角膜云翳、斑翳(一)

西醫的認識:

正常人的黑眼球即角膜是清亮透明的,如果將眼睛比作一架照相機的話,那么角膜就好比照相機的鏡頭。當角膜受到病菌的感染或外傷,清亮透明的角膜就會變得混濁,影響視物的清晰性,也就是俗話所說的“眼睛起蒙”,就好象透過有呵氣的玻璃看物體一樣,霧蒙蒙的。角膜混濁經過炎癥修復過程后形成的癜痕即為角膜翳,它是角膜炎癥痊愈的標志,多為永久性,不易消退。角膜翳薄厚不一,依據侵犯角膜的深淺及形態,分為云翳、斑翳和白斑三種。云翳侵犯角膜組織淺層,癜痕薄,尤由如天上的浮云,只有通過特殊檢查才有發現;白斑侵犯角膜組織全層,癜痕厚,呈瓷白色,肉眼即能發現;斑翳介于云翳和白斑兩者之間。

中醫的認識:

黑睛疾患初愈或近愈,紅退痛止,留有形狀不一、厚薄不等之瘢痕翳障,視物昏朦,眼內干澀,可無全身癥狀。黑睛疾患后期,邪退正復,病變修復,故紅退痛止。遺留瘢痕翳障,致黑睛失去晶瑩清澈,阻礙神光發越,故視物昏朦,甚則視力嚴重下降。津液虧耗,陰津不足,故眼內干澀。

簡要臨床分類:

角膜翳多是角膜炎癥或外傷治愈后遺留的瘢痕,根據瘢痕的形狀、范圍、深淺程度而命名,一般淺層瘢痕性混濁薄如云霧狀,通過混濁的部位仍能看清后面虹膜紋理者稱為角膜云翳;混濁較厚略呈白色,但仍可透見虹膜者稱為角膜斑翳;混濁很厚呈瓷白色,不能透見虹膜者稱為角膜白斑。如果角膜瘢痕組織中鑲嵌有虹膜組織稱之為粘連性角膜白斑,提示病變角膜有穿透史。角膜翳中醫稱之為宿翳,歷代中醫眼科文獻主要將其分為冰瑕翳、云翳、厚翳、斑脂翳四種.

起病要點:

常見因素有:角膜病變,常為淺層或深層角膜病變炎癥、角膜外傷及化學性酸堿燒傷愈后留下的瘢痕形式存在,中醫認為肝陰不足,虛火上炎,火邪灼津,灼傷角膜后而使角膜呈白色翳。

預防及注意事項:

一、關鍵是預防角膜炎癥的發生或避免角膜受到損傷,因此要思想重視,做到預防為主;要及早治療,早期治療可以使視力得到保護;中醫治療為主,角膜營養治療為輔;要鍛煉身體,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,因為目前為止,要藥水多是消炎抗病毒及潤滑作用,沒有褪翳的眼藥水。許多角膜云翳斑翳患者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,最終引起角膜損傷。

三、不要飲酒,酒精使眼血管擴張充血,加重病情;不要吃羊肉、牛肉、狗肉。由于病毒性角膜炎是免疫異常所致,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,要按時遵醫囑用藥。不要吹風受涼感冒,感冒后免疫力下降,尤其像病毒性角膜炎易復發的特點,反復發作加重病情;不要過早停藥,炎癥控制后繼續遵醫囑用藥用藥,鞏固治療效果,防止卷土重來;不要隨意用激素,尤其角膜潰瘍期用激素可能使角膜穿孔的危險。因為過勞和熬夜使免疫力下降,也會使治療效果打折扣。

四、忌用藥偷工減料,一天要保證早晚各一次不能減少,道理很簡單用藥如用兵這就好比打仗攻克一個城市本來需要數萬精兵如果兵力減少結果可想而知;(除非感冒發燒或其他急癥)詳情咨詢主治醫師。

五、忌見好就收,可遵醫囑停藥。

西醫治療方法:

目前西醫醫療界尚無藥物治療方案,只有做光學角膜移植,需要了解的是角膜移植有一定的局限性和危險性和明顯的弊端。

1、光學性角膜移植手術存在一定風險:這也是不可避免客觀存在的

2、做了角膜移植并不是終生的:具體因眼部情況而定。有的可以保持終身,有的僅僅可以維持幾個月或幾年

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