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Chorioretinal dystrophy of the retina

Symptoms of chorioretinal dystrophy

There are two forms: non-exudative (dry, atrophic) and exudative (wet).

Dry nonexudative dystrophy is an early form of the disease and occurs in 85-90% of cases. It is characterized by metabolic disorders between the vessels and the retina of the eye. Colloidal substances (decomposition products) accumulate between the basal layer formed by the vascular and reticular membranes and the pigment epithelium of the retina, redistribution of the pigment and atrophy of the pigment epithelium occur.

The disease begins asymptomatically and progresses slowly. Visual acuity remains normal for a long time, but there may be a curvature of straight lines, duality, distortion of the shapes and sizes of objects. Gradually, the image becomes blurred when looking straight (like through a layer of water), visual acuity begins to decline. This process can stabilize at some stage, but it can also lead to a complete loss of central vision.

In the second eye, the disease begins to develop no later than five years after the first lesion. In 10% of cases, dry dystrophy turns into a heavier wet form. When this occurs, the penetration of fluid (blood) through the walls of the newly formed vessels and its accumulation under the retina.

Exudative dystrophy has four stages of development:

Detachment of the pigment epithelium. Visual acuity persists, slight manifestations of farsightedness or astigmatism, the appearance of fog or cloudy spots before the eyes are possible. The process may have a reverse development (prileganie places of detachment).

Detachment of neuroepithelium. A significant reduction in vision is added to the above symptoms, including the loss of the ability to read and write. Indistinct borders and edema of the detachment zone, pathological proliferation of blood vessels are noted.

Hemorrhagic detachment of the pigment and neuroepithelium. Vision remains low. A large pink-brown center of pigment with clear boundaries is formed. Cystic modified retina protrudes into the vitreous body. When the rupture of the newly formed vessels hemorrhages occur.

Cicatricial stage. At the site of the lesion, fibrous tissue is formed and a scar is formed.

Treatment

Treatment may be medication, laser and, less commonly, surgery. It is aimed at stabilizing and compensating for the process, since the complete restoration of normal vision is impossible.

In the atrophic non-exudative form, disaggregants, angioprotectors, antioxidants and vasodilators (Cavinton) are prescribed 2 courses per year (in spring and autumn), stimulation of the retina by a defocused helium laser beam.

In an exudative form of exacerbation, local and general dehydration therapy, laser coagulation of the retina and subretinal neovascular membranes are preferred, preferably with a krypton laser.

Surgical treatment methods are aimed either at improving the blood supply to the posterior segment of the eye (revascularization, vasoreconstruction with a non-exudative form), or at the removal of subretinal neovascular membranes.

If macular dystrophy is combined with cataract, the removal of a cloudy lens is performed using a well-known technique, but instead of the usual artificial lens, special intraocular lenses can be implanted, which shift the image to the unaffected retinal area (spherical prism lenses) or give an enlarged image on the retina (bifocal lenses).

Critical visual acuity, favorable for treatment, is 0.2 and higher. In general, the prognosis for vision is unfavorable.

The information provided in this section is intended for medical and pharmaceutical professionals and should not be used for self-medication. The information is given for familiarization and can not be considered as official.

What is chorioretinal dystrophy?

Chorioretinal dystrophy (CHRD) is a dystrophy of the central part of the retina. Synonyms: central dysformiform dystrophy, senile macular dystrophy. This age-related pathology, which occurs at the age of 50-60 years and is more common in women.

With age-related retinal degeneration, gradual irreversible changes occur in the macular (central) zone of the retina, the consequence of which is a significant loss of central vision. The retinal tissue is replaced by fibrous tissue with scar formation. Usually this process develops in parallel in both eyes, but in some cases it may occur ahead in one eye.

Even in severe cases, the CRHD does not lead to total blindness, since peripheral vision remains within the normal range. However, this completely loses the ability to perform work that requires a clear view (reading, writing, driving, etc.).

The incidence of the disease increases with age: at the age of 51–64, it is 1.6% of the total population, at the age of 65–74 years - 11%, over 75 years old - 28%.

The disease has a chronic, slowly progressive course. It should be differentiated from retinal detachment - these are different pathologies.

Causes of chorioretinal dystrophy

The causes and etiology of the CRHD are not fully understood.

The list of factors that increase the likelihood of its development includes:

Circulatory disorders in the vascular system of the eye,

Myopia (myopia) of medium and high degree

Excessive exposure of the eyes to ultraviolet radiation,

Infectious, toxic or traumatic eye damage,

The presence of bad habits.

Chorioretinal dystrophy develops under the influence of a combination of factors. It can be both a congenital disease with an autosomal dominant type of transmission, as well as a consequence of an infectious-inflammatory process.

Additional risk factors include:

Light pigmentation of the skin and iris,

Surgical treatment of cataracts in history.

Symptoms of chorioretinal dystrophy

Two forms of CHRD are distinguished: nonexudative (dry, atrophic) and exudative (wet).

Dry nonexudative dystrophy is an early form of the disease and occurs in 85-90% of cases. It is characterized by metabolic disorders between the vessels and the retina of the eye. Colloidal substances (decomposition products) accumulate between the basal layer formed by the vascular and reticular membranes and the pigment epithelium of the retina, redistribution of the pigment and atrophy of the pigment epithelium occur.

The disease begins asymptomatically and progresses slowly. Visual acuity remains normal for a long time, but there may be a curvature of straight lines, duality, distortion of the shapes and sizes of objects. Gradually, the image becomes blurred when looking straight (like through a layer of water), visual acuity begins to decline. This process can stabilize at some stage, but it can also lead to a complete loss of central vision.

In the second eye, the disease begins to develop no later than five years after the first lesion. In 10% of cases, dry dystrophy turns into a heavier wet form. When this occurs, the penetration of fluid (blood) through the walls of the newly formed vessels and its accumulation under the retina.

Exudative dystrophy has four stages of development:

Detachment of the pigment epithelium. Visual acuity persists, slight manifestations of farsightedness or astigmatism, the appearance of fog or cloudy spots before the eyes are possible. The process may have a reverse development (prileganie places of detachment).

Detachment of neuroepithelium. A significant reduction in vision is added to the above symptoms, including the loss of the ability to read and write. Indistinct borders and edema of the detachment zone, pathological proliferation of blood vessels are noted.

Hemorrhagic detachment of the pigment and neuroepithelium. Vision remains low. A large pink-brown center of pigment with clear boundaries is formed. Cystic modified retina protrudes into the vitreous body. When the rupture of the newly formed vessels hemorrhages occur.

Cicatricial stage. At the site of the lesion, fibrous tissue is formed and a scar is formed.

Diagnosis of chorioretinal dystrophy

The diagnosis is made on the basis of the patient's survey, visual acuity, ophthalmoscopy, campimetry, and Amsler's test (studies of the central visual field).

From instrumental diagnostic methods are used:

Laser scanning tomography of the retina,

Fluorescence angiography of the fundus.

Treatment of chorioretinal dystrophy

The choice of treatment depends on the form and stage of the process. The main goal is its stabilization and compensation. Treatment methods: drug, laser, surgical.

In case of nonexudative form, intravenous injections of antiagglomerates, anticoagulants and angioprotectors, vasodilators (“Cavinton”), antioxidants (“Emoxipin”), vitamin therapy are prescribed. Treatment should be continuous and take courses 2 times a year (autumn and spring).

In case of exudative form, general and local treatment is carried out, laser coagulation (cauterization) of the retina is possible in order to eliminate edema and destruction of the neovascular (formed from pathological vessels) membrane. This allows you to suspend the further development of the dystrophic process.

Surgical treatment is used to improve the blood supply to the back of the eye. This may be vitrectomy (removal of a part of the vitreous body), vasoreconstruction, revascularization (restoration of a normal microvascular network).

The prognosis is generally unfavorable, since it is impossible to restore vision. But even with a complete loss of central vision, the peripheral remains, sufficient for self-service in everyday life and orientation in space.

Author of the article: Marina Degtyarova, ophthalmologist, oculist

Protects the retina from excess UV rays of visual purple. Vitamin B2 (riboflavin) is necessary for its secretion. It enters the body from milk, eggs, meat, liver, croup. Even after heat treatment, riboflavin is retained in these products. Identify the flaw.

The retina of the eye needs a large consumption of nutrients and oxygen, since it is responsible for capturing light waves, transferring them to the nerve impulse and through it to the brain, where the image formation takes place. The lack of blood supply to the choroid causes.

The human eye has a very complex structure, the main place in which is exactly the retina. Due to the complex structure of the retina provides the eye the perception of various light pulses. Its function is to ensure the interaction of the optical system and visual departments, the location of which is.

Retinal macular dystrophy is a disease that affects the central area of ​​the retina and results in impaired vision. First of all, decreases the lumen of the lining of the membrane, which feeds the retina. As a result, tissues begin to lack the necessary.

Laser coagulation of the retina is a method that is used both for the treatment and prevention of eye diseases associated with vascular ruptures or their dystrophic changes, as well as for certain types of tumors. In order to prevent visual impairment, it has recently become increasingly used this procedure. She allows.

Basic pathology data

During the development of dystrophy, the level of central vision is significantly reduced. However, the lesion does not affect the area of ​​peripheral vision, which continues to function stably. Due to this, even with severe forms of the disease, the patient will normally navigate in a normal environment, although he will not be able to cope with such actions as driving or reading, without additional devices that correct vision.

The standard procedure of examination by an ophthalmologist does not allow to examine the condition of the peripheral zone of the eyes. However, it is in this area of ​​the retina that tissue is most often affected by degenerative processes. Since it is not immediately possible to detect them and begin treatment due to a practically asymptomatic course, the patient may face a number of additional complications, which ultimately lead to serious visual impairments, such as tearing of tissues or their detachment.

This disease is most common in the elderly with light pigmentation of the iris. The structure of their blood vessels is intensively subjected to age-related changes, as a result of which the retinal tissues begin to deteriorate vigorously. At the same time, the process of destruction is significantly accelerated if the patient has bad habits (alcohol, smoking).

By type and development (pathogenesis), the following SCRDs are distinguished:

  1. Dry atrophic (non-exudative) - an early form of the disease, in which a decrease in vision is accompanied by the death of the pigment epithelium. At the same time, it is necessary to be prepared for the fact that in the next 5 years the defeat will begin to actively develop in the second eye.
  2. Wet (exudative). It is quite rare. Complicated by detachment of various types of epithelium, hemorrhages in the area of ​​affected tissues and cicatricial deformity.

As a rule, such changes can be observed even in people whose vision is in a normal state.

Manifestations of the disease

As a rule, central chorioretinal dystrophy of the retina is attributed to multifactorial pathology, which can be triggered by:

  • poor heredity,
  • different stages of myopia,
  • disorders in the vascular system of the eye,
  • weakening of the immune system
  • intoxication with various chemicals or alcohol,
  • vitamin deficiency
  • concomitant diseases, such as diabetes.

The disease may begin to develop after various eye injuries, including cataracts and surgery.

In the initial stages, tissue degeneration in the retina usually proceeds without noticeable symptoms. The first of them occur only in the middle or severe stages of the disease. Thus, in patients with a dry form of dystrophy, in the course of deterioration of vision, a veil, flies or white flashes may appear periodically before the eyes.

The wet form of dystrophy is expressed by a strong distortion or blurring of surrounding objects, the development of color blindness (a violation of the difference in color) and an erroneous perception of objects in space.

If the SCRD is not detected in time and the treatment is not started, the tissues continue to deteriorate and the vision deteriorates dramatically. Detect the disease by examining the fundus. For this purpose, a special, three-mirror Goldman lens is most often used, allowing one to see even the most extreme regions of the retina.

Additional diagnostic methods:

  • conducting optical coherent and laser scanning tomography of the retina,
  • implementation of computer perimetry,
  • electroretinography,
  • fluorescein angiography of retinal vessels.

In the early stages of the diagnosis of the CHRD, the doctor can use a number of special tests that allow for a study of how badly the color rendition and visual contrast are impaired in the patient.

Chorioretinal dystrophy

In ophthalmology, chorioretinal dystrophy (age-related macular degeneration) refers to the vascular pathology of the eye and is characterized by gradual irreversible changes in the macular area of ​​the retina with a significant loss of central vision in both eyes in patients over 50 years of age. Even in severe cases, chorioretinal dystrophy does not cause complete blindness, since peripheral vision remains within the normal range, but the ability to perform clear visual work (reading, writing, driving control) is completely lost.

According to the pathogenesis, the following forms of age-related chorioretinal dystrophy are distinguished: dry atrophic (non-exudative) and wet (exudative). Dry chorioretinal dystrophy - an early form of the disease, occurs in 85-90% of cases, is accompanied by atrophy of the pigment epithelium and a gradual decrease in vision, with the second eye developing no later than 5 years after the disease of the first. In 10% of cases, dry chorioretinal dystrophy turns into a more severe and rapid moist form, complicated by retinal pigment and neuroepithelium of the retina, hemorrhages and cicatricial deformity.

1 Definition of inflammation

Chorioretinal vascular disorders are, for the most part, inflammatory processes that do not in the best way affect a person’s well-being.

What are these violations? What are their symptoms and causes?

It is noted that often any of the following infections can cause the development of pathology:

The disease can also develop as a result of the manifestation in a person of a clinical picture of infection of ENT organs or oral diseases. Развиться данное сосудистое нарушение может и по причине негативного воздействия на человеческий организм токсических веществ.Toxins often destroy human blood.

Along with this, experts note that, in addition to the infectious component and toxins, the cause may be an allergic manifestation, radiation exposure, impaired functioning of the body's immune system, or even injury.

How does chorioretinal vascular disorder manifest? Speaking about the clinical picture of this phenomenon, it can be primarily noted that the symptoms will directly depend on the localization of the inflamed area. And it may be the following:

  • macular (central),
  • peripapillary (surrounding the optic nerve),
  • equatorial,
  • peripheral.

If we take into account the prevalence of the disease, we can say that such a vascular disorder can be divided into several varieties:

  • focal,
  • multifocal disseminated (several foci),
  • diffuse.

The inflammatory process, occurring in acute form, can last up to three months. The disease, transformed into a chronic form, especially often manifests itself in relapses. Peripheral chorioretinitis can occur without any external manifestations, often its detection occurs quite randomly during a routine inspection.

A central or macular disorder is accompanied by signs such as misting and decreased visual acuity. The patient may complain about the appearance of flashes or dark spots in the eyes, while the shapes and sizes of objects may be distorted. Another symptom of this manifestation may be the so-called "night blindness". In this case, a person has difficulty orienteering in the twilight.

Regardless of which visual impairment a person begins to pay attention to, in any case, consultation of a specialist is necessary. After all, only he will be able to make a truly correct diagnosis and prescribe an effective way of treatment.

What is the difference between thrombosis and thrombophlebitis

2 Diagnosing Pathology

In order to ensure the presence of chorioretinal disorders, a special diagnosis is carried out. What is the definition of the disease?

Initially, a sick person is checked for the degree of visual acuity. Chronic chorioretinitis, for example, is accompanied by its decline. The next diagnostic method is computer perimetry. It is necessary to determine the contrast susceptibility of the retina.

In addition, specialists conduct biomicroscopy to identify possible changes in the vitreous body. Research in transmitted light can show various kinds of turbidity in the vitreous body. Often used and the survey using the lens Goldman. So, doctors can identify violations of the fundus. The classic signs of change in this case can be manifested yellow-gray lesions that have fuzzy boundaries, penetrate into the vitreous region, hemorrhage or exudate formed along the vessels.

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In addition to the aforementioned diagnostic methods, others are used. For example, the use of fluorescent angiography allows you to determine the presence of violations of the fundus vessels. Using electroretinography, you can determine the health of the retina. The structure of the focus of inflammation helps to determine the use of optical coherence tomography of the retina. Ultrasound is also used to identify possible opacities of the eye.

In addition to special ophthalmologic examinations, a patient undergoing suspected chorioretinal vascular disorders undergoes a number of examinations, including a complete blood count, fluorography, Mantoux reaction.

3 Medical tactic

The most difficult for treatment is the variant of the course of the disease, which has arisen due to the development of HIV infection. Often, this situation can turn for a person to complete loss of vision and blindness. Timely treatment measures should necessarily be based on an individual approach to the diagnosis and treatment of such patients.

In the course of therapeutic treatment, medical injections are used, the main effect of which is to localize the cause of the disease.

Antibiotics with a wide spectrum of action are also applicable, but after determining the type of pathogen, antibiotics of directional action begin to be applied.

Viral chorioretinitis also include the inclusion in the course of treatment of interferons and antiviral drugs. Syphilitic disorder is treated with the use of antibiotics belonging to the group of penicillin antibiotics.

It should be noted that the true cause of the disease will adjust the path of treatment. For example, therapy for toxoplasmic chorioretinitis will differ significantly from the treatment of chorioretinitis with herpes etiology.

And a little about the secrets ...

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Then read what Elena Malysheva says in her program about natural ways of treating the heart and cleaning the vessels.

Chorioretinal dystrophy of the retina is a disease that causes irreversible destruction of the tissues of the vascular layers of the eyeball, during which the vision deteriorates significantly. That is why it is so important to undergo an annual examination by an ophthalmologist, which can prevent or detect at the early stages the onset of destructive processes in the tissues of the retina, which can develop practically without symptoms.

During the development of dystrophy, the level of central vision is significantly reduced. However, the lesion does not affect the area of ​​peripheral vision, which continues to function stably. Due to this, even with severe forms of the disease, the patient will normally navigate in a normal environment, although he will not be able to cope with such actions as driving or reading, without additional devices that correct vision.

The standard procedure of examination by an ophthalmologist does not allow to examine the condition of the peripheral zone of the eyes. However, it is in this area of ​​the retina that tissue is most often affected by degenerative processes. Since it is not immediately possible to detect them and begin treatment due to a practically asymptomatic course, the patient may face a number of additional complications, which ultimately lead to serious visual impairments, such as tearing of tissues or their detachment.

This disease is most common in the elderly with light pigmentation of the iris. The structure of their blood vessels is intensively subjected to age-related changes, as a result of which the retinal tissues begin to deteriorate vigorously. At the same time, the process of destruction is significantly accelerated if the patient has bad habits (alcohol, smoking).

Chorioretinal dystrophy of the retina

By type and development (pathogenesis), the following SCRDs are distinguished:

  1. Dry atrophic (non-exudative) - an early form of the disease in which a decrease in vision is accompanied by the death of the pigment epithelium. At the same time, it is necessary to be prepared for the fact that in the next 5 years the defeat will begin to actively develop in the second eye.
  2. Wet (exudative). It is quite rare. Complicated by detachment of various types of epithelium, hemorrhages in the area of ​​affected tissues and cicatricial deformity.

As a rule, such changes can be observed even in people whose vision is in a normal state.

Differences between wet and dry forms of pathology

Possible complications

Even in severe dystrophy, retinal chorioretinal retina does not cause blindness, therefore, despite certain difficulties, a person will be able to determine the main characteristics of objects and see their movement in space if this occurs.

Special attention to vision control should be paid to women who are in the second trimester of pregnancy. During this period, their blood pressure is significantly reduced compared with normal, disrupting the stable operation of the circulatory system.

As a result, the flow of blood and nutrients to the ocular vessels in some women is impaired, causing the onset of degenerative processes. At the same time, the risk of their development increases significantly, if a woman had treated any eye disease before conception.

In order to avoid unforeseen complications, a pregnant woman should be examined by an ophthalmologist. If the risk of instantaneous dystrophy during childbirth is high, then a cesarean section will be performed to avoid loss of the fetus.

In addition, if a person is at risk, he needs to undergo an annual examination of the fundus of the eye doctor. Also, do not forget about therapeutic courses aimed at stabilizing the functioning of the vascular system.

These procedures will improve peripheral blood circulation, stimulation of metabolic processes in the tissues of the retina, which will even allow the patient to read with the help of special devices, such as a magnifying glass or telescopic glasses, which increase the image transmitted to the retina.

At the same time, it is imperative to exercise daily control over the level of blood pressure and protect eyes from exposure to ultraviolet rays. These same methods of eye protection are the main preventive measures for healthy people.

Vascular Disorder - The name is very common. There are several types of vessels themselves. By what signs can one understand that it is time to run to the doctor or dramatically change the way of life?

The main danger for blood vessels is atherosclerosis. The reason for its appearance are the so-called plaques that form under the thin inner lining of the arteries. Most of the "stuffing" of these plaques is cholesterol. How does this work? First of all, because the excess amount of cholesterol enters the body with food. At the same time, cholesterol synthesis in the liver increases. Thus, the content of cholesterol in the blood increases, and its excess is deposited in the wall of the arteries. A growing atherosclerotic plaque constricts the vessel lumen - and the blood flow is disturbed. Over time, the organs supplied by this artery receive less and less oxygen and nutrients. Tangible manifestations of atherosclerosis depend on what kind of body is “starving”.

If this is the heart, then the person feels pain in the heart and shortness of breath on exertion.

If the legs - then after a short walk, pain occurs as an intermittent claudication.

If the head - at the forefront of dizziness, memory and thinking, thinking, less headache.

How to recognize a vascular disorder? Unfortunately, a person begins to experience health problems in the late stages of atherosclerosis, since the blood supply to the organs suffers only when the lumen of the artery is closed by a plaque for more than three-quarters. Alas, with this size of plaque, only surgical or endoscopic intervention can help. Therefore, it is easier to engage in the prevention of atherosclerosis. It is particularly relevant for people whose closest relatives had problems with the cardiovascular system.

What to do? Try to eat as much fresh vegetables, seafood, garlic and black currant as possible, use more vegetable fats than animals - such a diet contains little cholesterol and maintains the optimal ratio of various lipids of fats in the blood. After thirty years, periodically take a blood test for lipid spectrum - this will help to identify violations that predispose to atherosclerosis. If there are violations, do not postpone the visit to the doctor - perhaps it is time to take medicines that reduce the production of cholesterol in the body. If atherosclerosis is not treated, over time the plaque loses its strength and collapses, clogging the artery. This leads, depending on the site of the blockage, to such serious complications as myocardial infarction, stroke, gangrene, etc.

Another common and serious disease of the arteries that leads to vascular disorders is obliterating endarteritis. This inflammation of the inner lining of the artery most often affects the arteries of the legs, leading to a narrowing of the vessel. Manifestations are similar to atherosclerosis, but develop faster. One of the main predisposing factors of endarteritis is the constant use of nicotine. Therefore, the only prevention can be the rejection of any types of smoking - not something to sit with a cigarette, you can not even chewing or snuff.

The most vulnerable part of the venous bed is the leg veins. For this injustice, we must thank the upright walk. It is through these veins that blood flows from the bottom up, against gravity. In order to avoid stagnation of blood, inside these veins are valves - folds of the inner shell, allowing blood to flow only in the right direction. The blood flow is also promoted by two natural ones, which performs this task only when walking and the diaphragm. Predisposition to weakness of the valvular apparatus and the venous wall is inherited. But that is not all. Their role is played by overweight, long stay in a sitting and standing position, physical inactivity, pregnancy - all this leads to the fact that the outflow of blood from the veins of the legs worsens even more.

The pressure in the veins increases, and they begin to stretch, which further aggravates the insufficiency of the valves and leads to even more blood stasis. Varicose veins develop.

How to recognize a vascular disorder? To suspect the onset of the disease will allow the following signs:

- after a long standing or sitting, there is a feeling of tiredness, aching and pulling pain in the legs,

- by the end of the day, there are swelling of the feet, which can spread to the legs,

- in the late stages of varicose veins, enlarged convoluted veins are visible under the skin.

What to do? First of all, pay attention to prevention. Especially if the family has already suffered from varicose veins. The prevalence of this disease is high: every third woman and every tenth man over 40 face it. Preventive actions are reduced to walking or leg exercises, to rest in the prone position and to lose weight.

Thrombophlebitis is dangerous because thrombi begin to grow on the inflamed inner membrane of the venous vessel, sometimes reaching impressive sizes. A severed blood clot is brought into the blood vessels of the lungs, blocking them. This condition is called pulmonary embolism and is fatal in more than half of the cases. Acute thrombophlebitis is treated only in a hospital setting. Often, thrombophlebitis requires surgery to remove a blood clot or an entire sore vein, unlike arteries; veins have many workarounds. However, the matter does not end with one operation: after inpatient treatment, it is usually recommended to wear compression knitwear and take medications that reduce thrombus formation.

The causes that lead to impaired blood flow along the capillary bed are diverse. Here are some immediate mechanisms that impair microcirculation:

- various disorders of the autonomic nervous system,

- with a lack of vitamins C and R,

- isolated microangiopathy (hereditary defects of capillary vessels),

How to recognize? Symptoms of chilliness in the toes and hands, rapid blanching of the fingers, ears and nose when going out into the cold or washing with cold water usually becomes a sign of a violation of capillary blood flow. In areas of reduced microcirculation, trophic disorders of the skin are often observed: desquamation, pigmentation, the formation of non-healing ulcers up to gangrene.

What to do? Pentoxifylline, ginkgo biloba plant preparations, etc., are used to expand the capillaries and improve blood flow. Vitamins C rutin is prescribed to reduce vascular fragility.

If you have completed any research Be sure to take their results to a consultation with a doctor. If the studies were not performed, we will do everything necessary in our clinic or with our colleagues in other clinics.

Have you had a broken vascular condition? You must be very careful about your overall health. People pay not enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, they are too late to heal. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identification of symptoms is the first step in the diagnosis of diseases in general. To do this, just need several times a year. be examined by a doctor, not only to prevent a terrible disease, but also to maintain a healthy mind in the body and the body as a whole.

If you want to ask a question to the doctor - use the online consultation section, maybe you will find the answers to your questions and read self care tips. Если Вас интересуют отзывы о клиниках и врачах – попробуйте найти нужную Вам информацию на форуме. Также зарегистрируйтесь на медицинском портале Eurolab, to be constantly updated with the latest news and updates on the site, which will be automatically sent to you by mail.

chorioretinal vascular disorders what is it

In section Diseases, Medicines to the question of ophthalmology: chorioretinal disorders with ischemic components - what is it? What are the symptoms? specified by the author Alexey Zotov the best answer is Choroid - the choroid (Actually, the choroid covers the entire posterior section of the sclera from the dentate line to the exit through the lattice plate of the optic nerve. Inside the choroid, the pigment epithelium, which already belongs to the retinal layers, is covered.
Retina (retina) - the inner shell of the eye, which is the peripheral part of the visual analyzer, contains photoreceptor cells that ensure the perception and conversion of electromagnetic radiation from the visible part of the spectrum into nerve impulses, and also ensures their primary processing.
Ischemia - local anemia, often caused by vascular factor (narrowing or complete obstruction of the arterial lumen), leading to temporary dysfunction or permanent damage to the tissue or organ.
Depending on what caused this pathology, the forms appear and symptoms ...

Causes of endocrine disease

AIT Hashimoto develops amid the failure of the immune system of human organism. The list of factors that contribute to the emergence of pathology includes:

  • genetic predisposition
  • infection of the human body by pathogenic flora,
  • toxic effects and radiation exposure,
  • chronic inflammatory processes,
  • the presence of autoimmune pathologies of other species,
  • addiction to smoking
  • taking drugs for an extended period of time,
  • psychological trauma
  • thyroid injury,
  • endocrine surgery;
  • insufficient amount of iodine in the human body or its excess,
  • poor environmental conditions
  • the presence of other types of pathologies of the endocrine system,
  • sharp hormonal failure.

Most experts have come to believe that this thyroid disease develops as a result of a combination of the genetic cause of the pathology with its concomitant factors.

Signs of endocrine disease

Hashimoto's disease has its symptoms, the appearance of which indicates the need to seek qualified medical care. Timely treatment of pathology provides an opportunity to avoid the consequences and the development of serious complications.

The main features of the stage of the disease, in which there is a marked decrease in thyroid productivity, include:

  • drowsiness, weakness, fatigue, malaise,
  • depressed state
  • problems with concentration and swallowing,
  • the appearance of swelling, constipation, pain in the joints, resulting in a decrease in their flexibility,
  • hair loss,
  • increase in body mass index and the development of obesity,
  • irritability,
  • reduced performance
  • cold intolerance,
  • the appearance of bags under the eyes
  • dry skin and fragility of the nail plates,
  • slow speech with a hoarse voice
  • violation of the frequency of menstrual flow.

When probing the neck, specialists can detect a hard and heterogeneous goiter Hashimoto. In the absence of proper treatment, endocrine pathology leads to an increase in the size of the thyroid gland and more pronounced severity of symptoms.

Diagnosis of the disease

Effectively eliminating the problem of developing specific antibodies that destroy thyroid cells depends on correctly identifying the causes that led to its development.

The main diagnostic measures to determine hypothyroidism, Hashimoto and other endocrine system pathologies include:

  • external examination of the patient
  • collecting a full history from the patient,
  • delivery of blood samples for analysis, which allows to determine the level of hormones produced by the thyroid gland,
  • the execution of the immunogram and the determination of antithyroid autoantibodies, an increased number of which indicates AIT,
  • ultrasound examination of the thyroid gland, allowing to determine the size of the gland,
  • endocrine organ biopsy.

Timely diagnosis of pathology eliminates the development of complications.

Causes of autoimmune thyroiditis

Sadly, the diagnoses of autoimmune thyroiditis (AIT) and chronic autoimmune thyroiditis (HAIT) are not at all uncommon. Especially in recent years, when the disease is rapidly "getting younger", increasingly affecting preschoolers and schoolchildren. In childhood, Hashimoto syndrome manifests itself especially sharply, the course of the disease is much faster, and the consequences are more devastating than in adults.

The primary cause of Hashimoto disease is a failure of the immune system. As in the case of other autoimmune diseases, a person’s immunity ceases to recognize its own cells, mistakenly considering them alien and seeking to destroy.

Predisposition to similar failures is inherited. But there are also extraneous factors that can activate Hashimoto's disease or accelerate its manifestation.

It is noted that the incidence of autoimmune thyroiditis among women is 10 times higher than among men. This is due to the greater workload of the female endocrine system, which works not linearly, but cyclically - in agreement with the reproductive system. The endocrine system of women, and the thyroid in particular, is much more vulnerable than the male.

In addition, pregnancy and childbirth themselves can provoke the occurrence of postpartum thyroiditis. During gestation, the woman’s immune system is naturally suppressed. After the birth of a child, on the contrary, it is sharply activated, which, with appropriate heredity, can cause Hashimoto's disease.

Acceptance of hormonal drugs, which, again, is more typical for women, can also provoke the development of Hashimoto's disease. This also applies to hormonal contraceptives, and to substitution therapy, which is commonly used for menstrual failures, amenorrhea or infertility.

Long-term use of certain drugs can also be considered a risk factor. Such drugs include, among others, iodine preparations (it accumulates in the thyroid gland and binds thyroid hormone protein - thyreoglobulin) and drugs for the treatment of SARS and influenza (any drugs that directly affect the immune system, stimulate the development of autoimmune diseases). Interferon preparations act in a similar way, which are used to treat blood diseases and hepatitis - they can cause the so-called cytokine-induced thyroiditis.

Finally, the adverse effect of environmental conditions and stresses on almost all body systems is widely known, and detailed explanations are not required here. The excess of some chemical elements in water or food, solar or radiation, chronic inflammatory processes, the load of the modern lifestyle - all this is extremely bad for the thyroid gland, and the immune system.

Symptoms and stages of Hashimoto disease

As mentioned above, Hashimoto's disease is especially dangerous because it is asymptomatic in the early stages. In the most typical case, the patient feels general malaise and is hampered with specific complaints.

The first stage of Hashimoto disease is associated with a sudden activation of the hormonal system. This happens when the patient’s immune system begins to produce antibodies that attack the thyroid gland. At this time, the thyroid gland is still completely healthy, but under the destructive effect of antibodies, it begins to actively release its hormones into the bloodstream. That is, there is a typical picture of hyperthyroidism - an increased function of the thyroid gland.

This phase can be accompanied by all the same symptoms as hyperthyroidism of any other origin - namely, increased motor activity, cardiac arrhythmia, itching and dry skin. Worse, the state of thyrotoxicosis, which is triggered by an excessive release of the thyroid hormones T3 and T4 into the blood, causes an acceleration of the general metabolism. What does "acceleration" of basic metabolism, which can manifest itself in increased heart rate, weight loss with an increase in hunger, insomnia, irritability, confusion, inability to concentrate. You can guess that with such symptoms the patient would rather go to check the nervous, not the immune system.

The second stage of the disease - the so-called hidden. It can last several months or several years. After a few months of hyperthyroidism, the thyroid resources are depleted, it “gets tired” to function in the hyperactive mode and goes into a state of euthyroidism - that is, it releases hormones in the normal mode.

In the meantime, cells are increasingly damaged by antibodies. As a result of their activity, remnants of destroyed thyrocytes enter the bloodstream, which, in turn, further activates the immune system. Therefore, at the end of the second stage, the patient begins to show signs of a state that reverses hyperthyroidism - hypothyroidism. But until then, the symptoms of this phase of Hashimoto's disease are blurred: the sick person may feel lethargy, weakness, and fatigue quickly. In the thyroid gland there may be nodules and seals, its size may grow or, conversely, decrease, but this is not necessary at all. Naturally, diagnostics during this period will be difficult - especially since the basic markers of thyroid problems, T4 and TSH, are usually normal at this stage of the disease.

In the third stage, autoimmune thyroiditis is associated with a sharp decrease in thyroid function. This is the period of the already pronounced hypothyroidism, when the patient feels enduring fatigue and drowsiness. In this phase, libido and potency are reduced, the menstrual cycle is disturbed. In childhood, this stage is characterized by a slowdown in the development of the whole, both physical and mental.

When autoimmune thyroiditis becomes chronic, the patient's body may begin to produce antibodies to thyroid stimulating hormone receptors (AT-TSH). Accordingly, the lack of thyroid hormones ceases to register with these receptors. In response, the thyroid further reduces the production of hormones. And this, in turn, reduces its efficiency (as "simple" affects any gland of the body). It turns out a vicious circle in which the development of hypothyroidism is accelerated.

Reasons to suspect Hashimoto disease

We have already talked about why it is so difficult to identify Hashimoto's disease. The difficulty lies not in the diagnostic methods themselves, but in referring the patient to the right specialist on the basis of ambiguous symptoms.

Most general practitioners and therapists conclude about problems with the thyroid gland on the basis of its size - after probing. And there is a "but." So in a latent form, Hashimoto's disease can only be detected by diagnosing the immune system. In this form of the disease, no changes on the part of the thyroid gland are observed at all - neither direct (change in the size or level of thyroid hormones), nor indirect (those that were listed above).

In the hypertrophic form of autoimmune thyroiditis, the mentioned symptoms can occur in different combinations, but the main thing is the enlargement of the thyroid gland. The thyroid can grow as a whole (up to the appearance of goiter), or individual nodes will be palpable in it. Accordingly, this form of Hashimoto disease is the most “convenient” for diagnosis.

There is also the so-called atrophic form of Hashimoto disease, when the thyroid gland can be only slightly reduced. But in this case we are already talking about the late stage of the disease, when it is much more likely to be diagnosed by manifestations of a sharp decrease in thyroid function than by changes in its size.

So, only clinical studies can lead to suspicions about Hashimoto's disease, while it is in a latent form. Therefore, it is recommended to be on your guard when the next of kin has problems with the immune system, and periodically make appropriate tests. If the thyroid gland has increased, or signs of pronounced hypothyroidism have appeared (constant weakness, fatigue, and indifference to everything), this is a direct signal to undergo the diagnosis of autoimmune thyroiditis.

Diagnosis of autoimmune thyroiditis

Ultrasound of the thyroid gland. Symptoms, nodules, cysts, general deterioration of tissue permeability to ultrasound rays, impaired blood circulation can speak about the symptoms of autoimmune thyroiditis. Anyway, all these symptoms appear only after some time after a failure in the immune system. Therefore, exploring the latter, you can "capture" the disease before.

Laboratory study of cellular immunity. This study includes the counting of T-lymphocyte helper cells and T-lymphocyte suppressors. If the number of the first (CD4) is two or more times the number of the second (CD8), this indicates the presence of some autoimmune activity in principle. That is, such a study serves as a non-specific marker of an autoimmune disease (there is no indication that it is the thyroid gland that is affected).

Determination of antibodies to proteins and receptors of the thyroid gland. When an autoimmune process has been identified and it is obvious that it is directed against the thyroid gland, it is necessary to determine how pronounced it is. This indicates the amount of antibodies AT TPO and AT TH. The more of them - the more active the immune system attacks the thyroid gland, and the worse the general condition of the patient. The appearance of AT TSH (antibodies to TSH receptors) signals an even more neglected situation.

Diagnosis of thyroid function. This study does not relate exclusively to the diagnosis of Hashimoto's disease, but it is necessary in the case of a disease already identified. A routine check includes tests for thyroid hormones: free T3, free T4 and TSH.

Treatment of Hashimoto's Disease in Classical Medicine

We have to admit that there is no single protocol for the treatment of autoimmune thyroiditis in conventional medicine. A generally accepted strategy of patient management is considered to be a thorough monitoring of well-being, regular laboratory tests and ultrasound of the thyroid gland. In addition, depending on the condition of the patient, the doctor may choose one of the following strategies:

At the initial stage of the disease (when the thyroid gland is still hyperactive), hormone replacement therapy is possible. Unfortunately, it is very likely that the patient will be forced to take them all his life. Naturally, this can not affect the state of the organism as a whole, since the long-term use of any hormones is accompanied by numerous side effects. In addition, this treatment is only symptomatic: it normalizes the work of the damaged thyroid, but does not affect the activity of the immune system - that is, it does not affect the cause of the disease.

A milder version of the drug treatment of autoimmune thyroiditis is phytotherapy. Often it is appointed simultaneously with hormonal. Also, depending on the nature of the disease, additional drugs can be prescribed: glucocorticoids, beta-blockers, anti-inflammatory drugs, vitamins.

In the late stages of Hashimoto's disease, surgical intervention is sometimes used — namely, the thyroid gland is removed. But this method is used only when the thyroid gland is greatly enlarged due to illness. As in the case of hormone replacement therapy, this method of treatment does not have a positive effect on the immune system. Quite the contrary: after the operation, the autoimmune process usually becomes even more active. In addition, it is worth noting that the removal of the thyroid gland leads to lifelong thyroid hormone deficiency - that is, the patient is likely to suffer from hypothyroidism all his life.

Alternative methods such as reflexology can also be used as a replacement for the radical methods of treating Hashimoto's disease described above. This may be traditional acupuncture, acupuncture, modern computer reflexology (exposure to ultra low currents). In principle, such treatment can be indicated at any stage of the disease. But, probably, few doctors will take the responsibility to recommend to the patient with severe negative symptoms that they refuse classical methods of treatment in favor of the alternative. In addition, reflexology sessions can be unpleasant (especially for children).

Treatment of Hashimoto Disease Bioenergy

Bioenergy treatment is a unique way to improve the condition for diseases that are difficult to classical medicine. Hashimoto disease is just the case when the bioenergy effect is more than justified. And, by combining comprehensively the doctor's prescriptions and bioenergy treatment sessions, one can achieve optimal results.

Impact on the patient's energy field is a non-invasive, non-contact and atraumatic treatment method. Биокоррекция не оказывает ни малейшего негативного влияния на организм и не даёт никаких побочных эффектов.And during the sessions, the patient experiences either neutral or pleasant sensations, which is especially important when working with children.

Causes of Choroiditis

In the overwhelming majority of cases, chorioretinitis of the eye develops as a result of the introduction of a foreign infectious agent or non-infectious agent into the vascular membrane of the eye:

  1. Mycobacterium tuberculosis,
  2. Pale Treponema (syphilis),
  3. Brucella,
  4. Cytomegalovirus,
  5. Toxoplasma,
  6. Onchozerk,
  7. Staphylococcus,
  8. Streptococcus,
  9. Herpes virus,
  10. Various fungi.

By itself, a condition in which there is a circulation of some infectious pathogen in the blood already represents a serious pathology and is often the result of immunodeficiency (immunosuppressants, HIV infection, chronic drug and alcohol intoxication, hypothermia).

In the development of chorioretinitis, the level of the immune response to the entry of antigen is of great importance - the more inflammation is expressed, the more severe the disease proceeds, the allergic component is often of decisive importance, and the entry of a foreign agent is only a trigger. There are also cases of autoimmune choroiditis, when damage to the choroid is a consequence of the aggression of the immune system against its own organism.

Types of choroiditis

On the path of penetration of the infectious agent, all choroiditis is divided into two groups:

  • Endogenous, the most frequent - develops as a result of contact with the source of the disease with blood flow.
  • Exogenous - a consequence of the spread of inflammation on the choroid from adjacent foci (inflammation of the cornea, iris, sclera injury).

According to the location of the pathological focus, chorioretinitis is divided into:

  1. Central chorioretinitis - the inflammatory process is located in the central part of the fundus,
  2. Peripapillary - inflammation is localized directly around the head of the optic nerve,
  3. Equatorial - the retina and choroid are inflamed in the equatorial part of the eye,
  4. Peripheral - an inflammatory process affects the edge of the fundus.

Assessing the nature of the most inflamed area, chorioretinitis is divided into focal (have a relatively small area and clearly defined boundaries) and diffuse (capture most of the fundus). In turn, focal chorioretinitis occurs as an isolated (single focus) and multiple.

Manifestations of chorioretinitis

Since in the choroid and retina there are no pain receptors, patients do not have a feeling of pain or a foreign body in the eye. Symptoms of chorioretinitis are associated with retinal lesions and consist of the following complaints:

  • Reduced visual acuity
  • Metamorphopia - a distorted perception of objects, their shape, size, position in space, color and other visual characteristics,
  • Photopsies - flashes, lightning and sparks in the eyes,
  • Scotomas are areas of “falling out” of view, when some part of the visual field stops functioning, it “goes blind”,
  • Hemeralopia - decreased vision at night, popularly referred to as "night blindness",
  • Fog or mist before eyes
  • Floating flies in the eyes.

In those rare cases where only the choroid is inflamed, complaints may be completely absent.

Tubercular chorioretinitis

Tubercular chorioretinitis at the present stage of development of medicine is considered as one of the manifestations of tuberculosis - a disease of the body as a whole, and not a separate organ. Thus, depending on the stage of the course of tuberculosis, chorioretinitis has various features of the course.

At the stage of primary tuberculosis, when the body's immunity system does not have a pronounced increase in sensitivity to the tubercle bacillus, the entry of Mycobacterium tuberculosis into the vascular membrane of the eye causes not developed disease, but abortively flowing asymptomatic inflammation, which almost always disappears without a trace and can be diagnosed only by chance when viewed from the eye bottom.

In secondary tuberculosis, when there is already formed a tuberculous focus and an increased sensitivity of the immunity to Mycobacterium tuberculosis, the entry of the tubercle bacillus into the vascular membrane of the eye causes infectious-allergic inflammation, with the formation of specific granulomas.

Tubercular chorioretinitis is characterized by a relapsing (recurring) course, in which there is a bright onset of the disease with a significant inflammatory component and an equally rapid extinction of inflammation and the clinic.

Tubercular chorioretinitis according to the degree of spread can be:

  1. Focal - in the fundus there is one or several (but not more than three) tuberculous granulomas (foci of inflammation),
  2. Disseminated - 4 or more centers of granulomatous inflammation of various prescription, which do not merge,
  3. Diffuse-focal - is rare, characterized by extensive damage to the structures of the eye, severe course with involvement in the inflammatory process of the elements of the vitreous body.

Tuberculosis of the choroid often entails a number of serious complications in the form of cataracts, retinal detachment, inflammation of the optic nerve, which often leads to a sharp decrease in visual function.

Toxoplasma chorioretinitis

Toxoplasma chorioretinitis - is observed in almost all cases of infection with toxoplasmosis - a parasitic disease of domestic animals (cats, dogs, rabbits, rodents and others), which is transmitted to humans. In most cases, it develops when toxoplasma is transmitted from an infected mother to a child through the placenta in utero. However, it is not excluded, although quite rare, cases of infection with toxoplasmosis in adults, especially when the immune system is inhibited.

The defeat of the choroid in toxoplasmosis begins with a retinal lesion, since the pathogen primarily affects it, and then the inflammation spreads to the choroid.

Toxoplasma chorioretinitis is characterized by a relapsing course and the fundus pattern depends on the stage of the disease. At the stage of remission (attenuation) in the fundus of the fundus clearly defined clearly marked pigmented lesions. In the acute stage, inflammation continues from the edge of the old focus. Also during exacerbation, frequent extensive hemorrhages in the retina, up to its detachment, are noted.

Due to the fact that infection with Toxoplasma during pregnancy has serious consequences for the fetus (often up to intrauterine death or deep congenital disability) it is strictly forbidden to contact a pregnant woman with domestic animals, their secretions, raw and insufficiently cooked meat.

Syphilitic chorioretinitis

Syphilitic chorioretinitis can be either congenital or acquired. In the case of congenital syphilis in a child, chorioretinitis can be cured as follows:

  • The fundus of the fundus contains a lot of small light yellow and dark foci in the form of "salt with pepper"
  • The periphery of the fundus contains large pigmented lesions with a small number of foci of atrophy of the choroid,
  • The peripheral parts of the fundus of the eye contain numerous areas of atrophy of the choroid with single inclusions of pigment lesions,
  • The periphery of the fundus is clearly pigmented, the zones of atrophy are not defined.

In each of the cases described, visual acuity decreases, the worst prognosis is of the latter type.

In the case of acquired syphilis, at the stage of the acute stage of the disease, diffuse chorioretinitis is observed with involvement in the vitreous process and retinal hemorrhages. At the stage of remission, signs of atrophic changes in the choroid come to the fore. In case of syphilitic chorioretinitis, marked impairment of vision is observed, which forces one to seek medical help at the onset of the disease.

Central serous chorioretinitis

Central serous chorioretinitis or central serous chorioretinopathy is a disease that was first described in 1866, the nature of which is still not reliably known and causes controversy among doctors and ophthalmologists.

At the beginning of the disease, a fog appears before the eyes, which after 2-3 days takes on the appearance of a dark spot in the field of view (positive scotoma). Also, patients often note metamorphopsia, photopsies, drop in vision to the hundredth, and other signs of retinal damage.

The disease proceeds in three stages and at the same time quite often goes cyclically.

In the first stage, the most pronounced manifestation of the above symptoms occurs. In the fundus in the area of ​​the macula, a slightly protruding round or oval opacification of the retina with clear contours that surrounds the vessels is determined.

After some time, up to several months, the second stage begins - in the fundus of the eye, the clouding resolves, and in its place the whitish spots are determined, while the symptoms persist, but slowly begin to regress.

At the third stage, a complete recovery of vision occurs, and residual phenomena in the form of small, yellow and discolored areas remain on the retina.

The disease can affect one or two eyes, pass without a trace or lead to severe visual impairment, it is extremely difficult to predict the outcome of this disease.

Diagnosis of chorioretinitis

Diagnosis of chorioretinitis of the eye is carried out on the basis of a systematic approach to determine the causes and the direct pathogen in order to assign adequate treatment aimed at all parts of the disease.

  1. The survey is conducted to determine complaints, the pace of their development, the establishment of comorbidities (autoimmune, infectious), injuries and eye operations.
  2. Visual inspection and palpation do not have any diagnostic significance.
  3. Laboratory research:
    • complete blood and urine analysis (to eliminate chronic inflammatory processes, autoimmune and systemic diseases),
    • biochemical blood test (blood glucose, liver enzymes), to determine the possibility of prescribing high doses of corticosteroid anti-inflammatory drugs,
    • bacteriological examination of the contents of the conjunctival cavity in order to determine the pathogen and its sensitivity to antibiotics,
    • Wasserman reaction (RW) to exclude syphilis,
    • immunological diagnosis of HIV, hepatitis B and C, toxoplasmosis.
  4. Instrumental studies:
    • visometry - definition of visual acuity,
    • biomicroscopy - determines the state of the eye's light-conducting systems,
    • tonometry - determines intraocular pressure,
    • ophthalmoscopy - allows you to assess the condition of the retina and choroid,
    • perimetry - determines the state of visual fields,
    • X-ray examination of the lungs and head in order to diagnose tuberculosis, injuries and foci of chronic infections, which can be the source of the chorioretinitis pathogen,
    • Fluorescein angiography - determines the state of the blood flow of the retina and choroid
    • Ultrasound of the eyeball - allows you to assess the condition of the eye membranes, when their visual inspection is difficult.

The list of other diagnostic procedures and expert consultations is determined by the attending physician, conducting a diagnostic search.

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