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病毒性角膜炎(一)

西医的认识:

? ? ? ?病毒性角膜炎是受病毒致病原感染角膜而引起的炎症。角膜浅层有丰富的三叉神经末梢,故该病常有明显的刺激症状,有畏光、流泪、酸痛等。角膜本属透明,一旦有病,则其透明度发生改变,病人主诉有视物模糊。该病一般沿三叉神经发病,病变部位侵犯较深,其感觉减退,但因炎症刺激角膜病变的邻近组织,因此刺激症状仍较明显。病毒性角膜炎,病程牧长,愈后且易复发。常可伴有葡萄膜反应,甚至出现虹膜睫状体炎、前房积脓,或继发青光眼,是临床上较为常见的致盲眼病之一。

中医的认识:

? ? ? ?该病中医称为"聚星障",此所见症,黑睛风轮有星翳,或聚或散,成簇排列,一旦星翳破溃,融合成片,呈树状的图象,则中医又称"花翳白陷"。该病多因肝肺郁热,复受风邪,风火相扇,上攻于风轮为患,也有肝脾湿热内壅,熏蒸黑睛罹病。常见畏光流泪,疼痛视糊,迁延不愈,日后黑睛留下翳障,视糊终身。若风邪上犯,引动内热,常以散风清热,若是肝脾湿热内结,升扰于目,发为该病,则以清热解毒.化湿退翳。治疗该病,若瞳孔紧小,也需配合应用西药扩瞳眼药水滴眼,以防瞳孔紧小之病变。该病常以体弱外邪侵袭而复发,故该病患者应在平时注意寒热,以防外感。

简要临床分类:

? ? ? ?临床上常见的病毒性角膜炎按病因分类有单纯疱疹性角膜炎、带状疱疹性角膜炎等。 单纯疱疹性:为单纯疱疹病毒引起的角膜炎,按抗原性及生物学特性将病毒区分为Ⅰ型和Ⅱ型。单疱病毒引起的角膜病变可侵及角膜各层,且相互转化,多见的典型形态为树枝状、地图状、盘状、角膜色素膜炎等。带状疱疹性:为水痘-带状疱疹病毒侵犯三叉神经眼支所致浅层树枝状或基质性角膜炎,伴有剧烈神经痛,分布区域皮肤上有串珠状疱疹。带状疱疹病毒与水痘病毒属同一种病毒,所以又称V-2病毒。带状疱疹病毒性角膜炎为潜伏性病毒感染疾病,静止期带状疱疹病毒潜伏于三叉神经节中,在机体细胞免疫力下降及外界刺激诱发下而复发。此种角膜炎可表现为点状、钱状、树枝状及基质层角膜炎、盘状角膜炎等。该病常并发于眼睑带状疱疹,同时伴有较重的葡萄膜炎,引起前房积血或积脓,基质层浑浊区内常有类固醇沉积物,虹膜可有萎缩。

起病要点:

病毒性角膜炎是眼科的常见病,其特点是反复发作,每次发作视力就下降一点,逐渐形成由点状逐渐形成树枝状连接成地图状、圆盘状由浅入深贯穿全层的角膜云翳、斑翳、白斑,甚至控制不住溃疡穿孔,最后导致失明,因此,防止或减少复发是关键。

预防及注意事项:

一、要从思想重视,做到预防为主;要及早治疗,及时早期治疗可以使视力得到保护;科学合理运用中西医结合正规治疗为主,角膜营养治疗为辅;坚持锻炼身体,增强体质,提高免疫力;治疗用药要连续、有效、科学。 二、不要乱用眼药水,许多病毒性角膜炎的发生是因为很多患者因为眼部的一时不适,没用及时检查,而是自己随意使用眼药水来缓解症状,最后引起病毒性角膜。眼科用药要在医嘱的指导下用药,而治疗时要谨记不要症状一缓解就停止用药。 三、不要饮酒,酒精使眼血管扩张充血,使病毒蔓延,加重病情;不要吃羊肉、牛肉、狗肉。简短说来由于病毒性角膜炎是由于免疫功能紊乱所致,而吃羊肉、牛肉、狗肉可加重这种免疫反应,导致病情加重;不要随意减少用药次数,抗病毒药滴眼液滴眼一天要保证6~8次,不要吹风受凉感冒,感冒后免疫力下降,使病毒性角膜炎易复发;不要过早停药,炎症控制后遵医嘱继续用药,巩固治疗效果,防止复发;不要随意用激素,激素可能使病毒感染扩散,加重病情;不要频繁更换医院或更换医生就诊,否则使治疗不够连贯,可能延误病情;不要过劳和熬夜,因为过劳和熬夜使免疫力下降,也会使病毒性角膜炎复发。
魏氏中医眼科的诊疗方法:
? ? ? ?目前由于过去抗生素滥用,病毒性角膜炎的常规治疗越发难以控制治疗,单纯用西医的治疗方式疗效不佳,且容易复发,部分患者炎症过后并且会呈现明显的散光及视力受损,因为角膜炎症溃疡过后大多数患者留下瘢痕(云翳、斑翳、白斑),即使做角膜移植手术还是会在缝合处留下明显层间疤痕,由于该病有复发频繁特性,很快又会侵蚀新的角膜移植片,形成角膜溃疡,严重者造成角膜穿孔。即使病情得到控制溃疡愈合在原有角膜翳的基础上会形成新的角膜翳。魏主任从医四十余年来对于该病总结了丰富的诊疗经验。辩证思路清晰,理法运用巧妙,结合代代相传的古法辩证,诊治该病求真务实、步步为营。即使留下云翳、斑翳、白斑也能通过祖传疗法进行褪翳治疗。详见角膜云翳及斑翳治疗介绍。

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