{"id":1559,"date":"2024-07-23T14:58:15","date_gmt":"2024-07-23T14:58:15","guid":{"rendered":"http:\/\/staging.livision-optika.com\/edukativni-centar\/bolesti-suznih-puteva\/"},"modified":"2024-11-11T08:11:20","modified_gmt":"2024-11-11T08:11:20","slug":"bolesti-suznih-puteva","status":"publish","type":"post","link":"https:\/\/livision-optika.com\/edukativni-centar\/bolesti-suznih-puteva\/","title":{"rendered":"Bolesti suznih puteva"},"content":{"rendered":"<p><span style=\"font-weight: bold;\">Poja\u010dano suzenje oka<\/span> &#8211; epifora (lat. Epiphora)<\/p>\n<p><span style=\"font-weight: bold;\">Uzroci i nastanak bolesti:<\/span><\/p>\n<p>U oftalmolo\u0161ku ambulantu se vrlo \u010desto javljaju pacijenti sa smetnjama zbog prevelikog suzenja oka. Ovo stanje se naziva epifora (lat. Epiphora). Kao \u0161to znamo suze se stvaraju u suznoj \u017elijezdi <br \/>(lat. Glandula lacrimalis) koja se nalazi ispod gornje vje\u0111e malo iznad i sa vanjske strane o\u010dne jabu\u010dice te u manjem obimu u drugim, pomo\u0107nim suznim \u017elijezdama. Suze se treptanjem raspore\u0111uju po cijeloj povr\u0161ini oka i odlaze u smjeru nosa gdje budu uvu\u010dene u suzne kanali\u0107e i suznu vre\u0107icu kroz koje odlaze u nos. Dakle, mo\u017ee se re\u0107i da poja\u010dano suzenje oka nastaje ukoliko se stvara previ\u0161e suza koje ne mogu dovoljno brzo iste\u0107i kroz kanali\u0107e ili uz normalnu koli\u010dinu suza ako su kanali\u0107i za\u010depljeni. Na poja\u010dano stvaranje suza utje\u010du emocije (pla\u010d), podra\u017eaji oka (dim, smog, nikotin podra\u017euju\u0107i plinovi), strana tijela (pra\u0161ina), upale, povrede spojnice i ro\u017enice te mnogi drugi faktori. Ote\u017eano ili onemogu\u0107eno otjecanje suza je uzrokovano su\u017eenjima suznih kanali\u0107e ili suzne vre\u0107ice zbog upala i povreda, a kod novoro\u0111en\u010dadi i zbog postojanja jedne membrane u odvodnim suznim putovima koja u normalnim okolnostima sama nestaje. <\/p>\n<p><span style=\"font-weight: bold;\">Simptomi:<\/span><\/p>\n<p>Pove\u0107ana koli\u010dina suza se umjesto prema nosu slijeva preko ruba vje\u0111e niz lice. Kako to poti\u010de na stalno brisanje oka i lica tako mo\u017ee do\u0107i do crvenila vje\u0111e i samog oka, a u jako izra\u017eenim i dugotrajnim slu\u010dajevima rub vje\u0111e promijeni svoj polo\u017eaj \u010dime spojnica postaje vi\u0161e izlo\u017eena upalama. <\/p>\n<p><span style=\"font-weight: bold;\">Postavljanje dijagnoze:<\/span><\/p>\n<p>Na osnovu specijalisti\u010dkog pregleda se mo\u017ee odrediti da li postoji podra\u017eivanje oka vanjskim faktorima koji bi mogli uzrokovati pove\u0107anu sekreciju \u017elijezda. Ukoliko to nije slu\u010daj, poku\u0161a se u suzne kanali\u0107e uvesti sonda i izvr\u0161iti njihovo pro\u0161trcavanje \u0161to mo\u017ee jasno pokazati da li i gdje postoji su\u017eenje. Pro\u0161trcavanje je bezbolna metoda kod koje se teku\u0107ina pod tlakom \u017eeli &#8220;progurati&#8221; kroz odvodni suzni sistem, \u010dime se istovremeno mo\u017ee odgurati ili probiti manja za\u010depljenja. Jo\u0161 preciznija pretraga je dakriocistografija, radiolo\u0161ka pretraga kod koje se u kanali\u0107e u\u0161trcava kontrastno sredstvo i potom se slika. <\/p>\n<p><span style=\"font-weight: bold;\">Lije\u010denje: <\/span><\/p>\n<p>Ako je uzrok suzenja podra\u017eivanje oka onda se ono treba zaustaviti ovisno o uzroku, bilo prekidom boravka u one\u010di\u0161\u0107enim prostorima bilo lije\u010denjem bolesti spojnice i ro\u017enice koje izazivaju ove smetnje. Pro\u0161trcavanje i ispiranje kanali\u0107a je u nekim slu\u010dajevima korisno no kod potpunog zastoja prolaska suza je naj\u010de\u0161\u0107e potrebna operacija. <br \/>U novoro\u0111ena\u010dkoj dobi se membrana u kanali\u0107ima poku\u0161ava probiti \u010dvrstim masiranjem unutra\u0161njeg o\u010dnog kuta u smjeru nosa. Ako ta tehnika ne daje rezultate onda se pristupa manjem operativnom zahvatu koji se obavlja u op\u0107oj anesteziji zbog potrebe da dijete za vrijeme njega bude potpuno mirno. Njime se u kanali\u0107e uvodi specijalna tanka sonda kojom se dolazi do membrane te se ona probija. Operacija ima odli\u010dne rezultate, a su\u017eenje gotovo trenutno nestaje.<\/p>\n<p><span style=\"font-weight: bold;\">Suho oko<\/span><\/p>\n<p><span style=\"font-weight: bold;\">Uzroci i nastanak bolesti:<\/span><\/p>\n<p><!--[if gte mso 9]><xml> <o_OfficeDocumentSettings>  <o_RelyOnVML\/>  <o_AllowPNG\/> <\/o_OfficeDocumentSettings><\/xml><![endif]--><!--[if gte mso 9]><xml> <w_WordDocument>  <w_View>Normal<\/w_View>  <w_Zoom>0<\/w_Zoom>  <w_TrackMoves\/>  <w_TrackFormatting\/>  <w_HyphenationZone>21<\/w_HyphenationZone>  <w_PunctuationKerning\/>  <w_ValidateAgainstSchemas\/>  <w_SaveIfXMLInvalid>false<\/w_SaveIfXMLInvalid>  <w_IgnoreMixedContent>false<\/w_IgnoreMixedContent>  <w_AlwaysShowPlaceholderText>false<\/w_AlwaysShowPlaceholderText>  <w_DoNotPromoteQF\/>  <w_LidThemeOther>HR<\/w_LidThemeOther>  <w_LidThemeAsian>X-NONE<\/w_LidThemeAsian>  <w_LidThemeComplexScript>X-NONE<\/w_LidThemeComplexScript>  <w_Compatibility>   <w_BreakWrappedTables\/>   <w_SnapToGridInCell\/>   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Normal\";\tmso-tstyle-rowband-size:0;\tmso-tstyle-colband-size:0;\tmso-style-noshow:yes;\tmso-style-priority:99;\tmso-style-parent:\"\";\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\tmso-para-margin-top:0cm;\tmso-para-margin-right:0cm;\tmso-para-margin-bottom:10.0pt;\tmso-para-margin-left:0cm;\tline-height:115%;\tmso-pagination:widow-orphan;\tfont-size:11.0pt;\tfont-family:\"Calibri\",\"sans-serif\";\tmso-ascii-font-family:Calibri;\tmso-ascii-theme-font:minor-latin;\tmso-hansi-font-family:Calibri;\tmso-hansi-theme-font:minor-latin;\tmso-bidi-font-family:\"Times New Roman\";\tmso-bidi-theme-font:minor-bidi;\tmso-fareast-language:EN-US;}<\/style>\n\n<![endif]--><span style=\"font-size:11.0pt;line-height:115%;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:&quot;Times New Roman&quot;;mso-bidi-theme-font:minor-bidi;mso-ansi-language:HR;mso-fareast-language:EN-US;mso-bidi-language:AR-SA\"><\/span>Suho oko nastaje zbog smanjene proizvodnje suza u suznoj \u017elijezdi. Ovo se doga\u0111a naj\u010de\u0161\u0107e kod \u017eena oko 50 godine starosti i kasnije \u0161to je povezano sa hormonskim promjenama, a znatno rje\u0111e kod mu\u0161karaca. Bolest mo\u017ee biti povezana sa bole\u0161\u0107u drugih sistema, npr. suho\u0107om usta kod sindroma Sj\u00c5\u2018egren ili reumatoidnim artritisom. Ukoliko se javlja samostalno uzrok joj je bolest suzne \u017elijezde i\/ili promijenjena kvaliteta suza pri \u010demu one lo\u0161ije i neravnomjernije prekrivaju oko i lak\u0161e isparavaju. Naravno da i vru\u0107i suhi zrak, nikotin i jo\u0161 neki \u010dimbenici imaju negativan utjecaj.<br \/>Ako bolest ima svoje reperkusije samo na ro\u017enici onda se naziva keratitis sika (lat. Keratitis sicca), a ako su poslijedice vidljive i na spojnici tada je nazivamo keratokonjunktivitis sika (lat. Keratoconjuncticitis sicca). Nedostatak suza koje imaju za\u0161titnu ulogu izaziva naime isu\u0161ivanje oka i stvaranje sitnih defekata na povr\u0161ini ro\u017enice te poja\u010dano trenje izme\u0111u vje\u0111a i oka prilikom treptanja.<\/p>\n<p><span style=\"font-weight: bold;\">Simptomi:<\/span><\/p>\n<p>Bolesnici se \u017eale na suho\u0107u o\u010diju, osje\u0107aj pijeska u o\u010dima, crvenilo i ponekad laganu bol. I sami ve\u0107inom shva\u0107aju da im nedostaje suza. <br \/><br style=\"font-weight: bold;\"><span style=\"font-weight: bold;\">Postavljenje dijagnoze:<\/span><\/p>\n<p>Pregledom u specijalisti\u010dkoj ambulanti se odmah mo\u017ee procijeniti da li je do\u0161lo do isu\u0161ivanja spojnice i ro\u017enice i do njihovog o\u0161te\u0107ivanja. Za procjenu koli\u010dine proizvedenih suza se primjenjuje Schirmer-ov test I. Kod ovog testa se u spojni\u010dnu vre\u0107icu postavlja jedan kraj testne trake izra\u0111ene od posebne vrste papira. Ispitanik kroz 5 minuta \u017emiri, a nakon toga vremena se mjeri du\u017eina trake koju su suze navla\u017eile. Normalan rezultat je oko 10-15 mm, a ispod 5 mm navla\u017eene trake je rezultat lo\u0161. Schirmer-ov test II se radi na jednak na\u010din samo \u0161to se spojnica anestezira kapima lokalnog anestetika kako bi se sprije\u010dilo refleksno suzenje zbog umetanja test trake. Dobiveni rezultat pokazuje samo temeljnu sekreciju. <\/p>\n<p><span style=\"font-weight: bold;\">Lije\u010denje:<\/span><\/p>\n<p>Nedostatak suza ili njihova lo\u0161ija kvaliteta se nadokna\u0111uju ukapavanjem umjetnih suza. Ova sredstva prekrivaju povr\u0161inu oka i tako je vla\u017ee i \u0161tite te smanjuju trenje izme\u0111u ro\u017enice i kapaka. Potrebno ih je koristiti vi\u0161e puta na dan, u prosjeku 4-6 puta, a trajanje terapije je vrlo dugotrajno i ovisno o uzroku smanjenja koli\u010dine suza. Kapi umjetnih suza nisu \u0161tetne niti imaju ikakve nuspojave \u010dak niti nakon vi\u0161egodi\u0161njeg kori\u0161tenja.<br \/><br style=\"font-weight: bold;\"><span style=\"font-weight: bold;\">Upala suzne \u017elijezde<\/span><\/p>\n<p>Upalu suzne \u017elijezde (lat. Dacryoadenitis acuta) izazivaju naj\u010de\u0161\u0107e bakterije no mo\u017ee biti povezana i sa drugim bolestima. <br \/>Upaljena \u017elijezda je vidljiva kao zadebljenje u podru\u010dju vanjskog dijela gornje vje\u0111e koje je pra\u0107eno crvenilom i ja\u010de bolno na dodir.<br \/>Lije\u010di se antibioticima, a korisna je i primjena toplih obloga. <\/p>\n<p><span style=\"font-weight: bold;\">Upala suzne vre\u0107ice<\/span><\/p>\n<p><span style=\"font-weight: bold;\">Uzroci i nastanak bolesti:<\/span><\/p>\n<p>Upala suzne vre\u0107ice nastaje kod djelomi\u010dnog ili potpunog zaustavljanja protoka suza kroz odvodne putove. U sekretu koji se u njima nakuplja se razvijaju bakterije koje izazivaju gnojnu upalu. Ona se mo\u017ee razviti vrlo naglo kroz 1-2 dana \u0161to se naziva akutni dakriocistitis (lat. Dacryocystitis acuta) ili bili trajno prisutna uz izmjenu perioda sa ja\u010dim i slabijim simptomima \u0161to nazivamo kroni\u010dni dakriocistitis (lat. Dacryocystitis chronica).<\/p>\n<p><span style=\"font-weight: bold;\">Simptomi:<\/span><\/p>\n<p>Akutna upala po\u010dinje crvenilom i oteklinom u unutra\u0161njem o\u010dnom uglu (podru\u010dju bli\u017ee nosu). Na pritisak se kroz suzne kanali\u0107e prema nosu vra\u0107a gnojni sadr\u017eaj. Tvorba sa vremenom postaje sve ve\u0107a. Stanje postaje izuzetno ozbiljno ukoliko upalom bude zahva\u0107eno i okolno tkivo orbite, a u tim slu\u010dajevima bude povi\u0161ena i tjelesna temperatura te se javlja bolnost kod pomicanja pogleda. Kod jakog gnojnog procesa ponekad dolazi do prsnu\u0107a pove\u0107ana suzne vre\u0107ice i ko\u017ee iznad nje i izlaska gnoja prema van.<br \/>Kroni\u010dna upala rijetko ima jako izra\u017eene upalne simptome, no stalno je prisutno poja\u010dano suzenje oka i vra\u0107anje sadr\u017eaja kod pritiska na suznu vre\u0107icu.<\/p>\n<p><span style=\"font-weight: bold;\">Postavljanje dijagnoze:<\/span><\/p>\n<p>Dijagnoza se postavlja na osnovu klini\u010dkog pregleda. Pritiskom prsta na suznu vre\u0107icu na suzne kanali\u0107e izlazi sluzavo-gnojan sadr\u017eaj. Mjesto za\u010depljenja je mogu\u0107e indirektno odrediti pomo\u0107u pro\u0161trcavanja suznih kanali\u0107a ili dakriocistografijom ukoliko je ona mogu\u0107a i potrebna.<\/p>\n<p><span style=\"font-weight: bold;\">Lije\u010denje:<\/span><\/p>\n<p>Kod akutnih upala je potrebna antibiotska terapija sve do povla\u010denja simptoma. Ako po povla\u010denju upale zaostanu su\u017eenja suznih putova mo\u017ee ih se poku\u0161ati pro\u0161iriti pro\u0161trcavanjem no vjerojatno \u0107e biti potreban operativni zahvat. Jednako tako se postupa i kod kroni\u010dnog dakriocistitisa.<br \/>Naj\u010de\u0161\u0107a vrsta operativnog zahvata je dakriocistorinostomija kod kojega se suzna vre\u0107ica spaja direktno sa sluznicom nosa i tako premo\u0161\u0107uje mjesto za\u010depljenja. Postoje i druge vrste operacija no koriste se znatno rje\u0111e. Nakon operacije simptomi nestaju i uspostavlja se normalan put odlaska suza pa tako nestaju uvjeti za javljanje nove upale.<\/p>\n<p>Literatura:<br \/>mr. sc. Pavan dr. Jo\u0161ko, &#8220;Bolesti oka&#8221;, Zagreb 2003.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Poja\u010dano suzenje oka &#8211; epifora (lat. Epiphora) Uzroci i nastanak bolesti: U oftalmolo\u0161ku ambulantu se vrlo \u010desto javljaju pacijenti sa smetnjama zbog prevelikog suzenja oka. Ovo stanje se naziva epifora (lat. Epiphora). Kao \u0161to znamo suze se stvaraju u suznoj \u017elijezdi (lat. 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