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真菌性角膜炎(一)

简介

? ? ? ?真菌性角膜炎是由致病真菌引起的、致盲率极高的感染性角膜病。中医辨证根据其发病特点亦属中医“凝脂翳”、“湿翳”范畴。 真菌性角膜炎在临床上较难诊断,容易误诊,常因治疗不当而造成失明。一般情况下,真菌不会侵犯正常角膜,但当有眼外伤、长期局部使用抗生素、角膜炎症及干眼症等情况时,非致病的真菌就可能变为致病菌,引起角膜继发性真菌感染。常见的致病菌为曲霉菌,其次是镰刀菌、白色念珠菌、头芽孢菌及链丝菌等。因致病菌种不同,角膜溃疡形态不一。 真菌性角膜炎并非少见。夏秋农忙季节发病率高。在年龄与职业上,多见于青壮年、老年及农民。

发病病因

(1)多由致病真菌引起包括(镰刀菌和曲霉菌、其他还有念珠菌属、青霉菌属和酵母菌等) (2)眼部植物性外伤心史:常见有树枝、甘蔗叶、稻草、麦芒等刺伤 (3)局部抵抗力下降:配戴角膜接触镜(软性角膜接触镜和 OK镜)可直接由角膜上皮糜烂或上皮擦伤引起真菌感染,也可以通过被真菌污染的保存液或清洁液引起感染 (4)机体免疫功能失调:与一些菌种的发病有关。如全身或局部长期使用广谱抗生素、糖皮质激素或免疫抑制剂

临床表现

? ? ? ?自觉有眼异物感、畏光流泪,视力减退症状,如果形成角膜侵润灶呈白色或灰色,致密,表面欠光泽,呈牙膏样或苔垢样外观,溃疡周围有胶原溶解形成的浅沟,或抗原抗体反应形成的免疫环。有时在角膜病灶旁可见伪足或卫星样侵润灶,病灶后可有斑块状纤维脓性沉着物。前房积脓,呈灰白色,粘稠或呈糊状。真菌穿透性强,进入前房或角膜穿破时易引起真菌性眼内炎。

诊断要点

? ? ? ?根据角膜植物损伤史,结合角膜病灶的特征,可作出初步诊断。实验室检查找到真菌和菌丝可以确诊。常用方法有角膜刮片Gram和Giemsa染色、10%-20%氢氧化钾湿片刮片及培养均为阴性,而临床又高度怀疑者,可考虑作角膜组织活检。此外,免疫荧光染色、电子显微镜检查和PCR技术也用于真菌角膜炎的诊断。角膜共焦显微镜作为非侵入性检查,可直接发现病灶内的真菌病原体 中医辨证要点: 真菌性角膜炎,辨证要点在于如何辨别风热偏重、湿热偏重,治疗以祛风清热解毒,清热祛湿为主

鉴别诊断

? ? ? ?重症的真菌性角膜炎,特别是镰刀菌性角膜炎,由于发病急骤,常合并有前房积脓及角膜穿孔,经常被误诊为绿脓杆菌性角膜溃疡,主要鉴别是:1 、绿脓杆菌性角膜溃疡:溃疡呈淡绿色,表面湿润而有光泽(由黏性坏死组织及分泌物构成),边缘光滑,与正常角膜之间有浸润水肿区。真菌性角膜炎具有典型的菌丝苔被病灶2 、单纯疱疹病毒:该病引起的坏死性角膜炎和棘阿米巴性角膜炎晚期盘状基质脓疡的临床表现非常酷似,应通过病史及实验室诊断加以鉴别。

预防

? ? ? ?预防是最关键的一步,因为患者绝大多数为农民,虽然整年均可发生,但主要集中在业夏收和秋收季节。 务必注意以下细节 1、养成良好的卫生习惯,勤洗手,常剪指甲 2、不要长期佩戴隐形眼镜;更换隐形眼镜时要小心 3、与急性结膜炎的预防相同,主要是切断传染源与注意眼和手的卫生

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The cornea is the eye's outermost layer. It is dome-shaped surface front part of the eye that covers the iris, pupil, and anterior chamber.

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Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss. A major risk factor is increased pressure in the eye.

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The cornea is the eye's outermost layer. It is dome-shaped surface front part of the eye that covers the iris, pupil, and anterior chamber.

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