基于络脉学说探讨眼手术相关性干眼

Discussion on dry eye related to ophthalmic surgery based on collateral theory

眼手术相关性干眼是指眼科手术后以泪膜稳态失衡为特征的干眼,包括术眼发生干眼或使原有干眼症状和体征加重。其发生率随着眼睑整形等眼部手术普及还将进一步增加,已成为临床眼科医生的重要挑战。络脉处于半表半里之间,是气血运行的支路,它外接肌肉、皮肤,内接脏腑,是病证传播的中心环节,外伤(如眼手术)损及人体肌肉、皮肤,络脉必受波及。目络是络脉在眼部的分支,五脏六腑化生的气、血、津液通过络脉渗入眼中,维持正常的视觉功能,又在眼部变成神水和神膏,滋养润目。因此,眼手术相关性干眼的核心病机是“目络损伤”。病机为眼手术损伤目络致气血精津亏虚出现目络失养,表现为眼干涩、异物感、疲劳感等症状。依据目络损伤的眼手术相关性干眼的病机特点,提出“复络充络,滋水涵木”为治法,对丰富其内涵和提高临床疗效,改善患者术后生活质量以及减缓焦虑抑郁的情绪具有重要意义。

Ophthalmic surgery-related dry eye refers to dry eye characterized by tear film homeostasis imbalance after ophthalmic surgery,including the occurrence of dry eye in the operated eye or the exacerbation of the existing dry eye symptoms and signs.Its incidence will further increase with the popularity of ophthalmic surgery such as blepharoplasty,which has become an important challenge for clinical ophthalmologists.The colleterals are located between half the surface and half the interior,and are the branches for the circulation of Qi and blood.They connect with the muscles and skin externally,and the viscera internally,which are the key link in the progression of diseases.Trauma(such as ophthalmoc surgery)damages the muscles and skin of the human body,thus the collaterals must be affected.The ocular collateral is the part of the collaterals in the eye,through which Qi,blood,essence and fluid generated by the internal organs penetrate into the eye to maintain normal visual function,and turn themselves into divine water and ointment in the eye,so as to nourish and moisten the eye.Therefore,the core pathogenesis of dry eye related to ophthalmoc surgery is"damage to the ocular collateral".The pathogenesis is that ophthalmic surgery may cause damage to the ocular collateral,resulting in deficiency of Qi,blood,essence and fluid,further resulting in loss of nourishment of the ocular collateral,manifested by symptoms such as dry eyes,foreign body sensation,and fatigue.According to the pathogenesis of dry eye related to ophthalmic surgery due to ocular collateral damage,the treatment of"restoring and filling collaterals and nourishing liver and kidney"is proposed,which is of great significance in enriching its connotation,improving clinical efficacy,and the quality of life of patients after surgery,and alleviating anxiety and depression.