病毒性角膜炎(一)

西醫的認識:

       病毒性角膜炎是受病毒致病原感染角膜而引起的炎癥。角膜淺層有豐富的三叉神經末梢,故該病常有明顯的刺激癥狀,有畏光、流淚、酸痛等。角膜本屬透明,一旦有病,則其透明度發生改變,病人主訴有視物模糊。該病一般沿三叉神經發病,病變部位侵犯較深,其感覺減退,但因炎癥刺激角膜病變的鄰近組織,因此刺激癥狀仍較明顯。病毒性角膜炎,病程牧長,愈后且易復發。常可伴有葡萄膜反應,甚至出現虹膜睫狀體炎、前房積膿,或繼發青光眼,是臨床上較為常見的致盲眼病之一。

中醫的認識:

       該病中醫稱為"聚星障",此所見癥,黑睛風輪有星翳,或聚或散,成簇排列,一旦星翳破潰,融合成片,呈樹狀的圖象,則中醫又稱"花翳白陷"。該病多因肝肺郁熱,復受風邪,風火相扇,上攻于風輪為患,也有肝脾濕熱內壅,熏蒸黑睛罹病。常見畏光流淚,疼痛視糊,遷延不愈,日后黑睛留下翳障,視糊終身。若風邪上犯,引動內熱,常以散風清熱,若是肝脾濕熱內結,升擾于目,發為該病,則以清熱解毒.化濕退翳。治療該病,若瞳孔緊小,也需配合應用西藥擴瞳眼藥水滴眼,以防瞳孔緊小之病變。該病常以體弱外邪侵襲而復發,故該病患者應在平時注意寒熱,以防外感。

簡要臨床分類:

       臨床上常見的病毒性角膜炎按病因分類有單純皰疹性角膜炎、帶狀皰疹性角膜炎等。

單純皰疹性:為單純皰疹病毒引起的角膜炎,按抗原性及生物學特性將病毒區分為Ⅰ型和Ⅱ型。單皰病毒引起的角膜病變可侵及角膜各層,且相互轉化,多見的典型形態為樹枝狀、地圖狀、盤狀、角膜色素膜炎等。

帶狀皰疹性:為水痘-帶狀皰疹病毒侵犯三叉神經眼支所致淺層樹枝狀或基質性角膜炎,伴有劇烈神經痛,分布區域皮膚上有串珠狀皰疹。帶狀皰疹病毒與水痘病毒屬同一種病毒,所以又稱V-2病毒。帶狀皰疹病毒性角膜炎為潛伏性病毒感染疾病,靜止期帶狀皰疹病毒潛伏于三叉神經節中,在機體細胞免疫力下降及外界刺激誘發下而復發。此種角膜炎可表現為點狀、錢狀、樹枝狀及基質層角膜炎、盤狀角膜炎等。該病常并發于眼瞼帶狀皰疹,同時伴有較重的葡萄膜炎,引起前房積血或積膿,基質層渾濁區內常有類固醇沉積物,虹膜可有萎縮。

起病要點:

病毒性角膜炎是眼科的常見病,其特點是反復發作,每次發作視力就下降一點,逐漸形成由點狀逐漸形成樹枝狀連接成地圖狀、圓盤狀由淺入深貫穿全層的角膜云翳、斑翳、白斑,甚至控制不住潰瘍穿孔,最后導致失明,因此,防止或減少復發是關鍵。

預防及注意事項:

一、要從思想重視,做到預防為主;要及早治療,及時早期治療可以使視力得到保護;科學合理運用中西醫結合正規治療為主,角膜營養治療為輔;堅持鍛煉身體,增強體質,提高免疫力;治療用藥要連續、有效、科學。

二、不要亂用眼藥水,許多病毒性角膜炎的發生是因為很多患者因為眼部的一時不適,沒用及時檢查,而是自己隨意使用眼藥水來緩解癥狀,最后引起病毒性角膜。眼科用藥要在醫囑的指導下用藥,而治療時要謹記不要癥狀一緩解就停止用藥。

三、不要飲酒,酒精使眼血管擴張充血,使病毒蔓延,加重病情;不要吃羊肉、牛肉、狗肉。簡短說來由于病毒性角膜炎是由于免疫功能紊亂所致,而吃羊肉、牛肉、狗肉可加重這種免疫反應,導致病情加重;不要隨意減少用藥次數,抗病毒藥滴眼液滴眼一天要保證6~8次,不要吹風受涼感冒,感冒后免疫力下降,使病毒性角膜炎易復發;不要過早停藥,炎癥控制后遵醫囑繼續用藥,鞏固治療效果,防止復發;不要隨意用激素,激素可能使病毒感染擴散,加重病情;不要頻繁更換醫院或更換醫生就診,否則使治療不夠連貫,可能延誤病情;不要過勞和熬夜,因為過勞和熬夜使免疫力下降,也會使病毒性角膜炎復發。

魏氏中醫眼科的診療方法:

       目前由于過去抗生素濫用,病毒性角膜炎的常規治療越發難以控制治療,單純用西醫的治療方式療效不佳,且容易復發,部分患者炎癥過后并且會呈現明顯的散光及視力受損,因為角膜炎癥潰瘍過后大多數患者留下瘢痕(云翳、斑翳、白斑),即使做角膜移植手術還是會在縫合處留下明顯層間疤痕,由于該病有復發頻繁特性,很快又會侵蝕新的角膜移植片,形成角膜潰瘍,嚴重者造成角膜穿孔。即使病情得到控制潰瘍愈合在原有角膜翳的基礎上會形成新的角膜翳。魏主任從醫四十余年來對于該病總結了豐富的診療經驗。辯證思路清晰,理法運用巧妙,結合代代相傳的古法辯證,診治該病求真務實、步步為營。即使留下云翳、斑翳、白斑也能通過祖傳療法進行褪翳治療。詳見角膜云翳及斑翳治療介紹。

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