keratoconjunctivitis sicca
Introduction
Introduction to dry keratoconjunctivitis In addition to insufficient secretion of primary tears, dry keratitis can also be seen in the following situations: 1. Chronic diseases such as endocrine diseases, anemia, vitamin deficiency. 2, acute diseases such as acute exfoliative dermatitis, Stevens-Jonhnson's syndrome, ocular pemphigus. 3. Trauma and surgery of the eyelids and conjunctiva may damage most of the basal secretory and reverse secretory catheters. Insufficient secretion of primary tears is commonly referred to as the syndrome in the clinic. There are two types of generalized and narrow sense. The so-called generalized syndrome (SJS) refers to diseases such as rheumatoid arthritis (such as rheumatoid arthritis) combined with other systemic immunity in addition to dry mouth. Dry keratitis (KCS for short). basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: dry eye
Cause
Cause of dry keratoconjunctivitis
Exogenous (30%):
Because the conjunctiva is exposed, it is susceptible to inflammation caused by various external microorganisms, wind dust, physical and chemical poisons, and the like. Exogenous is a biological concept, but it is often used in medicine. Corresponding to endogenous, refers to all non-ontological factors, that is, factors that come from the outside and can act on the ontology. For example, weather, soil, and water quality are exogenous factors that cause seed variability; such as bruising is an exogenous factor that worsens the condition of hemophilia patients.
Endogenous (40%):
Pathogenic bacteria infect the conjunctiva through blood or lymph, or allergic reactions to other parts of the body. Inflammation can also spread directly from neighboring tissues. Conjunctivitis is classified into bacterial, viral, chlamydial, fungal, allergic, etc. according to its etiology. The common clinical manifestations are sudden conjunctival hyperemia, burning sensation, itching, and more secretions. General vision is not affected. Examination reveals redness and swelling of the eyelids, conjunctival hyperemia, nipple follicular hyperplasia, conjunctival hyperemia of the bulbar conjunctiva, and sometimes edema and conjunctiva. Hemorrhage, secretions in the conjunctival sac, to determine the source of the disease needs to be a smear of secretions for bacterial and cytological examination.
Other factors (30%):
Conjunctival hyperemia, exudation, papillary hypertrophy, and follicular formation due to infection, allergies, and trauma.
Prevention
Dry keratoconjunctivitis prevention
1, develop a habit of blinking, dry eye disease is a stress-type illness, the problem is that the eyes are staring in one direction for a long time, so the best way to avoid eye fatigue is to rest properly, avoid continuous operation.
(1) It is very important to have a pair of suitable glasses. For those over 40 years old, it is best to use a bifocal lens, or wear glasses with a lower degree when typing.
(2) The posture and distance of the work are also very important. Try to keep the distance at 60cm and adjust the most appropriate posture so that the line of sight can be kept down about 30°. This angle can relax the neck muscles, and Minimize the area of the surface of the eye that is exposed to the air.
2, long-term computer operators, should eat more fresh vegetables and fruits, while increasing the intake of vitamin A, B 1, C, E, in order to prevent corneal dryness, dry eyes, decreased vision, and even night blindness, etc., computer Operators should eat more foods rich in vitamin A. Vitamin C can effectively inhibit cell oxidation. The main functions of vitamin E are: lowering cholesterol, removing body waste, preventing cataracts, and rich in vitamin E and vitamin B1 in walnuts and peanuts. It can be nutritious, green leafy vegetables contain a lot of vitamin B1, and green tea can be properly consumed every day. Because the lipopolysaccharide in tea can improve the body's hematopoietic function, tea also has the function of preventing radiation damage.
3. In order to avoid the reflective or unclear screen, the computer should not be placed on the opposite side or the back of the window. The ambient lighting should be soft. If there is a window behind the operator, the curtain should be pulled up to avoid the bright light directly shining on the screen and reflecting the bright image. Eye fatigue, usually, the average person blinks less than 5 times a minute to dry the eyes. When a person works in front of the computer, the number of blinks is only one-third of the usual, thus reducing the lubricant and enzyme in the eye. Secretion, should be more blinking, at least once every hour to rest your eyes.
4, in order to reduce the dryness of the eye, you can use corneal nutrient solution in the eye, such as: Beifu Shu eye drops, Xiao Laiwei eye drops and some artificial tears, and other eye exercises can also relax eyes, reduce vision The role of fatigue.
Complication
Dry keratoconjunctivitis complications Complications
This disease is a disease involving multiple systems.
(1) Oral: mild lesions are often neglected by patients. When heavier, saliva is less. Food stimulation and chewing can not increase saliva secretion, red tongue, chapped or ulcerated, inconvenient movement, no saliva accumulation at the bottom of tongue, chewing and swallowing Difficulties, dental caries and gingivitis are common, the teeth are powdery or small pieces broken, the lips and mouth are dry and chapped, and there is bad breath. About half of the patients have swollen sputum, severely form a squirrel-like face, and the inferior gland can swollen. Big.
(B) Eye: dry keratoconjunctivitis, dry eye, itching, may have foreign body or burning sensation, blurred vision, like a curtain, photophobia, corneal opacity, erosion or ulceration, small blood vessel hyperplasia Perforated in severe cases, can be combined with iris choroiditis; conjunctival inflammation, bulbar conjunctival vasodilation; less tears, a few lacrimal gland enlargement, easy to be complicated by bacteria, fungal and viral infections, occasionally with exophthalmos as the first symptom.
(3) Respiratory tract: nasal mucosa gland invasion causes nasal dryness, nasal discharge, often snoring and nasal sputum inflammation, Ou's tube blockage can occur serous otitis media, conductive deafness; throat dry, hoarse, Sputum is sticky, complicated by bronchitis, bronchitis, pleurisy, interstitial pneumonia and atelectasis. Patients with no clinically significant lung lesions may have restrictive ventilation disorder and decreased gas diffuse function.
(4) Digestive tract: pharyngeal and esophageal dryness can make dysphagia difficult. Occasionally, posterior esophageal stricture of annular cartilage, gastric mucosa due to infiltration of adenoid lymphocytes, gastric mucosal wrinkle arm thickened gastric acid secretion can form cobblestone-like pseudocancer; with atrophy The incidence of gastritis can be as high as 70.5%, the intestinal absorption function can be impaired, and the response to gastrin and trypsin is impaired, suggesting that subclinical pancreatitis is more common, and hepatosplenomegaly accounts for 1/5 cases.
(5) Urinary tract: renal lesions account for 1/3, usually interstitial nephritis, renal tubular function defects, renal tubular acidosis, renal diabetes, amino aciduria, and uric acid reabsorption, etc., also have concurrency Glomerulonephritis, the deposition of IgM and complement in glomeruli.
(6) The nervous system: all levels of nerve tissue can be damaged, the central nervous system is involved in 25%, and the peripheral nerve is 10% to 43%. The former can be affected from the meninges to the brain parenchyma and various parts of the spinal cord. Wide range, including nerve roots, axonal, myelin, sensory and motor branches can be involved; clinical manifestations include mental disorders, convulsions, hemianopia, aphasia, hemiplegia, paraplegia, ataxia, etc. The mechanism is the inflammation of nerve tissue Vascular lesions cause changes in ischemia or blood loss or due to mononuclear cell infiltration.
(7) Muscle: involving about 2%, manifested as myalgia, muscle weakness, caused by interstitial myositis, interstitial small blood vessels surrounded by lymphocytes and monocytes infiltration, can also appear green hair in renal tubular acid Poisoning, low blood stamina to the periodic paralysis caused by the upstream.
(8) Joints: About 10% of cases involve joints, which are swollen and painful, often non-invasive joints.
(9) Skin and mucous membranes: dry like ichthyosis, nodular erythema, purpura, Raynaud's phenomenon and skin ulcers; vaginal mucosa may also dry and shrink.
(10) Lymph nodes: local or systemic lymph nodes can be swollen.
The most common secondary SS associated with connective tissue disease is rheumatoid arthritis (35-55%), others with SLE, PSS, MCTD, nodular polyarteritis, Hashimoto's thyroiditis, primary bile Sexual cirrhosis, chronic active hepatitis, etc.
In pseudo-lymphoma, lymphocyte infiltration in SS is usually limited to salivary glands and lacrimal glands. It is a benign process of progressive dry eye. There is also obvious extra-glandular lymphoid cell infiltration, clinically showing lymphadenopathy, lung, kidney and liver. , spleen, muscles, etc., blood leukopenia, gamma globulin increased, macroglobulin increased, histopathology showed that the infiltrating cells of the diseased tissue were pleomorphic, which were large and small lymphocytes, plasma cells and cytoplasmic cells, which lasted for several years. Benign disease, called pseudolymphoma, some of these cases can be converted into malignant lymphoma, invasive cells are highly undifferentiated, tissue structure is destroyed, infiltration exceeds the envelope, the prevalence of SS patients with malignant lymphoma Significantly increased compared to the control population.
Symptom
Dry keratoconjunctivitis symptoms Common symptoms Eye swelling, dry eye dry corneal opacity tears Dry eyes Corneal dry spots Continuous blinking red blood cells
The foreign body sensation, burning sensation, heavy eyelids, and increased secretions of the eyes may cause photophobia, tearing, and varying degrees of visual loss when the lesions involve the cornea.
Examine
Examination of dry keratoconjunctivitis
1. If necessary, conjunctival epithelial scraping and secretion smear or culture to check bacteria, fungi, virus isolation, etc., and do drug sensitivity test.
2. For those with irritation, check the cornea with fluorescein staining.
3. Epidemiological investigations should be conducted when necessary.
4. Chronic conjunctivitis should be asked whether there is ametropia, excessive alcohol and tobacco, lack of sleep or long-term exposure to sand, smoke and other medical history. Check for chronic inflammation in nearby tissues, such as chronic dacryocystitis.
Diagnosis
Diagnosis and differentiation of keratoconjunctivitis
There are two types of dry keratoconjunctivitis, conjunctival hyperemia, corneal epithelium (shallow punctate keratitis) and / or conjunctival epithelium scattered, slender point-like shedding, lesions mainly between the upper and lower eyelids (in the eyelid or exposed Area), which can be stained with fluorescein, and the number of blinks in the patient increases. However, a small number of patients have reduced the number of blinks due to dry eyes.
