wiTeli Tvalis sindromi zogad praqtikaSi

miRebulia “klinikuri praqtikis erovnuli<br />

rekomendaciebis (gaidlainebi) da<br />

daavadebaTa marTvis saxelmwifo<br />

standartebis (protokolebi) SemuSavebis,<br />

Sefasebisa da danergvis erovnuli sabWos"<br />

2009 wlis 30 dekembris #2 sxdomis<br />

gadawyvetilebis Sesabamisad<br />

<strong>wiTeli</strong> <strong>Tvalis</strong> <strong>sindromi</strong><br />

pirvelad jandacvaSi<br />

danarTi 2<br />

klinikuri mdgomareobis marTvis saxelmwifo<br />

standarti<br />

(protokoli)<br />

damtkicebulia saqarTvelos Sromis,<br />

janmrTelobisa da socialuri dacvis<br />

ministris 2010 wlis 24 seqtembris<br />

# 301/o brZanebiT<br />

1

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<strong>wiTeli</strong> <strong>Tvalis</strong> <strong>sindromi</strong> pirvelad<br />

jandacvaSi<br />

(protokoli)<br />

1. ganmarteba<br />

`<strong>wiTeli</strong> Tvali” erT-erT yvelaze gavrcelebuli simptomokompleqsia<br />

ofTalmologiaSi. Aaris <strong>Tvalis</strong> siwiTliT mimdinare daavadebebi,<br />

romelTa marTva dasaSvebia ojaxis eqimis mier. amave dros, rig<br />

SemTxvevebSi aucilebelia pacientis dauyovnebliv gagzavna<br />

ofTalmologTan.<br />

daavadebaTa klasifikacia xorcieldeba imisda mixedviT, aris Tu ara<br />

SesaZlebeli maTi marTva ojaxis eqimis mier da rodis igzavneba<br />

pacienti ofTalmologTan (ixileT cxrili #1, #2, #3).<br />

cxrili #1<br />

daavadebebi, romelTa gamovlenisas saWiroa pacientis dauyovnebliv<br />

gagzavna ofTalmologTan<br />

paTologia Civilebi / simptomebi lokalizacia<br />

mwvave daxurulkuTxiani<br />

glaukoma<br />

rqovanas ucxo sxeuli<br />

keratiti (virusuli,<br />

baqteriuli)<br />

tkivili Tvalbudisa da<br />

Tavis areSi, cremldena,<br />

gulisreva, SesaZloa<br />

pirRebineba<br />

tkivili, iritacia,<br />

cremldena<br />

tkivili, fotofobia,<br />

cremldena, mxedvelobis<br />

dabindva<br />

unilateraluri<br />

unilateraluri<br />

unilateraluri<br />

cxrili #2<br />

daavadebebi, romelTa gamovlenidan araugvianes 48 saaTisa pacienti<br />

unda gaigzavnos eqim-ofTalmologTan<br />

daavadeba Civilebi / simptomebi lokalizacia<br />

skleriti Zlieri tkivili, hiperemia unilateraluri<br />

mwvave wina uveiti tkivili, fotofobia unilateraluri<br />

kanalikuliti<br />

dakriocistiti<br />

tkivili, Sesieba,<br />

gamonadeni sacremle<br />

wertilebidan<br />

tkivili, Sesieba da<br />

siwiTle sacremle parkis<br />

areSi<br />

unilateraluri<br />

unilateraluri<br />

2

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cxrili #3<br />

daavadebebi, romelTa marTva SesaZlebelia ojaxis eqimis mier<br />

daavadeba Civilebi / simptomebi lokalizacia<br />

subkoniunqtivuri<br />

hemoragia<br />

blefariti (quTuTos<br />

kideebis anTeba)<br />

Kkoniunqtiviti<br />

virusuli<br />

baqteriuli<br />

alergiuli<br />

rqovanas erozia<br />

pingvekula, pterigiumi<br />

ar aRiniSneba Uuni- an bilateraluri<br />

wva, ucxo sxeulis<br />

SegrZneba, qerclebi<br />

quTuToebis kideebze<br />

ufero gamonadeni<br />

moTeTro an moyviTalo<br />

Cirqovani gamonadeni<br />

lorwovani gamonadeni,<br />

damaxa-siaTebelia<br />

koniunqtivaluri hiperemia<br />

tkivili, fotofobia,<br />

cremldena, dabinduli<br />

mxedveloba<br />

iritacia, ucxo sxeulis<br />

SegrZneba<br />

episkleriti ar aRiniSneba<br />

ofTalmopaTia<br />

Tireotoqsikozis dros<br />

wva, cremldena, ucxo sxeulis<br />

SegrZneba, diplopia,<br />

mxdevelobis daqveiTeba,<br />

egzofTalmi<br />

uni- an bilateraluri<br />

uni- an bilateraluri<br />

uni- an bilateraluri<br />

bilateraluri<br />

unilateraluri<br />

uni- an bilateraluri<br />

metwilad<br />

unilateraluri<br />

uni- an bilateraluri<br />

im SemTxvevaSi, roca me-3 cxrilSi aRweril paTologias Tan sdevs<br />

mxedvelobis daqveiTeba, mkurnaloba uSedegoa saSualod 1-2 kviris<br />

ganmavlobaSi, pacienti aucileblad unda gaigzavnos ofTalmologTan.<br />

3

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2. klinikuri simptomatika<br />

daavadeba<br />

infeqciuri<br />

keratiti<br />

daxurulkuTxiani<br />

glaukoma<br />

<strong>wiTeli</strong> <strong>Tvalis</strong> klinikuri simptomatika<br />

gamomwvevi<br />

mizezi<br />

baqteria,virusi,<br />

soko an paraziti<br />

asaki, viwro wina<br />

saknis kuTxe,<br />

viwro wina<br />

kamera<br />

klinika<br />

cxrili #4.<br />

baqteriuli keratiti: <strong>Tvalis</strong> siwiTle, ucxo<br />

sxeulis SegrZneba, blefarospazmi, cremldena,<br />

fotofobia, rqovanas infiltracia, rqovanas<br />

wyluli, hipopioni, moyviTalo feris<br />

gamonadeni<br />

virusuli keratiti: <strong>Tvalis</strong> siwiTle, ucxo<br />

sxeulis SegrZneba, fotofobia, cremldena,<br />

ufero gamonadeni, rqovanaze aRiniSneba<br />

datotvili formis, moruxo feris defeqti,<br />

iRebeba fluoresceiniT. xSirad axlavs<br />

preaurikularuli limfadenopaTia<br />

epizoduri mwvave xasiaTis tkivili<br />

Tvalbudisa da Tavis areSi, SesaZloa<br />

gulisreva da pirRebineba. Tvali<br />

palpatorulad mkvrivia da daWimuli,<br />

gamoxatulia mkveTri hiperemia, guga mcired<br />

gafarToebulia, sustad an ar reagirebs<br />

Suqze, aRiniSneba fotofobia, SesaZloa<br />

rqovanas danisvla maRali TvalSida wnevis<br />

gamo. Ucxo sxeulis SegrZneba damaxasiaTebeli<br />

ar aris.<br />

ucxo sxeuli <strong>Tvalis</strong> mkveTri gaRizianeba, siwiTle, tkivili<br />

skleriti sistemuri<br />

daavadebebi:<br />

revmatoiduli<br />

arTriti da sxva<br />

autoimunuri<br />

daavadeba<br />

(vegeneris<br />

granulomatozi,<br />

recidiuli<br />

poliqondriti<br />

da a.S) agreTve<br />

tuberkuliozi<br />

da sifilisi<br />

iridocikliti sxvadasxva<br />

sistemuri<br />

daavadeba,<br />

infeqcia<br />

<strong>Tvalis</strong> mkveTri, mewamuli feris hiperemia,<br />

aRiniSneba Zlieri tkivili, palpaciiT Tvali<br />

mgrZnobiarea, mxedveloba ar qveiTdeba Tu<br />

procesSi ar erTveba rqovana da <strong>Tvalis</strong> ukana<br />

segmenti<br />

damaxasiaTebelia tkivili, fotofobia,<br />

perilimburi ineqcia, dabinduli mxedveloba,<br />

guga Seviwroebulia, sinaTleze reagirebs<br />

duned an ar reagirebs, aRiniSneba ukana<br />

sineqiebi, precipitatebi endoTeliumze.<br />

ar axasiaTebs ucxo sxeulis SegrZneba,<br />

gamonadeni. cremldena mcired aris<br />

gamoxatuli<br />

4

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daavadeba<br />

blefariti<br />

kanalikuliti,<br />

dakriocistiti<br />

subkoniunqtivuri<br />

hemoragia<br />

mSrali<br />

keratokoniunqtiviti<br />

(mSrali <strong>Tvalis</strong><br />

<strong>sindromi</strong>)<br />

entropioni,<br />

eqtropioni<br />

gamomwvevi<br />

mizezi<br />

infeqciuri,<br />

arainfeqciuri,<br />

xSiri gamomwvevi<br />

mizezia<br />

stafilokoki,<br />

seboreuli<br />

dermaiti,<br />

demodeqsi<br />

sacremle gzebis<br />

gamavlobis<br />

darRveva<br />

tramva,<br />

hipertoniuli<br />

daavadeba,<br />

vilebrandis<br />

daavadeba,<br />

hemofilia,<br />

autoimunuri<br />

Trombocitopeniu<br />

ri purpura.<br />

ganmapirobebeli<br />

faqtorebia:<br />

xvela, cemineba,<br />

Rebineba da a.S<br />

sacremle apkis<br />

darRveva,<br />

quTuTos<br />

araswori dgoma,<br />

sistemuri<br />

autoimunuri<br />

daavadeba<br />

(siogrenis<br />

<strong>sindromi</strong>),<br />

menopauza,<br />

zedmetad mSrali<br />

garemo,<br />

wamlismieri<br />

ZiriTadad<br />

asakobrivia,<br />

SesaZloa iyos<br />

Tandayolili an<br />

ganviTardes<br />

meoradad<br />

klinika<br />

wina blefariti: qerclebis arseboba wamwamis<br />

Zirebze.<br />

ukana blefariti_quTuTos kideebis gasqeleba<br />

siwiTle, teleangieqtaziebi daxSuli<br />

cximovani jirkvlebis sadinrebis irgvliv,<br />

maTi hipo- an hiperfunqcia, SesaZloa<br />

monacrisfro_moyviTalo qafismagvari<br />

gamonadeni <strong>Tvalis</strong> gareTa kuTxesTan<br />

ZiriTadad unilateraluria, damaxasiaTebelia<br />

tkivili, Sesieba, siwiTle sacremle arxisa da<br />

sacremle parkis areSi, aRiniSneba Cirqovani<br />

gamonadeni<br />

subkoniunqtivur sivrceSi sisxlCaqceva<br />

gaSlili hemoragiis an sqeli koltis saxiT<br />

ucxo sxeulis SegrZneba, wva. sawyis etapze<br />

SesaZloa cremldena. aRiniSneba<br />

hiperemia.yvela es simptomi dRis bolos metad<br />

aris gamoxatuli<br />

entropioni_aRiniSneba wamwamiT rqovanas<br />

dazianeba da erozia, <strong>Tvalis</strong> siwiTle,<br />

fotofobia, cremldena<br />

eqtropioni_aRiniSneba cremldena, <strong>Tvalis</strong><br />

gamoSroba<br />

5

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daavadeba<br />

lagofTalmi<br />

koniunqtiviti<br />

rqovanas erozia<br />

pingvekula,<br />

fterigiumi<br />

Tireoiduli<br />

ofTalmopaTia<br />

episkleriti<br />

gamomwvevi<br />

mizezi<br />

saxis nervis<br />

dazianeba,<br />

quTuTos<br />

retraqcia,<br />

nawiburebi da<br />

Sexorcebebi<br />

quTuToze,<br />

egzofTalmi<br />

baqteriuli,<br />

virusuli,<br />

alergiuli,<br />

kontaqturi<br />

linzebis<br />

gamoyenebis<br />

Sedegad<br />

ganviTarebuli<br />

tramva<br />

idiopatiuri<br />

autoimunuri<br />

daavadeba<br />

infeqciuri,<br />

arainfeqciuri<br />

klinika<br />

<strong>Tvalis</strong> naprali gafarToebulia, qveda<br />

quTuTo daweulia da moSorebulia <strong>Tvalis</strong><br />

kakals, Tvali mudmivad Riaa, aRiniSneba<br />

<strong>Tvalis</strong> simSrale, rqovanas sxvadasxva saxis<br />

dazianeba (distrofia, keratiti, wyluli)<br />

baqteriuli koniunqtiviti_blanti TeTri an<br />

moyviTalo feris gamonadeni Tvalidan,<br />

mkveTri koniunqtivaluri ineqcia, papilaruli<br />

reaqciiT<br />

virusuli koniunqtiviti_SesaZloa win<br />

uZRodes rinorea, zeda sasunTqi gzebis<br />

infeqcia. metwilad calmxrivia. axasiTebs<br />

koniunqtivaluri hiperemia, ucxo sxeulis<br />

SerZneba, fotofobia, SesaZloa aRiniSnos<br />

qavili. qveda quTuTos folikuluri reaqcia.<br />

preaurikularuli limfadenopaTia.<br />

gonoreuli koniunqtiviti_hiperemia da didi<br />

raodenobiT Cirqovani gamonadeni<br />

qlamidiuri koniunqtiviti_damaxasiaTebelia<br />

folikuluri reaqcia.<br />

alergiuli koniunqtiviti_<strong>Tvalis</strong> qavili,<br />

siwiTle, gamonadeni variabeluria :lorwovani,<br />

gamWvirvale_moTeTro. damaxasiaTebelia<br />

procesis sezonuri gamwvaveba.<br />

tkivili, cremldena, sinaTlis SiSi, ucxo<br />

sxeulis SegrZneba.<br />

ar axasiaTebs tkivili, SesaZloa gaxdes<br />

anTebiTi da gamoiwvios <strong>Tvalis</strong> hiperemia da<br />

iritacia.<br />

gaoreba, koniunqtivi, hiperemia,zeda quTuTos<br />

retraqcia, periorbitaluri qsovilis<br />

SeSupeba. simptomebi: ucxo sxeulis SegrZneba,<br />

<strong>Tvalis</strong> simSrale, <strong>Tvalis</strong> xamxamis sixSiris<br />

Semcireba, SesaZloa rqovanas dazianeba,<br />

optikuri neiropaTiis ganviTareba da<br />

mxedvelobis daqveiTeba.<br />

siwiTle, romelic ZiriTadad seqtoruli<br />

xasiaTisaa, ar axasiaTebs tkivili, gamonadeni<br />

da mxedvelobis daqveiTeba.<br />

6

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3. diferencialuri diagnozi<br />

mxedve-<br />

lobis<br />

simaxvile<br />

`<strong>wiTeli</strong> <strong>Tvalis</strong>~ diferencialuri diagnozi<br />

ucxo<br />

sxeulis<br />

SegrZneba <br />

fotofobia<br />

gamonadeni<br />

damaxasiaTebeli<br />

niSani<br />

cxrili #5<br />

marTva,<br />

ofTalmologTan<br />

gagzavna<br />

jiblibo N _ _ _ tkivili marTva<br />

qalazioni<br />

blefariti<br />

koniunqtiviti<br />

N _ _ _ tkivilis gareSe marTva/ofTalmo<br />

logTan gagzavna<br />

N<br />

baqteriuli N _ _<br />

virusuli N _ _<br />

alergiuli N _ _<br />

mSrali<br />

<strong>Tvalis</strong><br />

<strong>sindromi</strong><br />

_<br />

_<br />

N _ _<br />

episkleriti N _ _<br />

subkoniunqtivuri<br />

hemoragia<br />

rqovanas<br />

erozia<br />

ucxo sxeuli<br />

infeqciuri keratiti<br />

N an ↓ _ _<br />

mSrali<br />

qerclebi<br />

quTuTos<br />

kideebze<br />

Cirqovanlorwovani <br />

Llorwovanserozuli <br />

Llorwovanserozuli<br />

cremldena<br />

an simSrale<br />

N an ↓ + + cremldena<br />

N an ↓ + +<br />

baqteriuli N an ↓ + +<br />

virusuli<br />

_<br />

_<br />

Llorwovanserozuli <br />

Cirqovanlorwovani<br />

N an ↓ + + cremldena<br />

iridocikliti<br />

N an ↓ _ +<br />

hifema N an ↓ _ +/_<br />

hipopioni N an ↓ _ +/_<br />

daxurulkuTxiani<br />

glaukoma<br />

N an ↓<br />

_<br />

+/_<br />

_ an<br />

gamWvirvale<br />

_/<br />

cremldena<br />

_/Cirqovani<br />

gamonadeni<br />

_/cremldena<br />

qronikuli<br />

Uuxvi gamonadeni<br />

SesaZloa<br />

gamonadenis<br />

gareSe<br />

marTva/ofTalmo<br />

logTan gagzavna<br />

marTva/ofTalmol<br />

ogTan gagzavna<br />

marTva/ofTalmol<br />

ogTan gagzavna<br />

qavili marTva<br />

seqtoruli<br />

hiperemia, yru<br />

tkivili<br />

eqstravazaluri<br />

hemoragia<br />

anamneziT travma,<br />

defeqti, romelic<br />

iRebeba<br />

fluoresceiniT<br />

anamneziT tramva,<br />

moTeTro<br />

infiltratebi<br />

rqovanaze<br />

Mmonacrisfro<br />

infiltratebi,<br />

gaumWvirvale,<br />

gantotvili<br />

kerebi rqovanaze<br />

Gguga<br />

Seviwroebulia,<br />

sinaTleze ar<br />

reagirebs,<br />

eriTrocitebis<br />

done wina kameraSi<br />

Lleikocitebis<br />

done wina kameraSi<br />

Gguga<br />

gafarToebulia,<br />

sinaTleze<br />

reagirebs duned<br />

marTva/ofTalmol<br />

ogTan gagzavna<br />

marTva/ofTalmol<br />

ogTan gagzavna<br />

marTva<br />

marTva/ofTalmol<br />

ogTan gagzavna<br />

gagzavna<br />

ofTalmologTan<br />

ofTalmologTan<br />

gagzavna<br />

ofTalmologTan<br />

gagzavna<br />

ofTalmologTan<br />

gagzavna<br />

ofTalmologTan<br />

gagzavna<br />

ofTalmologTan<br />

gagzavna<br />

ofTalmologTan<br />

gagzavna<br />

7

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4. gamokvlevis sqema<br />

gamokvlevis sqema gulisxmobs pacientis mdgomareobis Sefasebas,<br />

anamnezis Sekrebas da sadiagnozo gamokvlevebis Catarebas.<br />

pacientis Sefaseba<br />

pacientis mdgomareobis Sefaseba _ <strong>wiTeli</strong> <strong>Tvalis</strong> marTvis ZiriTadi<br />

maxasiaTeblebia mxedvelobis simaxvilis gansazRvra da <strong>Tvalis</strong> wina<br />

monakveTis gamokvleva xelis sanaTis saSualebiT. ofTalmologTan<br />

gagzavnis Sesaxeb gadawyvetilebis miRebaSi gvexmareba anamnezi da<br />

pacientis sruli Sefaseba.<br />

anamnezi<br />

<strong>wiTeli</strong> <strong>Tvalis</strong> mqone pacientTa umravlesobas ainteresebs, sWirdeba<br />

Tu ara eqimis konsultacia. arsebuli Civilebi da garkveuli<br />

anamnezuri monacemebi gansazRvravs eqim-specialistis konsultaciis<br />

aucileblobas da SesaZlo mimarTvas. qvemoT mocemuli SekiTxvebi<br />

unda daesvas yvela pacients:<br />

daqveiTda Tu ara mxedveloba dazianebul TvalSi? _ SegiZliaT<br />

Tu ara dazianebuli TvaliT Cveulebrivi nabeWdis wakiTxva?<br />

pacientebs, romlebsac aReniSneba mxedvelobis daqveiTeba,<br />

satelefono konsultaciiT daxmarebas ver gavuwevT; maT<br />

esaWiroebaT eqimis mier gasinjva da, miRebuli monacemebis<br />

Sesabamisad, ofTalmologTan gagzavna.<br />

xom ar gaqvT ucxo sxeulis SegrZneba TvalSi? _ TiTqos raRac<br />

gaqvT TvalSi Cavardnili, romelic xels giSliT <strong>Tvalis</strong><br />

gaxelaSi? ucxo sxeulis SegrZneba rqovanas dazianebis niSania.<br />

ucxo sxeulis SegrZnebis obieqturi mtkicebuleba, rodesac<br />

pacienti ver axels Tvals, metyvelebs procesSi rqovanas<br />

CarTvaze. aseT pacientebs dauyovnebliv esaWiroebaT<br />

ofTalmologTan gagzavna. xSirad pacientebi aRniSnaven “qviSis<br />

SegrZnebas TvalSi”, romelic damaxasiaTebelia alergiuli an<br />

virusuli koniunqtivitisTvis, an mSrali <strong>Tvalis</strong> <strong>sindromi</strong>sTvis.<br />

es mxolod pacientTa subieqturi SegrZnebaa ucxo sxeulis<br />

arsebobisa, maT ar aReniSnebaT rqovanas dazianeba da umetes<br />

SemTxvevaSi ar saWiroeben ofTalmologTan gagzavnas.<br />

xom ar aRiniSneba fotofobia? _ xom ar xarT mgrZnobiare<br />

mkveTri Suqis mimarT? pacientebi, romlebsac aReniSnebaT<br />

fotofobia, aucileblad unda Sefasdnen ofTalmologis mier.<br />

rqovanas dazianebis dros aRiniSneba fotofobiis da ucxo<br />

sxeulis SegrZnebis obieqturi niSnebi. aRniSnuli Civilis mqone<br />

pacientebi sinaTlis Sesamcireblad xSirad atareben quds an<br />

mzis saTvales, dazianebul Tvalze mifarebuli aqvT xeli, Tavi<br />

qvemoT aqvT daxrili an zurgiT dganan sinaTlis wyarosTan.<br />

xSirad iTxoven sinaTlis Caqrobas gamosakvlev oTaxSi.<br />

8

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iritisTvis damaxasiaTebelia fotofobiis obieqturi niSnebi. am<br />

SemTxvevaSi ucxo sxeulis SegrZneba ar aRiniSneba.<br />

xom ar aRiniSneboda saxis travma? _ xom ar mogxvdaT TvalSi<br />

TiTi an raime sagani? xom ar migiRiaT travma blagvi sagniT?<br />

xom ar atarebT kontaqtur linzebs? _ anamnezSi kontaqturi<br />

linzebis tareba, gamonadenis arseboba da <strong>Tvalis</strong> siwiTle<br />

gvafiqrebinebs keratitis arsebobaze.<br />

xom ar aRiniSneba, cremlis garda, raime gamonadeni, romelic<br />

mTeli dRis ganmavlobaSi grZeldeba? _ fufxi, romelic<br />

dilaobiT aRiniSneba da dRis manZilze Tan axlavs serozuli<br />

gamonadeni, damaxasiaTebelia alergiisTvis, jiblibosTvis,<br />

virusuli da alergiuli koniunqtivitisTvis, mSrali <strong>Tvalis</strong><br />

<strong>sindromi</strong>sTvis. pacientebi diliT arsebul fufxs xSirad<br />

aigiveben CirqTan.<br />

baqteriul koniunqtivits da keratits axasiaTebs blanti moyviTalo<br />

gamonadeni, romelic mTeli dRis manZilze grZeldeba da esaWiroeba<br />

specifikuri mkurnaloba. ojaxis eqimis mier dasaSvebia baqteriuli<br />

koniunqtivitis mkurnaloba, romelsac Cveulebriv ar axasiaTebs<br />

mxedvelobis simaxvilis daqveiTeba, ucxo sxeulis SegrZneba an<br />

fotofobia. baqteriuli keratitis SemTxvevaSi aucilebelia<br />

dauyovnebliv ofTalmologTan gagzavna. am dros mxedveloba<br />

qveiTdeba an rCeba ucvleli, obieqturad damaxasiaTebelia ucxo<br />

sxeulis SegrZneba da fotofobia.<br />

<strong>zogad</strong>i meTvalyureoba _ <strong>zogad</strong>i meTvalyureoba gansazRvravs,<br />

ramdenad martivia problema, sawyis etapze eqvemdebareba ojaxis eqimis<br />

marTvas, Tu saWiroebs ofTalmologTan gagzavnas.<br />

quTuToebisa da koniunqtivitis daavadebebi ar iwvevs ucxo sxeulis<br />

SegrZnebas an fotofobias. gamosakvlev oTaxSi pacients Tvalebi Ria<br />

aqvs, diskomforti ar eqmneba Sida ganaTebis gamo. virusuli an<br />

alergiuli koniunqtivitis dros pacientebi uCivian rinoreas,<br />

limfadenopaTias an zeda sasunTqi gzebis dazianebis sxva simptomebs.<br />

infeqciuri keratitis, iritis an daxurulkuTxiani glaukomisTvis<br />

damaxasiaTebelia obieqturi niSnebi, romlebic problemis ufro<br />

seriozul genezze miuTiTebs. am daavadebebis arsebobisas saWiroa<br />

ofTalmologis konsultacia.<br />

ofTalmologiuri gamokvleva<br />

mxedvelobis simaxvile unda ganesazRvros yvela pacients, romelic<br />

TvalTan dakavSirebuli CiviliT mogmarTavT (yoveli satelefono<br />

konsultaciis dros unda iqnas miRebuli informacia mxedvelobis<br />

cvlilebis Sesaxeb). TiToeuli <strong>Tvalis</strong> Semowmeba warmoebs cal-calke.<br />

standartulad iyeneben snelenis an sivcevis tabulas (5 - metriani<br />

distanciisTvis).<br />

alternativas warmoadgens mxedvelobis gansazRvra axlo manZilze.<br />

sTxoveT pacients misTvis Cveul, komfortul manZilze wagikiTxoT<br />

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mcire monakveTi wignidan an Jurnalidan. mniSvnelovania mxedvelobis<br />

simaxvilis dadgena kategoriebis mixedviT: mxedveloba kiTxvis dros<br />

(mcire da didi Srifti); mxolod sagnobrivi mxedveloba (xelis<br />

moZraoba an TiTebis daTvla) an Suqis SegrZneba. am gamokvlevis<br />

Catareba aucilebelia yvela sxva manipulaciis Catarebamde.<br />

im SemTxvevaSi, rodesac saeWvoa quTuTos paTologia, koniunqtivaluri<br />

procesi, rqovanas erozia an ucxo sxeulis arseboba, arsebuli<br />

mxedvelobis simaxvile ojaxis eqims afiqrebinebs mkurnalobis<br />

dawyebis aucileblobis Sesaxeb. meore mxriv, Tu mxedvelobis<br />

simaxvile daqveiTebulia, Tan erTvis <strong>Tvalis</strong> siwiTle da pacients<br />

aqvs tipuri Civilebi, unda vifiqroT iseT seriozul daavadebaze,<br />

rogoric aris infeqciuri keratiti, iriti an daxurulkuTxiani<br />

glaukoma. aseTi paTologiis mqone pacientebs esaWiroebaT<br />

ofTalmologi.<br />

xelis sanaTiT gamokvleva _ sazRvraven gugebis zomas, formas,<br />

pirdapir da SeuRlebul reaqcias da ikvleven wina segments.<br />

gamokvlevis dros daxmarebas gagiwevT Semdegi SekiTxvebi:<br />

reagirebs Tu ara guga sinaTleze? _ saSualo donis midriazi<br />

gvxvdeba daxurulkuTxiani glaukomis dros. guga ar regirebs<br />

sinaTleze da misi diametria 4-5 mm.<br />

xom ar aris guga zomaSi Zalian patara (1-2 mm)? _ miozi (viwro<br />

guga 1-2 mm diametris) metwilad damaxasiaTebelia rqovanas<br />

eroziisaTvis, infeqciuri keratitis da iritisTvis. Tu<br />

fluoresceinis CawveTebis Semdeg rqovanas defeqtis SeiReba, e.i<br />

aRiniSneba rqovanas erozia, romelsac Tan axlavs ucxo sxeulis<br />

SegrZneba. iritis dros rqovana ar iRebeba da ar aRiniSneba<br />

ucxo sxeulis SegrZneba. rqovanas dazianebas metwilad iwvevs<br />

travma uSualod rqovanasTan kontaqtiT. travmuli iriti blagvi<br />

travmis Sedegad viTardeba rqovanas dazianebis gareSe.<br />

xom ar aRiniSneba Cirqovani gamonadeni? _ Cirqovani gamonadeni<br />

damaxasiaTebelia baqteriuli koniunqtivitis da keratitisTvis.<br />

koniunqtivitis SemTxvevaSi rqovanaze ar aRiniSneba dazianebuli<br />

ubnebi da rqovana ar iRebeba fluoresceiniT.<br />

<strong>Tvalis</strong> siwiTlis Sefaseba _ difuzuri inicireba, romelic<br />

moicavs quTuToebis da bulbarul (<strong>Tvalis</strong> kaklis) koniunqtivas,<br />

metwilad metyvelebs pirvelad koniunqtivalur procesze. igi<br />

SeiZleba iyos baqteriuli, virusuli, alergiuli, toqsikuri an<br />

araspecifikuri (mag; mSrali <strong>Tvalis</strong> <strong>sindromi</strong>). aRniSnuli<br />

nozologiebis dros mTliani koniunqtivaluri garsi Tanabrad<br />

aris CarTuli procesSi. perikornealuri ineqcia<br />

damaxasiaTebelia iseTi seriozuli daavadebebisaTvis,<br />

rogoricaa infeqciuri keratiti, iriti an daxurulkuTxiani<br />

glaukoma.<br />

rqovanaze xom ar aRiniSneba TeTri laqa, gaumWvirvale ubnebi an<br />

ucxo sxeuli? zemoCamoTvlili niSnebi damaxasiaTebelia<br />

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infeqciuri keratitisTvis. aRniSnuli defeqtebis aRmoCena<br />

SesaZlebelia fluoresceiniT SeRebvis gareSec. rqovanaze<br />

arsebuli procesis dadasturebisTvis fluoresceins iyeneben<br />

gamokvlevis bolo etapze. baqteriuli keratitisTvis<br />

damaxasiaTebelia TeTri laqa, xolo herpesuli (herpes simplex)<br />

keratitisTvis - moruxo gantotvili defeqti, romelic iRebeba<br />

fluoresceiniT. rqovanas eroziis arsebobis drosac xdeba<br />

rqovanas defeqtis SeRebva fluoresceiniT.<br />

aris Tu ara hipopioni an hifema? _ hipopioni (anTebiTi<br />

ujredebis dagroveba wina sakanSi); hifema (sisxlCaqceva wina<br />

sakanSi). orive SemTxvevaSi aucilebelia pacientis dauyovnebliv<br />

gagzavna ofTalmologTan. hipopionis arseboba migviTiTebs<br />

infeqciur keratitze an endofTalmitze. aseTi pacientebis<br />

gagzavna ofTalmologTan maqsimum ramdenime saaTSi unda moxdes.<br />

aranakleb mniSvnelovania hifema, romelic blagvi an gamWoli<br />

travmis Sedegia. saswrafod unda moxdes penetraciis xarisxis<br />

da dazianebis donis gansazRvra ofTalmologis mier.<br />

<strong>Tvalis</strong> fskeris gamokvleva _ <strong>wiTeli</strong> <strong>Tvalis</strong> diferencialuri<br />

diagnostikisTvis fskeris gamokvleva ar aris rekomendebuli.<br />

quTuTos da koniunqtivaluri procesebis dros aRniSnuli gamokvleva<br />

martivad ganxorcielebadia. misi Catareba rTuldeba iritis da<br />

keratitis SemTxvevaSi, rodesac guga Zalian viwroa da pacientebs<br />

aReniSnebaT fotofobia. daxurulkuTxiani glaukomis SemTxvevaSi<br />

miuxedavad imisa, rom guga saSualo zomisaa, momatebuli TvalSida<br />

wneviT ganpirobebuli rqovanas SeSupebis gamo fskeris gamokvlevis<br />

warmoeba praqtikulad SeuZlebelia.<br />

5. <strong>wiTeli</strong> <strong>Tvalis</strong> mkurnaloba<br />

`<strong>wiTeli</strong> <strong>Tvalis</strong>~ mkurnaloba<br />

daavadeba mkurnaloba<br />

mwvave daxrulkuTxiani<br />

glaukoma<br />

referali ofTalmologTan<br />

rqovanas ucxo sxeuli referali ofTalmologTan<br />

keratiti referali ofTalmologTan<br />

iridocikliti referali ofTalmologTan<br />

Tireoiduli ofTalmopaTia<br />

mxedvelobis daqveiTebis SemTxvevaSi, referali<br />

ofTalmologTan<br />

subkoniunqtivuri hemoragia mkurnalobas ar saWiroebs<br />

blefariti<br />

cxrili #6<br />

quTuToebis higiena, adgilobrivad antibiotikebis<br />

malamo, damatenianebeli saSualebebis instiliacia<br />

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daavadeba mkurnaloba<br />

mSrali keratokoniunqtiviti<br />

xelovnuri cremlisa da sxva damatenianebeli<br />

saSualebebis instiliacia dReSi4_8 jer;<br />

ntropioni, eqtropioni mkurnaloba qirurgiulia<br />

lagofTalmi<br />

baqteriuli koniunqtiviti<br />

gonoreuli koniunqtiviti<br />

qlamidiuri koniunqtiviti<br />

virusuli koniunqtiviti<br />

alergiuli koniunqtiviti<br />

rqovanas erozia<br />

pingvekula, fterigiumi<br />

episkleriti<br />

mkurnaobis araefeqturobis SemTxvevaSi, referali<br />

ofTalmologTan. SesaZlebelia silikonis sacobebis<br />

Canergva sacremle wertilebSi.<br />

xelovnuri cremlisa da damatenianebeli<br />

saSualebebis adgilobrivi instiliacia. qirurgiuli<br />

Careva _ tarzorafia.<br />

antibiotikebis adgilobrivi instiliacia 4-jer<br />

dReSi, 7_10 dRe. mozrdilebSi ciprofloqsacini,<br />

moqsifloqsacini.<br />

levomicetini 0,25%-iani, albucidi 30%-iani, cinkis<br />

sulfati. bavSvebSi 1 wlis asakidan levofloqsacinis<br />

wveTebi, 1 wlis asakamde tobramicini. progresirebis<br />

SemTxvevaSi, referali ofTalmologTan.<br />

adgilobrivad: levofloqsacini, moqsifloqsacini,<br />

ciprofloqsacini,<br />

rocefini 1 gr. erTxel dReSi i.m<br />

azitromicini 1 gr. erTxel dReSi peroralurad an<br />

doqsiciklini 100mg 3-jer dReSi, 10_14 dRe.<br />

adgilobrivad: levofloqsacini, moqsifloqsacini,<br />

ciprofloqsacini.<br />

referali ofTalmologTan, vinaidan SesaZloa<br />

ganviTardes virusuli keratiti. kortikosteroidebis<br />

gamoyeneba ofTalmologis gareSe dauSvebelia.<br />

adgilobrivad kromolini, lodoqsamidi, olopatadini<br />

4-jer dReSi,<br />

damatenianebeli saSualebebis instiliacia.<br />

antibiotikebis instiliacia.<br />

regeneraciuli saSualebebi, mag., natriumis<br />

hialuronati.<br />

damatenianebeli saSualebebis adgilobrivi<br />

instiliacia.<br />

steroidebi: deqsameTazoni, ara umetes 7 dRisa.<br />

adgilobrivad steroidebis instiliacia.<br />

perorelurad – arasteroiduli anTebis<br />

sawinaaRmdego saSualebebis miReba.<br />

rekomendebulia ofTalmilogis konsultacia<br />

6. gaidlaini, romelsac eyrdnoba aRniSnuli protokoli<br />

- `<strong>wiTeli</strong> <strong>Tvalis</strong> <strong>sindromi</strong> pirvelad jandacvaSi~.<br />

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7. implementaciisaTvis saWiro resursebi<br />

<strong>zogad</strong> saeqimo <strong>praqtikaSi</strong> <strong>wiTeli</strong> <strong>Tvalis</strong> diagnostirebisa da<br />

marTvisaTvis saWiro adamianuri da materialur-teqnikuri resursi<br />

warmodgenilia Semdeg cxrilSi.<br />

adamianuri<br />

ojaxis eqimi an ubnis eqimi<br />

Terapevti<br />

resursi funqciebi / mniSvneloba<br />

klinikuri Sefaseba<br />

<strong>zogad</strong>i praqtikis eqTani diagnozis dadastureba<br />

registratori<br />

mdgomareobis marTvis Taobaze<br />

gadawyvetilebis miReba<br />

menejeri/administratori medikamenturi mkurnalobis Catareba<br />

materialur-teqnikuri<br />

ofTalmoskopi diagnostireba<br />

sivcevis tabula diagnostireba<br />

laboratoriuli SesaZleblobebi<br />

diferenciuli diagnostika<br />

saWiroebis SemTxvevaSi<br />

pacientis saganmanaTleblo pacientis ganaTleba<br />

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