角膜擦傷

到中醫眼科求診的病人大多是患有眼底或後期嚴重眼疾,今次跟大家分享一個外眼病-角膜擦傷(Corneal Abrasion)。因這病疼痛劇烈,這類病人大多會跑到西醫眼科處求診。這例顯示出中醫眼科並不單能治慢性病,也能治一些較急外眼病。

患者為一名廿歲年青男士,因打籃球時被籃球撞傷右眼,自述當時視力未見異常。次日早上到來求診,症狀為右眼球刺痛、持續流淚、畏光,眼有黏性分泌物。

檢查:
視力: 右眼:0.5 左眼:1.0

生理顯微鏡檢查:
右眼角膜中央表皮擦傷伴明顯水腫(見下圖),鼻側球結膜充血

左眼前段未見異常

角膜擦損

眼底檢查:雙眼未見明顯異常

診斷:中醫眼科先要辨明疾病屬外障與內障,屬翳或膜,翳又分新翳與宿翳。此症則屬外障病之新翳,治法則以退翳明目為主。

治療:當天處方口服中藥伴人工淚液,2天後覆診。

覆診(第3天):
病者刺痛及畏光症狀已消除,仍有輕微流眼水

右眼視力已回復至1.0 

生理顯微鏡檢查:右眼角膜表皮已基本復原,未見明顯水腫。(見下圖)
治療:由於角膜基本癒合,再予1星期中藥以鞏固療效。

已康復角膜膜

此病例可見中醫眼科除能治眼底疾患外,對角膜病亦有其治療特色,可於短時間內促進角膜復原。由於角膜外傷後,有部份患者因處理不當而導致角膜疤痕影響視力;亦有部份患者因角膜最外的表皮層(Epithelium)不能再緊緊貼附於"包氏層"(Bowman's Layer),而發展成"復發性角膜糜爛"(見下圖)。

治療此病重點在於促進角膜康復外,亦要預防感染。如傷口癒合不佳,則會較易導致"復發性角膜糜爛"。

復發性角膜糜爛

 

 

 

 

 

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