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玻璃体混浊(一)

西医的认识:

? ? ? ?玻璃体内透明的凝胶体,如果出现不透明体,就成为玻璃体混浊,玻璃体混浊不是一种独立的疾病,常表现为某些眼病的症状之一。最常见的是老年性变性、近视性变化、玻璃体后脱离和生理性飞蚊症,此外视网膜脱离、葡萄膜炎、原发性家族性淀粉样变性、闪光性玻璃体液化等也可出现眼前黑影等感觉。

中医的认识:

? ? ? ?玻璃体混浊(飞蚊症)属神膏疾病,其病内应肝、胆、脾、肾。肝藏血,血养水,水养膏,肾为肝之母,乃神水之源。肝肾两亏,不能荣养目窍,神光衰微,神膏失养,则变清稀,或变混浊,致眼前黑花飞舞。胆附于肝,随肝为病,胆汁减神膏衰而致病。脾为气血生化之源,脾虚则五脏六腑之精气不能上注于目,目失所养,神膏变混;若脾气虚衰,不能收摄统血,血不循经,溢出络处,进入神膏,也可致神膏混浊 中医称为云雾移晴,蝇翅黑花,蝇影飞越,等范畴。

发病要点:

1、先天性混浊,为胚胎发育时的异常残留物,多在幼年时就能感觉到。 2、内因性混浊:即由玻璃体本身的变性引起,主要有三种,一是有玻璃体后裂孔的玻璃体后脱离,患者眼前常有一环状的黑影,高度近视眼患者多见,第二种是星状玻璃体症,老年男性多见,第三种称为因辉样玻璃体液化,可能与动脉硬化,高胆固醇血症等有关。这三种变性对视力影响均不大。 3、外因性浑浊:主要包含以下几种情况如葡萄膜炎,炎性渗出物和炎性细胞进入玻璃体形成灰白色尘埃状,絮状或团块状混浊。出血,因视网膜静脉炎,静脉阻塞,糖尿病,高血压,外伤或手术引起的出血进入玻璃体,在血液进入及吸收过程中形成红色,黄色,灰白色的片状或团状混浊。色素,外伤,葡萄膜炎等使色素颗粒进入玻璃体。4、寄生虫及其代谢产物,眼内肿瘤或全身其他部位肿瘤眼部转移,引起混浊。眼外伤玻璃体内异物存留。因眼外伤,出血,糖尿病等引起玻璃体内纤维组织增生。玻璃体变性,多见于老年人及高度近视者,玻璃体透明质酸解聚液化,糖尿病及高胆固醇血症者玻璃体内可有胆固醇结晶体沉着。

症状体征:

1、发病突然,常有反复。2、眼前出现烟柱式或黑云状暗影,有的很快失明,仅留光感。3、裂隙灯下检查可见玻璃体内有鲜红色血块,或棕黄色陈旧出血。4、检眼镜下见尘状、条状及块状混浊飘浮,或仅见稀微红光,或无红光。5、反复出血者,玻璃体内可见增殖性条索或膜,伴有新生血管。

预防及注意事项:

? ? ? ?预防原则应早期诊断,早期治疗,防止炎症,出血等引起玻璃体混浊,加强安全宣传教育,减少眼外伤。日常预防有以下几点: 1、补充维生素。维生素 A 是眼部必不可少的一种营养素;维生素 C 、维生素 E能破坏自由基,提高眼部免疫机能,防止视力下降;B 族维生素可促进眼内细胞的新陈代谢,对眼疾患者很有帮助。像动物肝脏、蛋类、干豆类、肉类、蘑菇、新鲜蔬菜和水果中都含有大量的维生素,应多吃。 2、多吃些海鲜类、未精制的谷物类、鱼类食物。这些食物对眼睛很有帮助,因为它们当中多含锌、硒等矿物质,能够缓解眼部疲劳,防止视力下降。 3、少喝含咖啡因的饮料,烟酒最好不要沾染,以免造成视力模糊,加重眼病。 4、饮食宜清淡,少食辛辣刺激性食物。 5、饮食上宜多配些能补肝益肾,补气养血的食谱。 6、避免剧烈运动或眼外伤(高度近视眼尤其要注意) 7、避免劳累熬夜,嗜酒无度

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