaged extracellular matrix of the cornea is played by the deficiency of limbal stem cells (LSC) produced by its epithelium, as well as the deviations associated with the expression of extracellular enzymes - matrix metalloproteinases, which are designed to ensure timely apoptosis of obsolete (damaged) masters of metalloproteinases, which are designed to ensure timely apoptosis of obsolete (damaged) masters of metalloproteinases that are designed to ensure timely apoptosis of obsolete (damaged) masters of metalloproteinases, which are designed to ensure timely apoptosis of outdated enzymes - matrix metalloproteinases. Cell differentiation of regenerated tissues.

Symptoms of the eyesore

The earliest signs of the appearance of a white catcher are manifested by a feeling of veil in front of the affected eye - if the scar tissue is concentrated closer to the center.

At the beginning of the formation of leucomas on the periphery of the cornea, symptoms in the form of reduced vision will appear later - as the area of damage increases.

Many patients complain of increased secretion of tear fluid, the appearance of a sensation of contamination of the eye, the light spots and lines appearing before the eyes.

Since the scar tissue on the cornea does not have capillaries, there can be no red eyesore in the eye. But neovascularization of the cornea, that is, excessive growth of blood vessels from the limbal choroid plexus, may occur. And the redness of the sclera occurs for a number of reasons, in detail in the material -  Redness of the eyes.

Complications and consequences

If the cornea is damaged by an infection or was injured, the thorn formed at the injury site can distort or block the light passing through the cornea, and this causes complications and consequences, such as reduced visual acuity and deprivation amblyopia.

If intraocular pressure is elevated, that is, there is glaucoma in the history, and the thorn is not very thick, then it can significantly project relative to the corneal surface, and then a corneal staphyloma is formed.

A leucoma located in the central part of the cornea can cause blindness.

Diagnostics of the eyesore

Inspection using a slit lamp -  corneal biomicroscopy  - a classic ophthalmic  examination of the eye. [12]

In addition, instrumental diagnostics is performed using  corneal keratometry  and optical coherent tomography. Fields of view are determined by computer perimetry; measured and intraocular pressure.

Differential diagnosis

Differential diagnostics is designed to distinguish leuku cornea from the whitish hue of the pupil associated with clouding of the lens in a disease such as cataracts.

A belmus on the white of the eye (on the sclera) does not form, but there may be a slightly elevated formation of a yellowish color on the white of the eye or conjunctiva (closer to the inner corners of the eyes), resembling a wen on the eye, or, as is often said, a growth on the human eye. This formation of a benign character occurs in people of age and is called a pingvecula; it does not affect vision and, as a rule, does not manifest itself.

Treatment of the eyesore

What if there is a thorn in the eye? Quickly go to an ophthalmologist (optometrist) who knows how to remove the eyesore.

Only surgical treatment can completely remove corneal leucoma:  corneal transplantation  or  keratoprosthesis  using a synthetic cornea analog (keratoprosthesis). [13]

Corneal transplantation, such as penetrating keratoplasty (PK) and lamellar keratoplasty (LK), is an excellent treatment for eyesore that want to regain their visual acuity. However, after corneal transplantation, many people experience graft rejection and chronic loss of endothelial cells. [14], [15]

Keratopigmentation (QFT) has been used for cosmetic purposes for centuries when visual reconstruction is ineffective. [16]Galen (131-201 AD) used copper sulfate to stain the leucoma of the cornea [17], [18]. Later, surgeons used Indian ink to shade the scars of patients with corneal leucoma. Cosmetic contact lenses are known to be the most commonly used method for improving aesthetics [19]. However, people may be intolerant of wearing contact lenses, refusing a prosthesis for psychological reasons, or have chronic inflammation and infection [20].

But in the early stages of the formation of the diarrhea, drug therapy is used.

To improve the microcirculation in the eye and enhance fibrinolysis, medications containing methylethylpyridinol hydrochloride are used:  [21]Lacmox, Emoxipin, Emoxypharm. Method of application - instillation in the conjunctival sac (three times a day, one or two drops). The duration of treatment is determined by the doctor. Drops can cause temporary itching, burning and redness of the eyes.

Such drops for eyes from the cataract, such as Carnosine (Sevitin), Taurine (Tauphon), Hilo-kea (with sodium hyaluronate and dexpanthenol), Ayurvedic means  Uzala  (Ujal) can also be prescribed. Drops with glucocorticosteroids, in particular with dexamethasone (reduces neovascularization and lymphangiogenesis, improves the barrier function of the eye)  [22],  [23]hyaluronidase are used. [24]

The antitubus drug Collalizin (in the form of a lyophilisate for preparing a solution) is used by electrophoresis and phonophoresis. [25]Also, physiotherapy treatment is carried out using a different proteolytic enzyme - lidaza, corticosteroids (hydrocortisone) and potassium iodide solution.

It is recommended to take vitamins, first of all, ascorbic acid, (vitamin C accelerates the proliferation of corneal epithelial cells and the healing of epithelial defects)  [26]tocopherol acetate [27], [28], and thiamine. [29]Read more -  Vitamins and Vision

It should be borne in mind that treating an eye disease at home does not lead to its disappearance, and that dripping onion juice (mixed with honey or milk) into the eyes is useless and dangerous, since this “folk treatment” may cause additional irritation of the cornea and retina. Eyes.

There is no clinical evidence of efficacy and herbal treatment, in particular, washing and drowning eyes with decoctions of eyebright (Euphrasia officinalis), golden whiskers (Callisia fragrans) and blue cornflower (Centaurea cyanus). Although these medicinal plants, including onion juice,  [30]can be used as an adjuvant for inflammation of the conjunctiva of the eyes.

Prevention

There is one more phraseological unit - “keep as the pupil of the eye”, that is, try to preserve something important. The cornea is the most important structure of our eyes: before the light enters the photoreceptors of the retina, it must pass through the cornea, and therefore it must remain transparent.

Prevention of corneal leucoma is the early detection and treatment of corneal inflammation (herpetic or bacterial keratitis), dry eye; use of goggles in production, protection of eyes against ultraviolet radiation, etc.

Forecast

In the case of an old wallet, the forecast depends on the effectiveness of its treatment. But in terms of etiology, the formation of a scar on the cornea is directly dependent on the diseases that affect the cornea, as well as on the severity and nature of the damage.