慢性青光眼

簡介:

       青光眼是一種引起視神經損害的疾病。視神經由很多神經纖維組成,當眼內壓增高時,可導致神經纖維損害,引起視野缺損。早期輕微的視野缺損眾通常難以發現,如視神經嚴重受損,可導致失明。盡早地進行青光眼的檢查、診斷和治療是防止視神經損害和失明的關鍵。

       青光眼的病因――前房是位于角膜之后、虹膜和瞳孔之前的空隙,后房則在虹膜、瞳孔之后,晶狀體之前。前、后房內充滿了透明的液體,我們稱之為房水,房水在前、后房內不斷地循環流動,并且不斷地生成、排出,使眼壓維持在一個穩定的水平。(提醒您注意的是,房水并不是我們淚水的一部分)。

       眼球內是一個封閉的結構,如果房水排出通道一房角阻塞,房水排出受阻,眼內壓升高,引起眼球壁壓力太大,則導致視神經損害

臨床癥狀:

青光眼的種類主要有四種:先天性青光眼、原發性青光眼、繼發性青光眼、混合型青光眼。各種類型的青光眼的臨床表現及特點各不相同。

1、急性閉角型青光眼:發病急驟,表現為患眼側頭部劇痛,眼球充血,視力驟降的典型癥狀。疼痛沿三叉神經分布區域的眼眶周圍、鼻竇、耳根、牙齒等處放射;眼壓迅速升高,眼球堅硬,常引起惡心、嘔吐、出汗等;患者看到白熾燈周圍出現彩色暈輪或像雨后彩虹即虹視現象。

2、亞急性閉角型青光眼(包括亞臨床期、前驅期和間歇期):患者僅輕度不適,甚至無任何癥狀,可有視力下降,眼球充血輕,常在傍晚發病,經睡眠后緩解。如未及時診治,以后發作間歇縮短,每次發作時間延長,向急性發作或慢性轉化。

3、慢性閉角型青光眼:自覺癥狀不明顯,發作時輕度眼脹,頭痛,閱讀困難,常有虹視。發作時患者到亮處或睡眠后可緩解,一切癥狀消失。此型青光眼有反復小發作,早期發作間歇時間較長,癥狀持續時間短,多次發作后,發作間隔縮短,持續時間延長。如治療不當,病情會逐漸進展,晚期視力下降,視野嚴重缺損。

4、原發性開角型青光眼:發病隱蔽,進展較為緩慢,非常難察覺,故早期一般無任何癥狀,當病變發展到一定程度時,可出現輕度眼脹、視力疲勞和頭痛,視力一般不受影響,而視野逐漸縮小。晚期視野縮小呈管狀時,出現行動不便和夜盲。有些晚期病例可有視物模糊和虹視。因此原發性開角型青光眼的早期診斷非常重要,強調對可疑病例作相關檢查。

5、先天性青光眼:一般在幼兒或少兒時出現臨床表現。如在3歲以前發病,可出現羞明、溢淚、眼瞼痙攣和大角膜;3歲以后發病,則可表現為少兒進行性近視。

臨床類型:

       青光眼的種類主要有四種:先天性青光眼、原發性青光眼、繼發性青光眼、混合型青光眼。各種類型的青光眼的臨床表現及特點各不相同。

臨床診斷:

       青光眼病人的治療有賴于準確的診斷。青光眼病人的診斷與其他疾病一樣,根據病史、臨床表現及檢查結果進行綜合分析。 對可疑患者,首先應測量眼壓。眼壓大于3.20kPa(24mmHg)為病理性高眼壓,但一次眼壓偏高不能診斷青光眼,而一次眼壓正常也不能排除青光眼。因為眼壓在一日內呈周期性波動。日眼壓波動大于1.07kPa(8mmHg)為病理性眼壓。正常人雙眼眼壓接近,如雙眼壓差大于0.67kPa(5mmHg)也為病理性眼壓。其次應檢查眼底,觀察視盤改變,青光眼的視盤改變具有一定的特殊性,有重要的臨床價值。常表現為病理性陷凹,目前普遍采用陷凹與視盤直徑的比值(C/D)表示陷凹大小。C/D大于0.6或雙眼C/D差大于0.2為異常;視盤沿變薄,常伴有視盤沿的寬窄不均和切跡,表示視盤沿視神經纖維數量減少;視盤血管改變,表現為視盤邊緣出血,血管架空,視盤血管鼻側移位和視網膜中央動脈搏動。此外,眼底檢查可觀察視網膜神經纖維層缺損,由于它可出現在視野缺損前,被認為是青光眼早期診斷指征之一。

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