RU2197201C1 - Method for treating "dry" keratoconjunctivitis after esthetic blepharoplasty - Google Patents

Abstract

FIELD: medicine, ophthalmology. SUBSTANCE: one should perform the correction of microcirculation lesions with the help of a subsonic blepharopneumomassage at 0.5 porosity, 0.03- 0.1 kg/am amplitude, 4 Hz frequency, 173 db power, 10 min exposure for 10 d, in combination with acceleration of reparative corneal regeneration due to cotton applications of conjunctival cavity with poludane. The method enables to accelerate restoration and normalize the functions of precorneal lacrimal membrane. EFFECT: higher efficiency of therapy. 1 cl, 2 ex, 3 tbl

Description

 The invention relates to medicine and can be used in ophthalmology and plastic surgery for the treatment of "dry" keratoconjunctivitis resulting from operations associated with the excision of excess skin in the eyelids.

 Currently, treatment of “dry” keratoconjunctivitis is relevant, since every third patient who first visits a plastic surgeon and an ophthalmologist has clinical and functional signs of dry eye syndrome (VV Brzhesky. Diagnosis and treatment of dry eye syndrome ": Abstract. Thesis. -Doct. Medical Sciences. St. Petersburg.-1998.-C.1). The development of “dry” keratoconjunctivitis in patients after aesthetic blepharoplasty is performed puts one of the leading places the problem of both the possibility of performing aesthetic blepharoplasty and effective rehabilitation treatment.

 Violation of the mechanism of functioning of the tear film can occur at the level of both tear production and distribution of the tear film on the surface of the eyeball, changes in the structure of each layer, the rate of evaporation of the liquid, the intensity of the processes of cleavage of dying cells. According to the pathogenesis of "dry" keratoconjunctivitis is represented by three main mechanisms. The first is due to a decrease in the production of components of the tear film, which is reflected in the imbalance in the protein composition of the tear (Grus F.KN et al. Analysis of tear-protein as diagnostic tool for the detection of dry eaes. // Eur J Ophthalmol. - 1998. - V 8. - P.90-97). A decrease in total tear production leads to a decrease in the thickness of the watery layer, and a decrease in the secretion of mucins or lipids leads to a thinning of these layers (Bron AJ, et al. Prospects for the Dry Eye. // Trans. Ophthal. Soc. UK - 1985.- V. 104. - N8. - P.801-826). The second pathogenetic mechanism of the development of "dry" keratoconjunctivitis is due to a decrease in the stability of the precorneal lacrimal film due to lagophthalmus or pathology of the epithelial membrane (Norm MS Dessication of the precorneal film. I. Cornealwettingtime. // Acta ophthalmol. - 1969. - V. 47. - P. 865. -880), on the surface of which the tear film either breaks or does not form at all. With corneal scars, synblepharone and epithelialopathies of various origins, the congruence of the contacting surfaces of the eyeball and eyelids is violated, as a result of which, with blinking movements of the eyelids, the normal distribution of the lacrimal film no longer occurs. The third pathogenetic mechanism of the development of "dry" keratoconjunctivitis is due to a combination of a deficiency in the production of the main components of the tear film with a simultaneous violation of its stability.

 “Dry” keratoconjunctivitis after aesthetic blepharoplasty can be associated with an incorrect position of the lower eyelid, the causes of which are: edema of the eyelid, hematoma, damage to the circular muscle of the eyelids, especially with lateral dissection, removal of excess skin, fat, muscles, cicatricial deformation of the eyelid tissue, unilateral high myopia, large size of the eyeball, hypoplastic protrusions of the zygomatic bone. To a frequent complication after aesthetic blepharoplasty, which contributes to the appearance of signs of "dry" keratoconjunctivitis, lagophthalmos can also be attributed.

 Known local substitution therapy of "dry" keratoconjunctivitis, which consists in the daily use of artificial tear preparations (Lindahl G., et al. Clinical trial of sustained-release artifitial tears in keratoconjunctivitis sicca and Sjogren's synrome. Acta Ophthalm. / Kbl /. - 1988. - V.66. - VI - P.2-14). The main disadvantage of this method is toxicity to the corneal epithelium. The composition of artificial tear preparations includes preservatives: benzalkonium chloride, elorbutanol, chlorhexidine, etc. Long-term and frequent use of such drugs causes desquamation of corneal epithelial cells, which reduces the effectiveness of the treatment of “dry” keratoconjunctivitis.

 There is also known a method of treating "dry" keratoconjunctivitis, which consists in carrying out activities aimed at reducing the volatility of the components of the precorneal tear film. This method is selected as the closest analogue. It consists in the use of collagen plugs with the aim of obstructing the tear ducts (Gladkikh A.F. et al. A method for temporary obstruction of the tear ducts. // Improvement of methods and equipment used in the educational process, biomedical research and clinical practice. L., - 1991. - S.8-11). The main disadvantages of this method are both the limited duration of action (5-7 days), and its only symptomatic orientation. All of the above also reduces the effectiveness of the treatment of "dry" keratoconjunctivitis after aesthetic blepharoplasty.

 The technical result of the invention is the acceleration of recovery and normalization of the function of the precorneal tear film.

 The technical result is achieved due to the correction of microcirculation using pneumatic massage in combination with the acceleration of reparative regeneration of the cornea through the use of half-dan.

 The theoretical prerequisites of the invention were the results of clinical studies, which showed significant differences in the hemodynamic types of microcirculation in patients with a clinical picture of "dry" keratoconjunctivitis (12 people) and without it (7 people) after aesthetic blepharoplasty.

 Patients with "dry" keratoconjunctivitis noted: itching, foreign body sensation, burning in the eyes, mucous discharge from the palpebral fissures, frequent blinking, as well as the clinical picture of epitheliokeratopathy.

When analyzing dopplerograms in patients with "dry" keratoconjunctivitis, 3 hemodynamic types of microcirculation were found:
1 - normocirculatory. It was observed in 4 patients with "dry" keratoconjunctivitis. In this hemodynamic type, slow fluctuations in capillary blood flow predominate. 2 - spastic - was observed in 5 patients with "dry" keratoconjunctivitis. In this hemodynamic type, there is a decrease in blood flow into the microvasculature due to spasm of the bringing microvessels. 3 - spastic-atonic - was observed in 3 patients with "dry" keratoconjunctivitis. In this hemodynamic type of observation, a decrease in blood flow velocity at the level of the capillary and postcapillary unit — venules and postcapillaries.

 The characteristic hemodynamic type of microcirculation in patients with normal tear fluid production is predominantly normocirculatory. This conclusion is reflected in table 1 of the data on the frequency of the hemodynamic type of microcirculation in patients with "dry" keratoconjunctivitis, using a course of infrasound pneumomassage in combination with application of a half-dan (100 ME) solution on the conjunctiva for 0.5% novocaine, there is a relief of subjective manifestations , then the stability indicator of the precorneal tear film is restored, and after a month - the data of Schirmer’s test. In addition, there is an increase in blood flow into the microvasculature, as evidenced by an increase in microcirculation and a decrease in the amplitude of vasomotor vibrations, which is apparently associated with an increase in the partial oxygen tension in the tissues (Table 2). A month after the course of treatment, there is a tendency to the transition of the hyperemic type of microcirculation to normocirculatory (Table 3).

 Thus, the obtained data showed that the violation of microcirculation in the eyelids in patients with "dry" keratoconjunctivitis is expressed in a decrease in blood flow to the microvasculature due to spasm of the bringing microvessels. Effective correction of both microcirculatory disorders in patients after aesthetic blepharoplasty, using infrasound pneumomassage, and the relief of signs of epitheliokeratopathy, using a drug that affects the reparative regeneration of the cornea, half-dan, served as the basis for the widespread introduction of the proposed method into clinical practice.

 The combined method of treatment is carried out using the domestic apparatus “AVMO” (an ophthalmic vacuum massage apparatus), approved by the Ministry of Health of the Russian Federation for use in clinical practice. The device is a compressor, a control unit, micro-pressure chambers in the form of plastic glasses with appropriate supplies. Initially, a cotton application with a half-dan (100 IU) of 0.5% novocaine is introduced into the conjunctival cavity of the eye with clinical signs of "dry" keratoconjunctivitis. Further, after carefully adjusting the mini-pressure chambers in patients using the control unit, irritation pulses are sent to the orbit tissue with a duty cycle of 0.5, an amplitude of 0.03-0.1 kg / cm, an exposure frequency of 4 Hz, a power of 173 dB, with an exposure of 10 minutes. Previous studies have shown that these parameters do not have a damaging effect on the eyeball (Sidorenko E.I., Zelikman M.Kh., Kaplina A.V. Change in eye tissue with local exposure to infrasound // Ophthalmological Journal. - 1988, 2 .-- S. 109-111). The course of treatment consists of 10 sessions.

 Pain and any other unpleasant sensations during treatment with a combined method of treatment are not noted.

 Example 1

 Patient K., 55 years old, turned to the Institute of Plastic Surgery and Cosmetology for surgical correction of age-related changes in eyelid tissue. A study of microcirculation in the eyelids using Doppler laser fluometry showed a normocirculatory hemodynamic type of microcirculation. Studies of the lacrimal status revealed: the results of the Schirmer test were 15 mm, and the stability of the precorneal tear film was 15 s.

 A simultaneous aesthetic blepharoplasty was performed on the upper and lower eyelids. After surgery on day 3, the patient complained of soreness and "burning" in the right eye. Examination on the right revealed signs of epitheliokeratopathy. Studies of the lacrimal status on the right showed that the results of the Schirmer test are 10 mm, and the stability of the precorneal tear film is 6 s. On the left, the Schirmer test is 14 mm, and the stability of the precorneal tear film is 10 s.

 The patient was prescribed frequent installations with the "Tear Natural" drug for 10 days. Taking into account the complaints and signs of keratitis, after 10 days a cotton appliqué of the conjunctival cavity with half-dan and an ultrasonic pneumatic massage of the eyelids with a duty cycle of 0.5, an amplitude of 0.03-0.1 kg / cm, an exposure frequency of 4 Hz, a power of 173 dB with an exposure of 10 minutes are prescribed within 10 days. 7 days after the appointment of the course, the complaints disappeared. Lacrimal status on the right was restored 10 days after the start of treatment with the combined method. The patient is satisfied with the result of the treatment.

 Example 2

 Patient G., 53 years old, turned to the Institute of Plastic Surgery and Cosmetology for surgical correction of age-related changes in eyelid tissue. A study of microcirculation in the eyelids using Doppler laser fluometry showed a normocirculatory hemodynamic type of microcirculation. A study of the lacrimal status showed that the results of the Schirmer test were 14 mm, and the stability of the precorneal tear film was 12 s.

 A simultaneous aesthetic blepharoplasty was performed on the upper and lower eyelids. After surgery on day 2, the patient complained of a bilateral eversion of the lower eyelids, as well as soreness and "dryness" in the eyes. On examination, signs of epitheliokeratopathy were detected, mainly in the lower parts of the cornea. Examination of the lacrimal status on the right showed that the results of the Schirmer test were reduced, and the stability of the precorneal tear film was 4 s. A study of microcirculation over the centuries has shown a spastic hemodynamic type of microcirculation. The patient is assigned a combined course of infrasound pneumomassage. After 5 days, complaints of clinical signs of epitheliokeratopathy disappeared. After 10 days, the restoration of the lacrimal status and the disappearance of signs of eversion of the lower eyelid are noted. The patient is satisfied with the result of the treatment.

 Thus, the described method allows you to effectively treat patients with "dry" keratoconjunctivitis that arose after an aesthetic blepharoplasty. The method is simple to execute, unknown, does not require expensive equipment and there are no side complications.

Claims (2)

 1. A method of treating “dry” keratoconjunctivitis after aesthetic blepharoplasty, characterized in that at the same time a cotton application of the conjunctival cavity with half-dan and infrasound pneumatic massage of the eyelids is performed.  2. The method according to p. 1, characterized in that the infrasound pneumatic massage is carried out with a duty cycle of 0.5, an amplitude of 0.03-0.1 kg / cm, an exposure frequency of 4 Hz, a power of 173 dB with an exposure of 10 minutes for 10 days.

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