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结膜干燥症(神气枯瘁、神水将枯)一

简介:

? ? ? ?结膜干燥症(conjunctival xerosis)是一种主要由于结膜组织本身的病变而发生的结膜干燥现象,发病的原因比较多。在正常情况下,泪腺和结膜杯状细胞分泌的泪液使结膜经常保持湿润,一旦上述的滋润机能遭到破坏,即出现结膜干燥症。结膜干燥就可分上皮性结膜干燥症和实质性结膜干燥症。 西医临床上多应用鱼肝油滴眼,同时应用抗生素溶液及眼膏,以预防和治疗继发感染、角膜溃疡及角膜软化。中医认为神气枯瘁者轮廓无伤但视而昏花,开目闭目则干涩异常。翻开睑结膜细看之下目珠外面养睛神水,枯涩而不润泽,睛不清而珠不莹润。汁将内竭。气色干涩。有如蜗牛之涎。延游于黑白之间。徒光无润。须臾风轮内外。气象渐变。枯败如死木。故曰神气窟瘁。或者也叫做神水将枯。

分类:

1.上皮性结膜干燥症;2.实质性结膜干燥症;3、斯耶格兰氏(Sjogren)综合征。

病因

本症是全身性营养紊乱,维生素A缺乏、结膜囊菌群失调、泪腺机能失调的眼部表现 1、消化不良、胃肠炎、痢疾等都可影响维生素A的吸收,而维生素A的缺乏可又造成肠壁上皮的病变、如此形成恶性循环。 2、幼儿时期身体生长发育较快,对维生素A的需要量较大。当患麻疹、肺炎、百日咳等病时维生素A的消耗量增加。 3、成人维生素A缺乏:偶见于长期患严重胃肠道消化性疾病、维生素A吸收不良、肝肺疾病:如肝硬变、肝癌晚期,由于肝脏功能严重损害,造成脂肪吸收不良而引起脂溶性维生素A缺乏。 4、滥用抗生素眼药水:长期滴用各类大量抗生素及缓解视疲劳眼药水,导致结膜囊菌群失调,进而导致泪腺机能紊乱,长此下去势必造成干涩。因为多数眼药水在制作过程中,为了稳定药物性能或较长时间不被外界微生物污染,都含有防腐剂,这些成分可直接影响眼睛泪液成分,改变眼球表面的微环境,导致角膜上皮脱落、缺损、糜烂,严重者会发生角膜溃疡、角膜穿孔等。

病理

? ? ? ?正常情况下结膜角膜表面覆盖有由睑板腺分泌的油脂层,其下为泪腺分泌的水样液层,最内层为杯状细胞分泌的粘液层。这三层共同形成一层保护及湿润结膜的泪膜,当结膜上皮细胞层和结膜下组织因病变而被破坏,如严重沙眼瘢痕、白喉性结膜炎、结膜天疱疮、结膜化学伤或热烧伤、X线照射后,由于广泛瘢痕形成,使泪腺导管被瘢痕所阻塞,副泪腺及结膜杯状细胞被破坏,以致泪液和粘液不能湿润眼球。此外,各种原因所造成的眼睑闭合不全,使结膜和角膜长期暴露也可发生干燥。

常见临床表现

1、球结膜干燥失去光泽和弹性,透明度减低,当患者睁眼暴露结膜数秒钟后,则干燥更为明显。如果此时在球结膜上刮片检查可发现上皮细胞的角化颗粒与大量干燥杆菌,随后结膜活动性及弹性较差,在眼球转动时睑裂部球结膜出现与角膜缘平行的皱褶。在睑裂部角膜缘的两侧球结膜出现银白色泡沫状的三角形斑,基底向角膜缘,表面干燥不为泪液湿润称之为干燥斑(Bitot斑)。开始只是很少数的微小泡沫散发在结膜表面,断而成片状灰白色,由椭圆形变为三角形。结膜色素增生也是本病的早期表现,最初见于下穹窿部,在翻转下睑时,在下穹窿部结膜及半月皱襞处,最后在上穹窿部亦可出现浅棕色色素沉着,病愈后结膜干燥首先消失,但色素增生消失较慢。 2、早期结膜表面暗淡无光,组织变厚并趋向角化,以致外观如干燥的皮肤样,虽有眼泪也不能使其湿润。皱缩、干燥、角化的结膜上皮造成难以忍受的干燥感和怕光等痛苦,在结膜变化的同时,角膜也受累,开始上皮层干燥、混浊、导致视力下降甚至丧失。 3、对于睑外翻、眼睑缺损、突眼而使眼睑闭合不全时,可引起局部性结膜干燥与暴露性角膜炎。暴露部位的睑、球结膜充血、干燥、角化和增厚

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