干眼 dry eye disease
发表人：
裘凯凯
阅读量：
1086人
眼睛干涩
眼睛干燥等，当眼泪无法稳定保持眼表充分润滑时，就会发生这种情况。
常见原因：
老花
药物
激光眼科手术
干燥空气过多
减少眨眼
长时间使用计算机
隐形眼镜的使用
女性激素变化
治疗
自我治疗：在一些不太严重的情况下可能有帮助：
使用防护眼镜阻挡干燥空气
加湿室内空气
将计算机屏幕置于视线水平以下
避免接触烟雾
使用人工泪液
通过眨眼和闭上眼睛来频繁地锻炼眼睛
富含维生素A食物和不饱和脂肪酸适当补充（肝脏，胡萝卜和西兰花）欧米伽脂肪酸－３， EPA, DHA
如果您发现以下情况，请去看医生：
眼睛发红
眼睛疼痛
阅读困难
如果您发现以下情况，请立即就医：
视力丧失
视力
感染的迹象，如发烧，炎症，液体排出
可用于确定干眼症原因的测试和程序包括：1.全面的眼科检查。眼科检查包括您的整体健康状况和眼睛健康的完整病史，可以帮助您的医生诊断您眼睛干涩的原因；特别是角膜荧光素染色下的泪液破裂时间检查（BUT检查，角膜荧光素是否染色阳性）；2.测量眼泪量的测试。您的医生可能会使用Schirmer试验来测量您的泪液产生。结膜印迹细胞试验...３.泪液渗透压检查 ４.睑板腺相关检查：分布，开头透明度，堵塞等检查和评估等
Diagnosis
Tests and procedures that may be used to determine the
cause of your dry eyes include:
A comprehensive eye exam. An eye exam that includes a complete
history of your overall health and your eye health can help your
doctor diagnose the cause of your dry eyes.
A test to measure the
volume of your tears. Your doctor may measure your tear production
using the Schirmer test. In this test, blotting strips of paper are
placed under your lower eyelids. After five minutes your doctor
measures the amount of strip soaked by your tears.
Another option for measuring tear volume is the phenol red
thread test. In this test, a thread filled with pH-sensitive dye
(tears change the dye color) is placed over the lower eyelid, wetted
with tears for 15 seconds and then measured for tear volume.
A
test to determine the quality of your tears. Other tests use special
dyes in eyedrops to determine the surface condition of your eyes. Your
doctor looks for staining patterns on the corneas and measures how
long it takes before your tears evaporate.
A tear osmolarity
test. This type of test measures the composition of particles and
water in your tears. With dry eye disease, there will be less water in
your eyes.
Tear samples to look for markers of dry eye disease,
including elevated matrix metallo proteinase-9 or decreased
lactoferrin.
More Information
Eye exam
Treatment
Punctal plugsOpen pop-up dialog box
For
most people with occasional or mild dry eye symptoms, it's enough to
regularly use over-the-counter eyedrops (artificial tears). If your
symptoms are persistent and more serious, you have other options. What
you do depends on what's causing your dry eyes.
Some treatments focus on reversing or managing a condition or factor that's causing your dry eyes. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.
Treating the underlying cause of dry eyes
In some cases,
treating an underlying health issue can help clear up the signs and
symptoms of dry eyes. For instance, if a medication is causing your
dry eyes, your doctor may recommend a different medication that
doesn't cause that side effect.
If you have an eyelid condition, such as your lids turned outwards (ectropion), your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).
Medications
Prescription medications used to treat dry eyes include:
Drugs to reduce eyelid inflammation. Inflammation along the edge of
your eyelids can keep oil glands from secreting oil into your tears.
Your doctor may recommend antibiotics to reduce inflammation.
Antibiotics for dry eyes are usually taken by mouth, though some are
used as eyedrops or ointments.
Eyedrops to control cornea
inflammation. Inflammation on the surface of your eyes (cornea) may be
controlled with prescription eyedrops that contain the
immune-suppressing medication cyclosporine (Restasis) or
corticosteroids. Corticosteroids are not ideal for long-term use due
to possible side effects.
Eye inserts that work like artificial
tears. If you have moderate to severe dry eye symptoms and artificial
tears don't help, another option may be a tiny eye insert that looks
like a clear grain of rice. Once a day, you place the hydroxypropyl
cellulose (Lacrisert) insert between your lower eyelid and your
eyeball. The insert dissolves slowly, releasing a substance that's
used in eyedrops to lubricate your eye.
Tear-stimulating drugs.
Drugs called cholinergics (pilocarpine, cevimeline) help increase tear
production. These drugs are available as pills, gel or eyedrops.
Possible side effects include sweating.
Eyedrops made from your
own blood. These are called autologous blood serum drops. They may be
an option if you have severe dry eye symptoms that don't respond to
any other treatment. To make these eyedrops, a sample of your blood is
processed to remove the red blood cells and then mixed with a salt
solution.
Other procedures
Other procedures that may be used
to treat dry eyes include:
Closing your tear ducts to reduce tear loss. Your doctor may suggest this treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away.
Tear ducts can be plugged with tiny silicone plugs (punctal plugs).
These are removable. Or tear ducts can be plugged with a procedure
that uses heat. This is a more permanent solution called thermal
cautery.泪点塞
Using special contact lenses. Ask your doctor about
newer contact lenses designed to help people with dry eyes.
Some people with severe dry eyes may opt for special contact lenses that protect the surface of the eyes and trap moisture. These are called scleral lenses or bandage lenses.巩膜镜或绑带镜
Unblocking oil glands. Warm compresses or eye masks used daily can
help clear up blocked oil glands. A thermal pulsation device is
another way to unclog the oil glands, but it is unclear whether this
method provides any advantage over warm compresses.
Using light
therapy and eyelid massage. A technique called intense-pulsed light
therapy followed by massage of the eyelids has proved to help people
with severe dry eyes.
Lifestyle and home remedies
You may be able to manage your
dry eyes with frequent eyelid washing and use of over-the-counter
(OTC) eyedrops or other products that help lubricate your eyes. If
your condition is long term (chronic), use eyedrops even when your
eyes feel fine to keep them well lubricated.
Selecting and using OTC products for dry eyes
A variety of
nonprescription products for dry eyes are available, including
eyedrops (artificial tears), gels and ointments. Talk with your doctor
about which might be best for you.
Artificial tears may be all you need to control mild dry eye symptoms. Some people need to put drops in several times a day, and some use them only once a day.
Consider these factors when selecting an OTC product:
Preservative vs. nonpreservative drops. Preservatives are added to some eyedrops to prolong shelf life. You can use eyedrops with preservatives up to four times a day. But using the preservative drops more often can cause eye irritation.
Nonpreservative eyedrops come in packages that contain multiple
single-use vials. After you use a vial, you throw it away. If you rely
on eyedrops more than four times a day, nonpreservative drops are
safe.
Drops vs. ointments. Lubricating eye ointments coat your
eyes, providing longer lasting relief from dry eyes. But these
products are thicker than eyedrops and can cloud your vision. For this
reason, ointments are best used just before bedtime. Eyedrops can be
used at any time and won't interfere with your vision.
Drops that
reduce redness. It's best to avoid these as your solution for dry
eyes, as prolonged use can cause irritation.
Washing your eyelids
to control inflammation
For people with blepharitis and other
conditions that cause eyelid inflammation that blocks the flow of oil
to the eye, frequent and gentle eyelid washing may help. To wash your eyelids:
Apply a warm washcloth to your eyes热敷. Wet a clean cloth with warm
water. Hold the cloth over your eyes for five minutes. Rewet the cloth
with warm water when it cools. Gently rub the washcloth over your
eyelids — including the base of the eyelashes — to loosen any
debris.
Use a mild soap on your eyelids温和的肥皂. Use baby shampoo or
another mild soap. Put the cleanser on your clean fingertips and
gently massage your closed eyes near the base of your eyelashes. Rinse
completely.
More Information
Artificial tears人工泪液选择: How to
select eyedrops for dry eyes
Alternative
medicine替代治疗
Further study is needed, but some alternative
medicine approaches may help relieve your dry eye symptoms. Discuss
the benefits and risks with your doctor.
Fatty acids. omega-3脂肪酸口服Adding omega-3 fatty acids to your diet may
help relieve dry eye signs and symptoms. These are available as
supplements and in foods such as flaxseed, salmon and
sardines.
Castor oil eyedrops蓖麻油滴眼液. These eyedrops may improve
symptoms by reducing tear evaporation.
Acupuncture针灸. Some people
have seen their dry eye symptoms improve after acupuncture
therapy.
Preparing for your appointment
You're likely to
start by seeing your family doctor. He or she may then refer you to an
eye specialist (ophthalmologist). Because appointments can be brief,
it's a good idea to be well prepared for your appointment.
What you can do
List any symptoms you're experiencing, including
any that may seem unrelated to the reason for which you scheduled the
appointment.
List key personal information, including any recent
life changes.
Make a list of all medications, vitamins and
supplements that you're taking.
List questions to ask your
doctor.
For dry eyes, some basic questions to ask your doctor include:
What's the most likely cause of my dry eyes?
Do I need any
tests?
Can dry eyes get better on their own?
What are my
treatment options?
What are the potential side effects of each
treatment?
I have other health conditions. How can I best manage
these conditions together?
Is a generic drug available for the
medicine you're prescribing me?
Do you have any brochures or
other printed material that I can take with me?
What websites do
you recommend?
Do I need to plan for a follow-up
visit?
Don't hesitate to ask additional questions that may occur
to you during your appointment.
What to expect from your doctor
Your doctor may ask:
Can you describe your symptoms?
Do you recall when you first
began experiencing symptoms?
Have your symptoms been continuous
or occasional?
Do other members of your family have dry
eyes?
Have you tried over-the-counter eyedrops? Did they provide
relief?
Are your symptoms worse in the morning or late in the
day?
What medications do you take?
Have you had any
radiation to the head or neck?
What you can do in the
meantime
To relieve your signs and symptoms while you wait for
your appointment, try over-the-counter eyedrops. Look for lubricating
eyedrops (artificial tears) and avoid those that advocate reducing
redness in the eyes. Eyedrops that reduce eye redness can cause
additional eye irritation.
Sept. 24, 2020
Book: Mayo Clinic Guide to Better Vision
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相关文章
文章 干眼 dry eye disease
眼睛干涩 眼睛干燥等，当眼泪无法稳定保持眼表充分润滑时，就会发生这种情况。 常见原因： 老花 药物 激光眼科手术 干燥空气过多 减少眨眼 长时间使用计算机 隐形眼镜的使用 女性激素变化 治疗 自我治疗：在一些不太严重的情况下可能有帮助： 使用防护眼镜阻挡干燥空气 加湿室内空气 将计算机屏幕置于视线水平以下 避免接触烟雾 使用人工泪液 通过眨眼和闭上眼睛来频繁地锻炼眼睛 富含维生素A食物和不饱和脂肪酸适当补充（肝脏，胡萝卜和西兰花）欧米伽脂肪酸－３， EPA, DHA 如果您发现以下情况，请去看医生： 眼睛发红 眼睛疼痛 阅读困难 如果您发现以下情况，请立即就医： 视力丧失 视力 感染的迹象，如发烧，炎症，液体排出 可用于确定干眼症原因的测试和程序包括：1.全面的眼科检查。眼科检查包括您的整体健康状况和眼睛健康的完整病史，可以帮助您的医生诊断您眼睛干涩的原因；特别是角膜荧光素染色下的泪液破裂时间检查（BUT检查，角膜荧光素是否染色阳性）；2.测量眼泪量的测试。您的医生可能会使用Schirmer试验来测量您的泪液产生。结膜印迹细胞试验...３.泪液渗透压检查 ４.睑板腺相关检查：分布，开头透明度，堵塞等检查和评估等 Diagnosis Tests and procedures that may be used to determine the cause of your dry eyes include: A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes. A test to measure the volume of your tears. Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears. Another option for measuring tear volume is the phenol red thread test. In this test, a thread filled with pH-sensitive dye (tears change the dye color) is placed over the lower eyelid, wetted with tears for 15 seconds and then measured for tear volume. A test to determine the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate. A tear osmolarity test. This type of test measures the composition of particles and water in your tears. With dry eye disease, there will be less water in your eyes. Tear samples to look for markers of dry eye disease, including elevated matrix metallo proteinase-9 or decreased lactoferrin. More Information Eye exam Treatment Punctal plugsOpen pop-up dialog box For most people with occasional or mild dry eye symptoms, it's enough to regularly use over-the-counter eyedrops (artificial tears). If your symptoms are persistent and more serious, you have other options. What you do depends on what's causing your dry eyes. Some treatments focus on reversing or managing a condition or factor that's causing your dry eyes. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes. Treating the underlying cause of dry eyes In some cases, treating an underlying health issue can help clear up the signs and symptoms of dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn't cause that side effect. If you have an eyelid condition, such as your lids turned outwards (ectropion), your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon). Medications Prescription medications used to treat dry eyes include: Drugs to reduce eyelid inflammation. Inflammation along the edge of your eyelids can keep oil glands from secreting oil into your tears. Your doctor may recommend antibiotics to reduce inflammation. Antibiotics for dry eyes are usually taken by mouth, though some are used as eyedrops or ointments. Eyedrops to control cornea inflammation. Inflammation on the surface of your eyes (cornea) may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects. Eye inserts that work like artificial tears. If you have moderate to severe dry eye symptoms and artificial tears don't help, another option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eyedrops to lubricate your eye. Tear-stimulating drugs. Drugs called cholinergics (pilocarpine, cevimeline) help increase tear production. These drugs are available as pills, gel or eyedrops. Possible side effects include sweating. Eyedrops made from your own blood. These are called autologous blood serum drops. They may be an option if you have severe dry eye symptoms that don't respond to any other treatment. To make these eyedrops, a sample of your blood is processed to remove the red blood cells and then mixed with a salt solution. Other procedures Other procedures that may be used to treat dry eyes include: Closing your tear ducts to reduce tear loss. Your doctor may suggest this treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away. Tear ducts can be plugged with tiny silicone plugs (punctal plugs). These are removable. Or tear ducts can be plugged with a procedure that uses heat. This is a more permanent solution called thermal cautery.泪点塞 Using special contact lenses. Ask your doctor about newer contact lenses designed to help people with dry eyes. Some people with severe dry eyes may opt for special contact lenses that protect the surface of the eyes and trap moisture. These are called scleral lenses or bandage lenses.巩膜镜或绑带镜 Unblocking oil glands. Warm compresses or eye masks used daily can help clear up blocked oil glands. A thermal pulsation device is another way to unclog the oil glands, but it is unclear whether this method provides any advantage over warm compresses. Using light therapy and eyelid massage. A technique called intense-pulsed light therapy followed by massage of the eyelids has proved to help people with severe dry eyes. Lifestyle and home remedies You may be able to manage your dry eyes with frequent eyelid washing and use of over-the-counter (OTC) eyedrops or other products that help lubricate your eyes. If your condition is long term (chronic), use eyedrops even when your eyes feel fine to keep them well lubricated. Selecting and using OTC products for dry eyes A variety of nonprescription products for dry eyes are available, including eyedrops (artificial tears), gels and ointments. Talk with your doctor about which might be best for you. Artificial tears may be all you need to control mild dry eye symptoms. Some people need to put drops in several times a day, and some use them only once a day. Consider these factors when selecting an OTC product: Preservative vs. nonpreservative drops. Preservatives are added to some eyedrops to prolong shelf life. You can use eyedrops with preservatives up to four times a day. But using the preservative drops more often can cause eye irritation. Nonpreservative eyedrops come in packages that contain multiple single-use vials. After you use a vial, you throw it away. If you rely on eyedrops more than four times a day, nonpreservative drops are safe. Drops vs. ointments. Lubricating eye ointments coat your eyes, providing longer lasting relief from dry eyes. But these products are thicker than eyedrops and can cloud your vision. For this reason, ointments are best used just before bedtime. Eyedrops can be used at any time and won't interfere with your vision. Drops that reduce redness. It's best to avoid these as your solution for dry eyes, as prolonged use can cause irritation. Washing your eyelids to control inflammation For people with blepharitis and other conditions that cause eyelid inflammation that blocks the flow of oil to the eye, frequent and gentle eyelid washing may help. To wash your eyelids: Apply a warm washcloth to your eyes热敷. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Rewet the cloth with warm water when it cools. Gently rub the washcloth over your eyelids — including the base of the eyelashes — to loosen any debris. Use a mild soap on your eyelids温和的肥皂. Use baby shampoo or another mild soap. Put the cleanser on your clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse completely. More Information Artificial tears人工泪液选择: How to select eyedrops for dry eyes Alternative medicine替代治疗 Further study is needed, but some alternative medicine approaches may help relieve your dry eye symptoms. Discuss the benefits and risks with your doctor. Fatty acids. omega-3脂肪酸口服Adding omega-3 fatty acids to your diet may help relieve dry eye signs and symptoms. These are available as supplements and in foods such as flaxseed, salmon and sardines. Castor oil eyedrops蓖麻油滴眼液. These eyedrops may improve symptoms by reducing tear evaporation. Acupuncture针灸. Some people have seen their dry eye symptoms improve after acupuncture therapy. Preparing for your appointment You're likely to start by seeing your family doctor. He or she may then refer you to an eye specialist (ophthalmologist). Because appointments can be brief, it's a good idea to be well prepared for your appointment. What you can do List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. List key personal information, including any recent life changes. Make a list of all medications, vitamins and supplements that you're taking. List questions to ask your doctor. For dry eyes, some basic questions to ask your doctor include: What's the most likely cause of my dry eyes? Do I need any tests? Can dry eyes get better on their own? What are my treatment options? What are the potential side effects of each treatment? I have other health conditions. How can I best manage these conditions together? Is a generic drug available for the medicine you're prescribing me? Do you have any brochures or other printed material that I can take with me? What websites do you recommend? Do I need to plan for a follow-up visit? Don't hesitate to ask additional questions that may occur to you during your appointment. What to expect from your doctor Your doctor may ask: Can you describe your symptoms? Do you recall when you first began experiencing symptoms? Have your symptoms been continuous or occasional? Do other members of your family have dry eyes? Have you tried over-the-counter eyedrops? Did they provide relief? Are your symptoms worse in the morning or late in the day? What medications do you take? Have you had any radiation to the head or neck? What you can do in the meantime To relieve your signs and symptoms while you wait for your appointment, try over-the-counter eyedrops. Look for lubricating eyedrops (artificial tears) and avoid those that advocate reducing redness in the eyes. Eyedrops that reduce eye redness can cause additional eye irritation. Sept. 24, 2020 Book: Mayo Clinic Guide to Better Vision
裘凯凯
主治医师
珠海眼管家眼科诊所
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文章 霰粒肿 ｖｓ 麦粒肿
Hordeolum是一种在眼睑中发现的急性细菌感染。[1]这种感染是一种常见疾病，患者经常到他们的初级保健医生或急性护理中心进行评估和治疗。[2]患者通常表现为眼睑疼痛性红斑性炎症。麦粒体可以在外眼睑上形成，通常被称为麦粒肿。它也可能在内眼睑上形成，很容易被误认为是霰粒肿。[3]这种情况通常持续一到两周，是自限性的，并且经常自行消退。可以用热敷和按摩疗法治疗。可能需要局部使用抗生素，在极少数情况下，脓疱可能需要引流。[3] 病因学 它通常是由感染睫毛毛囊的葡萄球菌引起的。外部麦粒肿是由皮脂腺（蔡司）腺或汗腺（毛细胞）腺的阻塞引起的。[4]阻塞发生在睫毛线处，表现为疼痛的红色肿胀区域，发展成脓疱。内部麦粒肿是由睑板腺阻塞引起的，脓疱在眼睑的内表面形成。[3] Hordeola可能同时出现在上眼睑和下眼睑上。[4] 流行病学 Hordeolum是家庭实践和急性护理环境中的常见表现。[2]种族，性别或性别与大麦病流行率之间没有直接相关性。由于皮脂粘度增加，成人可能更容易患病。患有睑缘炎，脂溢性皮炎，酒渣鼻，糖尿病和脂质升高等疾病的患者也面临发生群淋巴细胞的风险增加。[3] 病理 生理 感染是由于蔡司、摩尔或睑板腺分泌物增厚、干燥或淤滞引起的。蔡司和莫尔腺是眼睛的睫状体。蔡司腺分泌具有防腐特性的皮脂，可以防止细菌的生长。[2]摩尔腺产生免疫球蛋白A，粘蛋白1和溶酶体，这对于免疫防御眼睛中的细菌至关重要。[5]当这些腺体堵塞或阻塞时，眼睛防御就会受损。淤滞可导致细菌感染，金黄色葡萄球菌是最常见的病原体。[4]在白细胞浸润发生局部炎症反应后，会出现化脓性口袋或脓肿。 历史和物理 仔细的病史和体格检查至关重要。患者通常会缓慢而隐匿地出现疼痛、发红和肿胀的眼睑，无异物或外伤史。如果麦粒肿的大小压在角膜上，视力可能会受到影响。患者不应报告眼痛，眼外运动应完整无痛。红斑局限于患眼睑。提供者应尝试定位脓疱，并且可能需要切除眼睑部分局限影响引流形成纤维包膜，特别是定位内部的麦粒肿。提供者应询问麦粒肿的任何诱发性疾病，这些疾病应在治疗中得到解决。眼球运动伴眶周肿胀和红斑的任何疼痛均提示眼眶蜂窝织炎，需要额外和更积极的管理和治疗。眼部持续或复发性疼痛肿块可能提示癌，需要活检。在这些情况下需要转诊眼科。[2][6][3] 评估 通常，没有与麦粒肿相关的诊断性检查，这是一种临床诊断。在极少数情况下，如果发生并发症，并且感染扩散并导致眶周或眼眶蜂窝织炎，则需要额外的检查和影像学检查。有时，内部麦粒肿会引起角膜刺激，在这种情况下，提供者可能会用荧光素染色眼睛，以确保没有角膜擦伤。[2] 治疗/管理 在许多情况下，病变可以在没有任何治疗的情况下自发引流。热敷也是有益的，按摩该区域也是如此。热敷的目的是软化肉芽肿组织并促进引流。迄今为止，还没有结论性研究表明，仅这种方法就会导致持续时间缩短或结局改善。眼睑按摩旨在帮助表达受感染腺体的脓性引流。使用无泪且 PH 平衡的生理盐水或温和不刺激角膜的洗面奶（例如婴儿洗面奶）进行眼睑清洁，可通过清除堵塞导管中的碎屑来促进排出。肥皂还可通过分解细胞膜来帮助去除细菌，它还可以治疗外部麦粒肿的根本原因，睑缘炎。[1]应特别注意挤压和按摩内部麦粒肿，因为这可能会导致角膜刺激或变形。[7] 持续性病变或较大病变可能需要抗生素治疗。这种治疗可能有助于缩短持续时间和严重程度。经常使用大环内酯类抗生素眼膏，如红霉素眼药膏，并具有润滑的额外好处。如果肿胀明显并对角膜造成压力，则可以短期使用局部类固醇。[8]如果感染扩散并进展为眶周或眼眶蜂窝织炎，则需要全身性抗生素。[2]持续性脓肿的切口和引流可能是必要的。[9]眼科医生应在局部麻醉下进行切口和引流。应将标本送往病理学，以排除更严重的疾病，包括癌症。 鉴别诊断 基底细胞癌 霰粒肿 气肿-眼眶（罕见） 前期蜂窝织炎 皮脂腺癌 鳞状细胞癌 形成颗粒和其他问题 虽然麦粒肿是一种常见的表现，但医生应确保在评估和治疗期间考虑并排除红眼皮疼痛的其他表现。其他应考虑的诊断包括眶周和眼眶蜂窝织炎、霰粒肿、皮脂腺癌和鳞状细胞癌。[6]提供者还应考虑可能导致群病复发的根本原因，如睑缘炎和酒渣鼻。应解决这些基础疾病，以防止这些患者群体中麦粒肿复发。[10] 霰粒肿可以模仿内部的Hordeolum，起初可能很难区分两者。霰粒肿在眼睑中间的皮脂腺周围形成。它是由腺体中泄漏到周围组织的分泌物分解形成的。最初，炎症可能产生疼痛，并可能表现为内部麦粒肿。然而，霰粒肿发展为无痛肉芽肿性结节，被认为是无菌性慢性炎症。[8] 提高医疗团队的成果 Hordeolum经常由急诊医生，执业护士或初级保健提供者遇到。在大多数情况下，感染可以通过保守治疗来控制。热敷的目的是软化肉芽肿组织并促进引流。持续性病变或较大病变可能需要抗生素治疗。这种治疗可能有助于缩短持续时间和严重程度。但是，如果感染量较大或病因不明，应将患者转诊至眼科医生处。[9]眼科医生应在局部麻醉下进行切口和引流。应将标本送往病理学，以排除更严重的疾病，包括癌症。 对于大多数大麦病患者，结果非常好。 A hordeolum is an acute, common bacterial infection of the eyelid. Patients with this condition often present to their primary care provider with painful, erythematous inflammation of the eyelid. This activity illustrates the evaluation and treatment of hordeolum and reviews the role of the professional team in managing patients with this condition. Objectives: Describe the typical clinical presentation of a hordeolum. Review the pathophysiology of hordeolum. Summarize the use of warm compresses, lid massage, and lid scrubs in the management of hordeolum. Identify the importance of improving care coordination among the interprofessional team to improve outcomes for patients affected with hordeolum. Access free multiple choice questions on this topic. Introduction A hordeolum is an acute bacterial infection found in the lid of the eye.[1] This infection is a common condition, and patients often present to their primary care physician or acute care center for evaluation and treatment.[2] The patient usually presents with painful, erythematous inflammation of the eyelid. The hordeolum can form on the external eyelid and is referred to commonly as a stye. It may also form on the inner eyelid and can be easily mistaken for a chalazion.[3] The condition often lasts one to two weeks, is self-limiting, and often resolves on its own. It may be treated with warm compresses and massage therapy. Topical antibiotics may be indicated, and in rare cases, the pustule may require drainage.[3] Etiology It is usually caused by Staphylococcus that infects the eyelash hair follicle. The external hordeolum is caused by a blockage of the sebaceous (Zeis) glands or sweat (Moll) glands.[4] The blockage occurs at the lash line and presents as a painful red swollen area that develops into a pustule. The internal hordeolum is caused by a blockage of the Meibomian glands, and the pustule forms on the inner surface of the eyelids.[3] Hordeola may present on both the upper and the lower eyelids.[4] Epidemiology Hordeolum is a common presentation in family practice and acute care settings.[2] There is no direct correlation between race, sex, or gender with regards to hordeolum prevalence. Adults may be more prone due to the increased viscosity of the sebum. Patients with conditions such as blepharitis, seborrheic dermatitis, rosacea, diabetes, and elevated lipids are also at increased risk for the development of hordeola.[3] Pathophysiology The infection occurs due to thickening, drying, or stasis of the Zeis, Moll, or Meibomian gland secretions. The Zeis and Moll glands are the ciliary glands of the eye. The Zeis gland secretes sebum with antiseptic properties that may prevent the growth of bacteria.[2] The Moll gland produces immunoglobulin A, mucin 1, and lysosomes which are essential in the immune defense against bacteria in the eye.[5] When these glands become clogged or blocked, the eye defenses are impaired. The stasis can lead to bacterial infection with Staphylococcus aureus being the most common pathogen.[4] After a localized inflammatory response occurs with infiltration by leukocytes, a purulent pocket or abscess develops. History and Physical A careful history of and physical exam is essential. The patient will usually relay a slow and insidious onset of a painful, red, and swollen eyelid without a history of foreign body or trauma. Visual acuity may be affected if the size of the hordeolum is pressing on the cornea. The patient should not report ocular pain, and their extraocular movements should be intact and painless. The erythema is localized to the lid of the affected eye. The provider should try to locate a pustule, and the eyelids may need to be everted, especially to locate an internal hordeolum. The provider should inquire about any of the predisposing conditions for hordeolum, and these conditions should be addressed and managed in treatment. Any pain in ocular movements with periorbital swelling and erythema is indicative of orbital cellulitis and requires additional and more aggressive management and treatment. Persistent or recurrent painful lumps in the eye may be indicative of carcinoma and require biopsy. Ophthalmology referral is indicated in these situations.[2][6][3] Evaluation Typically, there is no diagnostic testing associated with a hordeolum, and it is a clinical diagnosis. Rarely, additional testing and imaging will be required if complications occur, and the infection spreads and causes periorbital or orbital cellulitis. Occasionally, an internal hordeolum can cause corneal irritation, in which case the provider may stain the eye with fluorescein to ensure there is no corneal abrasion.[2] Treatment / Management In many cases, the lesions can spontaneously drain without any treatment. Warm compresses are also of benefit, as is massage to the area. These are often seen as the gold standard. Warm compresses are aimed at softening the granulomatous tissue and facilitating drainage. There are no conclusive studies to date, showing that this method alone causes any shortened durations or improved outcomes. Lid massage is intended to help express the purulent drainage from the infected gland. Lid scrubs with saline or mild shampoo (e.g., baby shampoo) that is tear-free and ph-balanced, may promote drainage by clearing debris from the clogged duct. Soap may also help to remove bacteria by breaking down cell membranes, and it may also treat an underlying cause of the external hordeolum, blepharitis.[1] Careful attention should be paid to compresses and massage for the internal hordeolum, as this could cause irritation or deformation to the cornea.[7] Persistent lesions or larger lesions may require antibiotic therapy. This treatment may help to shorten duration and severity. A macrolide antibiotic ointment such as erythromycin ophthalmic ointment is often used and has the added benefit of lubrication. If the swelling is significant and causing pressure on the cornea, topical steroids can be used for a short duration.[8] If the infection spreads and progresses to a periorbital or orbital cellulitis, systemic antibiotics are required.[2] Incision and drainage of a persistent abscess may be necessary.[9] An ophthalmologist should perform the incision and drainage under local anesthesia. The specimen should be sent to pathology to rule out more serious diseases, including carcinoma. Differential Diagnosis Basal cell carcinoma Chalazion Pneumo-Orbita(rare) Preseptal cellulitis Sebaceous gland carcinoma Squamous cell carcinoma Pearls and Other Issues While hordeolum is a common presentation, the practitioner should ensure that other manifestations of a painful red eyelid are considered and ruled out during evaluation and treatment. Other diagnoses that should be considered are periorbital and orbital cellulitis, chalazion, sebaceous gland carcinoma, and squamous cell carcinoma.[6] The provider should also consider underlying causes that can lead to a reoccurrence of hordeola such as blepharitis and rosacea. These underlying conditions should be addressed to prevent recurrent hordeolum in these patient populations.[10] A chalazion can mimic an internal hordeolum, and it may be difficult to distinguish between the two at first. The chalazion forms around the sebaceous gland in the middle of the eyelid. It forms from the breakdown of the secretions in the gland that leak into the surrounding tissues. Initially, the inflammation may produce pain and may present as an internal hordeolum. However, the chalazion develops into a painless granulomatous nodule and is considered an aseptic, chronic inflammation.[8] Enhancing Healthcare Team Outcomes Hordeolum is often encountered by the emergency physician, nurse practitioner, or primary care provider. In most cases, the infection can be managed with conservative treatment. Warm compresses are aimed at softening the granulomatous tissue and facilitating drainage. Persistent lesions or larger lesions may require antibiotic therapy. This treatment may help to shorten duration and severity. However, if the infection is large or the cause is not known, the patient should be referred to an ophthalmologist.[9] An ophthalmologist should perform the incision and drainage under local anesthesia. The specimen should be sent to pathology to rule out more serious diseases, including carcinoma. The outcomes for most patients with hordeolum is excellent. Review Questions References 1.Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev. 2017 Jan 09;1:CD007742. [PMC free article] [PubMed] 2.Pflipsen M, Massaquoi M, Wolf S. Evaluation of the Painful Eye. Am Fam Physician. 2016 Jun 15;93(12):991-8. [PubMed] 3.McAlinden C, González-Andrades M, Skiadaresi E. Hordeolum: Acute abscess within an eyelid sebaceous gland. Cleve Clin J Med. 2016 May;83(5):332-4. [PubMed] 4.Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004 Sep;25(9):312-20. [PubMed] 5.Takahashi Y, Watanabe A, Matsuda H, Nakamura Y, Nakano T, Asamoto K, Ikeda H, Kakizaki H. Anatomy of secretory glands in the eyelid and conjunctiva: a photographic review. Ophthalmic Plast Reconstr Surg. 2013 May-Jun;29(3):215-9. [PubMed] 6.Carlisle RT, Digiovanni J. Differential Diagnosis of the Swollen Red Eyelid. Am Fam Physician. 2015 Jul 15;92(2):106-12. [PubMed] 7.McMonnies CW, Korb DR, Blackie CA. The role of heat in rubbing and massage-related corneal deformation. Cont Lens Anterior Eye. 2012 Aug;35(4):148-54. [PubMed] 8.Jin KW, Shin YJ, Hyon JY. Effects of chalazia on corneal astigmatism : Large-sized chalazia in middle upper eyelids compress the cornea and induce the corneal astigmatism. BMC Ophthalmol. 2017 Mar 31;17(1):36. [PMC free article] [PubMed] 9.Hirunwiwatkul P, Wachirasereechai K. Effectiveness of combined antibiotic ophthalmic solution in the treatment of hordeolum after incision and curettage: a randomized, placebo-controlled trial: a pilot study. J Med Assoc Thai. 2005 May;88(5):647-50. [PubMed] 10.Papier A, Tuttle DJ, Mahar TJ. Differential diagnosis of the swollen red eyelid. Am Fam Physician. 2007 Dec 15;76(12):1815-24. [PubMed]
裘凯凯
主治医师
珠海眼管家眼科诊所
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文章 眼皮肿的原因分析
眼睛过敏 眼睑肿胀的最常见原因是眼睛过敏。1眼睛过敏可能会引起真正的不适，并扰乱日常活动，出现令人讨厌的症状，包括眼睑刺激和肿胀。 当免疫系统对灰尘或花粉等物质反应过度时，就会发生眼睛过敏。眼睛中的细胞释放组胺和其他化学物质，试图保护眼睛。这会导致眼睛内的血管肿胀，眼睛变得瘙痒，发红和流泪。 处方药在舒缓眼睛过敏症状方面非常有效。抗组胺药通常可以相当迅速地减少过敏引起的眼睑肿胀。 眼部麦粒肿和霰粒肿 麦粒肿是由炎症和感染引起的。当细菌进入眼睑的产油腺体时，就会发生这种情况。麦粒肿会感到瘙痒和压痛。它们通常看起来像眼睑上的红色凸起。当麦粒肿第一次开始时，眼睛可能会对光敏感，也许有点瘀伤。 霰粒肿是当其中一个腺体被阻塞时发生的事情。腺体变成坚硬的肿块，可能导致眼睑发红和肿胀。2 如果你有麦粒肿，试着给它一个温暖，湿的敷料，每天几次，每次5到10分钟。这通常使眼睛感觉更好，也可能有助于打开任何堵塞的毛孔。然后麦粒肿可以排出并开始愈合。 红眼病 红眼病或结膜炎是结膜的炎症。结膜是一层透明的膜，排列在眼睑内侧，覆盖眼睛的白色部分。红眼病通常由过敏、细菌或病毒引起。3 红眼病患者在早上醒来时可能会发现一只或两只眼睛粘在一起。眼睑可能肿胀，眼睛可能发红、发痒和刺激。 如何治疗红眼病（结膜炎） 蜂窝织炎 蜂窝织炎是眼睑肿胀的更严重原因。它是皮肤下层的细菌感染。眼科医生关注两种主要类型，当有人出现眼睑肿胀时。它们被称为前期蜂窝织炎和眼眶蜂窝织炎。4 前期蜂窝织炎是眼睑和/或周围皮肤的感染。患者经常有红眼，以及肿胀引起的疼痛。在大多数情况下，它只影响一只眼睛。 眼眶蜂窝织炎与鼻窦感染有关。感染扩散到构成眼窝的骨骼周围区域。4患有眼眶蜂窝织炎的人可能有眼睛凸出，来回移动眼睛时会感到疼痛。 如何发现和治疗蜂窝织炎 Grave's病病 患有格雷夫斯病或其他甲状腺问题的人经常患有眼睑肿胀。格雷夫斯病会导致眼睛凸起。虽然它可以比另一只眼睛更多地影响一只眼睛，但它通常涉及双眼。 有时格雷夫斯病会限制眼睛运动或导致复视。任何类型的甲状腺功能减退症或甲状腺激素水平低下都可能导致双眼肿胀或浮肿。5 概述 疱疹感染 疱疹成为眼病并不罕见 。疱疹病毒可以感染角膜，引起炎症。这是覆盖眼睛前部的透明圆顶。 眼疱疹，也称为眼部疱疹，可引起眼睑或眼表面本身的疼痛性溃疡。角膜和眼睑都受到影响。6 眼部疱疹的症状通常与红眼病的症状相同。 眼带状疱疹 总结 当你早上醒来时，眼睛看起来有点肿胀是正常的，但严重的眼睛肿胀不是。最常见的病因包括过敏、红眼病和麦粒肿，但皮肤感染、甲状腺疾病和疱疹是其他可能的原因。 EYE HEALTH MORE EYE ISSUES & SAFETY Common Causes of Eyelid Swelling By Troy Bedinghaus, OD Updated on November 01, 2021 Medically reviewed by Johnstone M. Kim, MD Print It's normal to see a bit of eyelid swelling when you first glance in the mirror in the morning. Yet sometimes the swelling doesn't go away as your body wakes up from sleep. Most people will have a swollen eyelid at some point in their lives. It may cause a little anxiety if the cause is unknown or if people around us can see it. Most causes of swollen eyelids are not serious, but you may need to see a doctor to rule out any related health problems. This article looks at the most common reasons for swollen eyelids. It also offers a few quick tips that may help you care for a swollen eyelid, as well as more serious medical issues to watch for. Verywell / Brianna Gilmartin. Eye Allergies The most common cause of eyelid swelling is eye allergies.1 Eye allergies may cause real discomfort and disrupt daily activities with annoying symptoms that include eyelid irritation and swelling. Eye allergies happen when the immune system overreacts to a substance like dust or pollen. Cells in the eyes release histamines and other chemicals to try and protect the eyes. This causes blood vessels inside the eyes to swell, and the eyes become itchy, red, and watery. Prescription drugs are very effective at soothing eye allergy symptoms. Antihistamines often reduce eyelid swelling caused by allergies rather quickly. Eye Styes and Chalazion A stye is caused by inflammation and infection. It happens when bacteria get into the oil-producing glands in the eyelid. Styes can feel itchy and tender. They usually look like a reddish bump on the eyelid. When a stye first starts, the eye may feel sensitive to light and maybe a little bruised. A chalazion is what happens when one of these glands gets blocked. The gland turns into a hard lump, which may cause redness and swelling of the eyelid.2 If you have a stye, try to put a warm, wet compress on it for five to 10 minutes a few times a day. This often makes the eye feel better, and may also help to open any blocked pores. The stye can then drain out and start to heal. Pink Eye Pink eye or conjunctivitis is an inflammation of the conjunctiva. The conjunctiva is a clear membrane that lines the inside of the eyelid and covers the white part of the eye. Pink eye usually is caused by allergies, bacteria, or viruses.3 People with pink eye may wake up to find one or both eyes stuck together with mucus when they wake up in the morning. The eyelids may be swollen, and the eyes may be red, itchy, and irritated. How to Treat Pink Eye (Conjunctivitis) Cellulitis Cellulitis is a more serious cause of eyelid swelling. It is a bacterial infection of the lower layers of the skin. There are two main types that eye doctors focus on when someone comes in with eyelid swelling. They are called preseptal cellulitis and orbital cellulitis.4 Preseptal cellulitis is an infection of the eyelid and/or surrounding skin. People often have red eyes, along with pain due to swelling. In most cases, it will affect just one eye. Orbital cellulitis is linked with a sinus infection. The infection spreads into the area around the bones that make up the eye socket.4 People with orbital cellulitis may have a bulging eye, and pain when moving their eyes back and forth. How to Spot and Treat Cellulitis Graves' Disease People with Graves' disease or other thyroid problems often suffer from eyelid swelling. Graves' disease can cause the eyes to bulge. Although it can affect one eye more than the other, it usually involves both eyes. Sometimes Graves' disease can limit eye motion or cause double vision. Any type of hypothyroidism, or low levels of thyroid hormones, can cause both eyes to seem swollen or puffy.5 An Overview of Graves' Disease Herpes Infection It is not uncommon for herpes to become an eye disease. The herpes virus can infect the cornea, causing inflammation. This is the clear dome that covers the front part of your eye. Eye herpes, also called ocular herpes, can cause painful sores on the eyelid or the eye surface itself. The cornea is affected as well as the eyelid.6 Symptoms of eye herpes often seem the same as symptoms of pink eye. Herpes Zoster Ophthalmicus Summary It's normal for eyes to look a little swollen when you wake up in the morning, but severe eye swelling is not. The most common causes include allergies, pink eye, and styes, but skin infections, thyroid disease, and herpes are other possible causes. A Word From Verywell Fortunately, a case of swollen eyelids usually will pass without trouble and be forgotten. Most people will experience them at some point, and they are easy to treat in most cases. That, however, may lead to a false sense of security. When a swollen eyelid is "no big deal," it seems like there's no reason to have the eye looked at by a doctor. But in some cases, it may be a symptom of a larger problem. If you're not sure, or if your eye doesn't get better in a few days, be sure to call your doctor for advice. FREQUENTLY ASKED QUESTIONS Why are my eyelids puffy in the morning? How do you treat a swollen eyelid?
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眼睛充血、眼屎和眼痒，请问是什么原因引起的？患者男性24岁
就诊科室：眼科
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医生建议：患者可能患有结膜炎，建议使用普拉洛芬滴眼液缓解症状，注意休息和眼部卫生。
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珠海眼管家眼科诊所
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就诊科室：眼科
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珠海眼管家眼科诊所
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我有850度近视和大散光，想知道如何选择合适的眼镜框架？
就诊科室：眼科
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