玻璃體混濁(一)

西醫的認識:

       玻璃體內透明的凝膠體,如果出現不透明體,就成為玻璃體混濁,玻璃體混濁不是一種獨立的疾病,常表現為某些眼病的癥狀之一。最常見的是老年性變性、近視性變化、玻璃體后脫離和生理性飛蚊癥,此外視網膜脫離、葡萄膜炎、原發性家族性淀粉樣變性、閃光性玻璃體液化等也可出現眼前黑影等感覺。

中醫的認識:

       玻璃體混濁(飛蚊癥)屬神膏疾病,其病內應肝、膽、脾、腎。肝藏血,血養水,水養膏,腎為肝之母,乃神水之源。肝腎兩虧,不能榮養目竅,神光衰微,神膏失養,則變清稀,或變混濁,致眼前黑花飛舞。膽附于肝,隨肝為病,膽汁減神膏衰而致病。脾為氣血生化之源,脾虛則五臟六腑之精氣不能上注于目,目失所養,神膏變混;若脾氣虛衰,不能收攝統血,血不循經,溢出絡處,進入神膏,也可致神膏混濁 中醫稱為云霧移晴,蠅翅黑花,蠅影飛越,等范疇。

發病要點:

1、先天性混濁,為胚胎發育時的異常殘留物,多在幼年時就能感覺到。

2、內因性混濁:即由玻璃體本身的變性引起,主要有三種,一是有玻璃體后裂孔的玻璃體后脫離,患者眼前常有一環狀的黑影,高度近視眼患者多見,第二種是星狀玻璃體癥,老年男性多見,第三種稱為因輝樣玻璃體液化,可能與動脈硬化,高膽固醇血癥等有關。這三種變性對視力影響均不大。

3、外因性渾濁:主要包含以下幾種情況如葡萄膜炎,炎性滲出物和炎性細胞進入玻璃體形成灰白色塵埃狀,絮狀或團塊狀混濁。出血,因視網膜靜脈炎,靜脈阻塞,糖尿病,高血壓,外傷或手術引起的出血進入玻璃體,在血液進入及吸收過程中形成紅色,黃色,灰白色的片狀或團狀混濁。色素,外傷,葡萄膜炎等使色素顆粒進入玻璃體。

4、寄生蟲及其代謝產物,眼內腫瘤或全身其他部位腫瘤眼部轉移,引起混濁。眼外傷玻璃體內異物存留。因眼外傷,出血,糖尿病等引起玻璃體內纖維組織增生。玻璃體變性,多見于老年人及高度近視者,玻璃體透明質酸解聚液化,糖尿病及高膽固醇血癥者玻璃體內可有膽固醇結晶體沉著。

癥狀體征:

1、發病突然,常有反復。2、眼前出現煙柱式或黑云狀暗影,有的很快失明,僅留光感。3、裂隙燈下檢查可見玻璃體內有鮮紅色血塊,或棕黃色陳舊出血。4、檢眼鏡下見塵狀、條狀及塊狀混濁飄浮,或僅見稀微紅光,或無紅光。5、反復出血者,玻璃體內可見增殖性條索或膜,伴有新生血管。

預防及注意事項:

       預防原則應早期診斷,早期治療,防止炎癥,出血等引起玻璃體混濁,加強安全宣傳教育,減少眼外傷。日常預防有以下幾點:

1、補充維生素。維生素 A 是眼部必不可少的一種營養素;維生素 C 、維生素 E能破壞自由基,提高眼部免疫機能,防止視力下降;B 族維生素可促進眼內細胞的新陳代謝,對眼疾患者很有幫助。像動物肝臟、蛋類、干豆類、肉類、蘑菇、新鮮蔬菜和水果中都含有大量的維生素,應多吃。

2、多吃些海鮮類、未精制的谷物類、魚類食物。這些食物對眼睛很有幫助,因為它們當中多含鋅、硒等礦物質,能夠緩解眼部疲勞,防止視力下降。

3、少喝含咖啡因的飲料,煙酒最好不要沾染,以免造成視力模糊,加重眼病。

4、飲食宜清淡,少食辛辣刺激性食物。

5、飲食上宜多配些能補肝益腎,補氣養血的食譜。

6、避免劇烈運動或眼外傷(高度近視眼尤其要注意)

7、避免勞累熬夜,嗜酒無度

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