結膜干燥癥(神氣枯瘁、神水將枯)一

簡介:

       結膜干燥癥(conjunctival xerosis)是一種主要由于結膜組織本身的病變而發生的結膜干燥現象,發病的原因比較多。在正常情況下,淚腺和結膜杯狀細胞分泌的淚液使結膜經常保持濕潤,一旦上述的滋潤機能遭到破壞,即出現結膜干燥癥。結膜干燥就可分上皮性結膜干燥癥和實質性結膜干燥癥。 西醫臨床上多應用魚肝油滴眼,同時應用抗生素溶液及眼膏,以預防和治療繼發感染、角膜潰瘍及角膜軟化。中醫認為神氣枯瘁者輪廓無傷但視而昏花,開目閉目則干澀異常。翻開瞼結膜細看之下目珠外面養睛神水,枯澀而不潤澤,睛不清而珠不瑩潤。汁將內竭。氣色干澀。有如蝸牛之涎。延游于黑白之間。徒光無潤。須臾風輪內外。氣象漸變。枯敗如死木。故曰神氣窟瘁。或者也叫做神水將枯。

分類:

1.上皮性結膜干燥癥;2.實質性結膜干燥癥;3、斯耶格蘭氏(Sjogren)綜合征。

病因

本癥是全身性營養紊亂,維生素A缺乏、結膜囊菌群失調、淚腺機能失調的眼部表現

1、消化不良、胃腸炎、痢疾等都可影響維生素A的吸收,而維生素A的缺乏可又造成腸壁上皮的病變、如此形成惡性循環。

2、幼兒時期身體生長發育較快,對維生素A的需要量較大。當患麻疹、肺炎、百日咳等病時維生素A的消耗量增加。

3、成人維生素A缺乏:偶見于長期患嚴重胃腸道消化性疾病、維生素A吸收不良、肝肺疾病:如肝硬變、肝癌晚期,由于肝臟功能嚴重損害,造成脂肪吸收不良而引起脂溶性維生素A缺乏。

4、濫用抗生素眼藥水:長期滴用各類大量抗生素及緩解視疲勞眼藥水,導致結膜囊菌群失調,進而導致淚腺機能紊亂,長此下去勢必造成干澀。因為多數眼藥水在制作過程中,為了穩定藥物性能或較長時間不被外界微生物污染,都含有防腐劑,這些成分可直接影響眼睛淚液成分,改變眼球表面的微環境,導致角膜上皮脫落、缺損、糜爛,嚴重者會發生角膜潰瘍、角膜穿孔等。

病理

       正常情況下結膜角膜表面覆蓋有由瞼板腺分泌的油脂層,其下為淚腺分泌的水樣液層,最內層為杯狀細胞分泌的粘液層。這三層共同形成一層保護及濕潤結膜的淚膜,當結膜上皮細胞層和結膜下組織因病變而被破壞,如嚴重沙眼瘢痕、白喉性結膜炎、結膜天皰瘡、結膜化學傷或熱燒傷、X線照射后,由于廣泛瘢痕形成,使淚腺導管被瘢痕所阻塞,副淚腺及結膜杯狀細胞被破壞,以致淚液和粘液不能濕潤眼球。此外,各種原因所造成的眼瞼閉合不全,使結膜和角膜長期暴露也可發生干燥。

常見臨床表現

1、球結膜干燥失去光澤和彈性,透明度減低,當患者睜眼暴露結膜數秒鐘后,則干燥更為明顯。如果此時在球結膜上刮片檢查可發現上皮細胞的角化顆粒與大量干燥桿菌,隨后結膜活動性及彈性較差,在眼球轉動時瞼裂部球結膜出現與角膜緣平行的皺褶。在瞼裂部角膜緣的兩側球結膜出現銀白色泡沫狀的三角形斑,基底向角膜緣,表面干燥不為淚液濕潤稱之為干燥斑(Bitot斑)。開始只是很少數的微小泡沫散發在結膜表面,斷而成片狀灰白色,由橢圓形變為三角形。結膜色素增生也是本病的早期表現,最初見于下穹窿部,在翻轉下瞼時,在下穹窿部結膜及半月皺襞處,最后在上穹窿部亦可出現淺棕色色素沉著,病愈后結膜干燥首先消失,但色素增生消失較慢。

2、早期結膜表面暗淡無光,組織變厚并趨向角化,以致外觀如干燥的皮膚樣,雖有眼淚也不能使其濕潤。皺縮、干燥、角化的結膜上皮造成難以忍受的干燥感和怕光等痛苦,在結膜變化的同時,角膜也受累,開始上皮層干燥、混濁、導致視力下降甚至喪失。

3、對于瞼外翻、眼瞼缺損、突眼而使眼瞼閉合不全時,可引起局部性結膜干燥與暴露性角膜炎。暴露部位的瞼、球結膜充血、干燥、角化和增厚

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