Swollen, dry eyes

Introduction High intraocular pressure will show eye swelling, while dry eye is caused by 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). "Dry eye syndrome" or dry conjunctiva, keratitis (dry angle, conjunctivitis) is a disease in which the conjunctiva and corneal epithelium cannot maintain normal function due to insufficient quality of the pre-corneal tear film or insufficient amount of tear fluid.

Cause

Causes of eye swelling and dryness:

Dry eye syndrome is a chronic disease that has several causes:

1. Due to advanced age, lack of sleep, mental stress and other physiological reasons, the quality of tears is reduced.

2. Taking some antihypertensive drugs and some neuroleptics have an effect on the tear film. For example, taking chlorpheniramine has a harmful effect on the tear film. Taking Xindean and some contraceptives can reduce the production of tears.

3. The environment, such as the room in which it is dry, causes an increase in the evaporation of tears.

4. Long-term computer operation, car driving, reading and other fine work, the number of blinks is reduced.

5. Due to contact lenses, allergic conjunctivitis, air pollution, ultraviolet rays and other reasons, the tears are reduced and the quality is degraded.

6. Long-term use of antibiotics, flora imbalance.

an examination

Related inspection

Ophthalmic examination slit lamp synovial fluid visual inspection

Examination and diagnosis of eye swelling and dryness:

Insufficient secretion of tears and dry mouth is the main basis for the diagnosis of this disease. Comprehensive clinical and laboratory findings, the following points are helpful for diagnosis:

1. The main eyes have dry eyes, burning sensation, increased secretions, shame and no tears, and tears do not increase when feelings are stimulated. The patient is in a state of pain that is crying and tearing.

2, Schirmer's I test: filter paper dipping wet less than 10 mm, tear river width less than 0.1 mm, suggesting insufficient tear secretion.

3, tear film rupture time (abbreviated as BUT): less than 10 seconds, indicating tear film instability, is a prominent sign of KCS caused by mucin deficiency in tears, suggesting that the goblet cells of the conjunctiva are seriously damaged or lost.

4, conjunctival sac (especially the lower jaw): rich in sticky strips of secretions, the surface of the cornea has a filament or point infiltration.

5, 1% diiodone red test: The coloring point is triangular, the base is to the limbus, the top points to the inner and outer ridges, mainly concentrated in the conjunctival epithelium in the cleft palate, and sometimes the epithelium in the lower third of the cornea is also colored. Methylcellulose affects the positive rate of this test.

6, conjunctival biopsy (ankle): conjunctival epithelial hyperplasia, keratinized surface, lymphocytes infiltration between basal cells, goblet cells reduced or disappeared. Superficial connective tissue hyperplasia and angiogenesis, with lymphocytic infiltration.

7. Parotid tube angiography: Inject the contrast medium into the rib gland or submandibular gland tube. In the filling period, take out the catheter and give the salivary secretion agent (such as lemon juice) to stimulate the secretion of saliva. After 5 minutes, take the second piece. Normal people are emptied of the contrast agent in saliva by 2 minutes, while patients with SJS and KCS can show a point-like dilation of the surrounding duct of the parotid duct. In severe cases, it is mulberry-like or forms a cavity.

8. Parotid isotope scan: After a 99m sputum was taken in the normal gland, a sharp scan was generated. After the injection of 99-labeled sodium perrhenate, 3, 8 and 15 minutes of scintigraphy was performed to record the 99m of the parotid gland. Involvement. The results of the scan are similar to those of the parotid gland.

9, lip gland biopsy: visible diffuse lymphocytes infiltration around the small leaf duct without ductal epithelial hyperplasia. If the lip gland biopsy is suspicious, a lacrimal gland or salivary gland biopsy is further confirmed.

10, the pathological changes of the lacrimal gland are classified into 4 stages. Stage 0 glandular normal; stage 1 with mild chronic inflammatory cell infiltration, irregular catheter arrangement, intralobular fibrosis; stage 2 normal lobular structure destruction, extensive lymphocytic infiltration and acinar atrophy; stage 3 with few acinar cells Residual. Stage 4 glandular fibrosis.

11, hematological examination often shows mild anemia, eosinophilia, erythrocyte sedimentation rate.

12, immunological examination: serum albumin decreased, globulin increased, IgA, IgM, IgG increased, lymphocyte transformation rate showed low cellular immunity.

Differential diagnosis

Differential diagnosis of eye swelling and dryness:

1, scleral edema: scleral edema is common in scleritis. The sclera is a tissue composed of a small amount of cells and blood vessels, mostly composed of collagen. The surface is covered by the bulbar conjunctiva and the fascia, and it is not in direct contact with the external environment, so it is rarely sick. According to the statistics of most scholars, the incidence rate is only about 0.5% of the total number of patients with eye diseases. Due to the collagen nature of the basic components of the sclera, it is determined that the pathological process is slow and the resulting collagen disorder is difficult to repair. The eyeball is the "window" of collagen, so scleritis is often an ocular manifestation of systemic connective tissue disease.

2, cystoid macular edema: cystoid macular edema is not an independent disease, but refers to a fluid volume between the macular area outside the network layer Henle fiber lesions. It is one of the important reasons for the loss of vision. It is currently believed that damage to the blood retinal barrier (internal barrier) and/or pigment epithelial barrier (external barrier) can cause cystoid macular edema. Common in diabetic retinopathy, retinal vein occlusion, Coats disease, cataract and retinal detachment surgery, retinal vasculitis, choroiditis; subretinal neovascular membrane, choroidal tumor.

3, lacrimal gland cysts: lacrimal gland cysts are rare, generally seen in inflammation or trauma, the formation of chronic inflammation affects the muscles of the lacrimal duct, so that the contraction of the lacrimal duct is reduced, the inflammatory infiltration around the duct makes the wall weak, Inflammatory stimuli promote the secretion of tears, causing the gland to passively expand and form cysts.

4, eye pain: patients with refractive errors have visual fatigue, eye pain, reading can not last long and other symptoms. Refractive abnormalities are also called refractive errors. Myopia, hyperopia and old light are all refractive errors.

5, elevated intraocular pressure: the eyeball is divided into two parts: the eye wall and the eye content. Intraocular pressure is the pressure that interacts between the contents of the eyeball and the wall of the eyeball. Normal people's intraocular pressure is maintained within a certain range (10-21 ml of mercury) to maintain the normal shape and vision of the eye. The contents of the eye include a lens, a vitreous body, aqueous humor, and the like. One of the functions of aqueous humor is to maintain intraocular pressure. Normally, the aqueous humor is in a dynamic cycle. If any part of the aqueous circulation channel is obstructed, or if the aqueous humor is excessive, it will cause an increase in intraocular pressure.

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