眼底出血(一)

西醫的認識: 顧名思義,眼底出血是一種臨床表現,并不是一種病名,引起眼底出血的原因很多,如高血壓視網膜病變、糖尿病視網膜病變、眼底動脈血管瘤、視網膜靜脈栓塞、眼外傷等等,均可導致眼底出血。由于各種不同的病因導致相同的病理損害,如視網膜出血,滲出,微血管瘤、新生血管等。 本病由于病因復雜,所以病程長,易反復發作,嚴重影響視力,引起諸多嚴重的并發癥。如黃斑病變(黃斑囊樣水腫、黃斑變性),新生血管性青光眼、玻璃體積血、視神經萎縮、增殖性視網膜病變、牽拉性視網膜脫離,如不及時有效的治療,常可導致失明。

中醫的認識: 中醫解釋眼底出血屬于中醫血證范疇,《靈樞?決氣》云:“中焦受氣,變化而赤,是謂血。”《景岳全書?雜證謨》云:“凡七竅之靈,為四肢之用……凡形質所在,無非血之用也。”后世醫家根據《靈樞?大惑論》記載:“五臟六氣之精氣,皆上注于目而為之精,精之窠為眼,骨之精為瞳子,筋之精為黑眼,血之精為絡,其窠氣之精為白眼,肌肉之精為約束,裹頡筋骨血氣而與脈并為系,上屬于腦,后出于項中。”將其發展中醫五輪學說。故眼底出血又屬于中醫學的“內障”眼病范疇。根據各種眼病病變所引起的不同程度的視功能障礙而有不同的稱謂,如“暴盲”、“云霧移睛”、“視瞻昏渺”等本病病程較長,危害諸多,嚴重影響患者視力,并能引起視網膜脫離等重癥。

起病要點:

1、眼底出血的根源,其實質與患者自身血液的質量改變有關。高血脂、高血糖、全血粘度超標、血流動力學下降、血管壁基底膜增厚、無菌雜質沉淀、血管管腔變窄、韌性降低、通透性增加都為眼底出血提供了必備的條件。

2、同時由于供血不足導致視網膜及視覺神經系統因缺氧、缺水發生病變。血栓堵塞、管內壓增高導致血管滲血或局部破裂也是出血的最直接誘因。 

癥狀體征:

(1)突然眼前一片漆黑,僅見手動或僅有光感。

(2)驟然間眼前如有圓的黑影遮住,不隨眼轉動而漂浮,正中方向注視物體完全不見,兩旁物體則模糊可見。

(3)突然眼內有如線條狀黑影向某一方向直射,進展迅速,且逐漸加多,最后終至遮住眼前,視物一片模糊,無法分辨。

(4)驟然眼前出現紅光閃閃,逐漸加多,以致紅光滿目,視物不明。

(5)發病先兆,多數有眼脹,眼珠跳動等感覺。

(6)多數反復發作,每次發作,亦有以上某些癥象,即使積血不退,當繼續出血時,還可能有以上的某些感覺。

       由于眼底出血的原因及部位不同,預后及對患者視力的影響也不一樣,依照出血量的多少,出血部位不同而產生不同的癥狀。如出血量少,位于視乳頭及視網膜周邊部,可以沒有明顯的癥狀,如出血量多,患者感到眼前有黑影浮動,視線被部分或完全遮擋,僅剩光感的視力。如出血位于視網膜中心(黃斑區)患者中心視力喪失,即中心區視物不清有暗影遮擋,周邊尚有部分視力

預防及注意事項:

1、預防出血宜用眼適度,不要干重體力活,不要作俯臥撐及劇烈活動,不要長時間看書報、電視,建議看過40分鐘后休息2~3分鐘,不要過度興奮、疲勞、激動或惱怒,保持良好和充足的睡眠,避免服用堅硬食物,注意補充含適應維生素類的蔬菜,瓜果。

2、睡眠充足有助于滋潤眼睛,減少眼睛的血絲。

3、清潔眼瞼,以免因殘屑、油脂、細菌、化妝品等塵屑導致眼睛發炎,布滿血絲。

4.早點睡,不要等到12點睡,那已經很晚了,最好是10點之前。睡眠時間以8小時為宜。放松點,多做點戶外活動。出現眼底出血后首先要臥床休息,避免活動和精神緊張,做好血壓、血糖等的控制。

5、要少吸煙、少飲酒,少吃有刺激性的食物,禁喝濃茶或咖啡

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