Traditional Chinese medicine treatment of exophthalmos

Abstract: exophthalmos is one of the main symptoms of orbital diseases. The normal position of the eyeball in the orbit is maintained by the interaction of various tissues in the orbit. For example, the blood vessels and fat in the retrobulbar tissue and the normal tension of the oblique muscle tend to move the eyeball forward; The orbital diaphragm and its smooth muscle, the tension of the four rectus muscles and the medial and lateral canthus ligaments can prevent the protrusion of the eyeball. Exophthalmos or enophthalmos refers to the abnormal position of the eyeball in the orbit, which should be distinguished from those caused by too large or too small eyeballs. Exophthalmos can be measured with an exophthalmometer. The degree of exophthalmos in Chinese normal people is about 12 ~ 14 mm, and the difference between the two eyes is generally 0.5 ~ 2 mm. If the difference is too large, it is morbid The distance between the outer edges of bilateral bony orbit is called orbital distance, and the average distance in normal cases is 95 mm. The direction of exophthalmos can be different, which mainly depends on the location and nature of orbital lesions. Clinically, the location of orbital lesions and the way to guide surgery can be inferred according to the direction of exophthalmos. Exophthalmos can be divided into unilateral and bilateral. Bilateral protrusion is mostly caused by systemic diseases. Such as endocrine exophthalmos. Unilateral protrusion is often caused by orbital and intracranial diseases. However, systemic diseases such as leukemia and lymphoma can also be caused. Exophthalmos can be divided into true and false. Pseudoexophthalmos is usually caused by ocular diseases, such as corneal staphyloma, axial high myopia and congenital glaucoma. True exophthalmos can be divided into inflammatory, endocrine, vascular, neoplastic, traumatic and rare parasitic. I. endocrine exophthalmos endocrine exophthalmos is also known as Basedow disease or Graves disease or exophthalmos goiter. Exophthalmos is one of its main symptoms. The etiology of this disease is not fully understood. It is generally believed that it is closely related to pituitary thyroid dysfunction. Clinically, the disease can be divided into thyrotoxic exophthalmos caused by hyperthyroidism and thyrotropin produced by pituitary gland.

(1) Thyrotoxic exophthalmos: the onset of this disease is fast, and it is common in female patients. Bilateral or unilateral exophthalmos protrude to the front. The mechanism of exophthalmos is considered to be autoimmune disorder. The extraocular muscles swell due to the infiltration of lymphocytes and plasma cells, reducing the force of pulling the eyeball backward. On the other hand, due to the excitation of sympathetic nerve, Muller smooth muscle spasm makes the eyelid retract , the eyeball moves forward, the palpebral fissure increases obviously, and the eyeball looks straight forward in a staring state; Eyelid swelling and hypertrophy, difficulty in upper eyelid turnover: when the patient looks down, the upper eyelid does not droop with the eyeball, and the upper limbus of cornea and upper sclera are exposed; Blink movement decreased and the ability of convergence decreased; Hypotonia of extraocular muscles and different degrees of eye movement disorders and diplopia; The pupils on both sides can be unequal in size. The pupils are sensitive to adrenaline drops and are easy to disperse. The degree of exophthalmos is not as good as thyrotropin exophthalmos. Pressing the exophthalmos with fingers can make it return to its original position. Only a few more serious cases can cause exposure keratitis, retinopathy and optic neuropathy.

(2) Thyrotropin exophthalmos: this disease is also called malignant exophthalmos or pituitary exophthalmos. The ocular symptoms are more significant than the poisoning symptoms of the whole body, and most middle-aged male patients. Its pathogenesis and symptom characteristics can be divided into three categories:

1. Lack of thyroid endocrine hormone and increase of compensatory thyrotropin. Exophthalmos, eyelid and conjunctival edema, and the basic metabolic rate is lower than normal 。

2. Thyroid endocrine hormone increased and basic metabolism was hyperactive. Under normal circumstances, the balance between thyroxine and thyrotropin is achieved through feedback. After partial thyroidectomy, its function decreases, weakens the inhibitory effect of thyrotropin on the anterior pituitary, and is replaced by an increase in thyrotropin. Exophthalmos, eyelid swelling, conjunctival edema, extraocular muscle paralysis, basal metabolic rate changed greatly before and after operation, and often decreased significantly after operation.

3. Thyroid endocrine hormone and thyrotropin increased at the same time. There were symptoms of thyroid poisoning and severe exophthalmos, and the basic metabolic rate was higher than normal. Due to edema of retroocular tissue, hypertrophy and degeneration of extraocular muscles, infiltration of round cells and increase of intraorbital pressure, the disease pushes the eyeball forward and cannot return to its original position. Ocular symptoms are significantly worse than thyroxine exophthalmos, often accompanied by exposure keratitis, retinal and optic nerve edema, and symptoms such as tears, photophobia, burning sensation, eye swelling pain and diplopia, but the disease has a trend of self-healing.

II Pulsatile exophthalmos

(1) Etiology pulsatile exophthalmos is common in internal carotid artery and cavernous sinus vascular fistula. Because the internal carotid artery passes through the cavernous sinus, it is the common site of arteriovenous fistula. The causes of the disease can be divided into two categories: 1. Traumatic: it can be seen in skull base fracture or penetrating injury. 2. Idiopathic: it is rare and occurs in congenital or acquired internal carotid aneurysm or arteriosclerosis Patients, mostly unilateral.

(2) Clinical manifestations:

1. Exophthalmos on the affected side, pulsating with pulse and accompanied by murmur.

2. Exophthalmos can be reduced by pressing the eyeball or ipsilateral common carotid artery with fingers.

3. Eyelid and conjunctiva are swollen and congested with diplopia.

4. Paralytic keratitis can be caused when the first branch of the V cranial nerve is involved.

5. It is above the orbit due to varicose veins And a soft swelling can be touched on the inside.

6. Fundus examination often found optic papilledema, retinal vein tortuosity and retinal hemorrhage. The degree of vision loss varies.

7. The disease suddenly occurs, and the affected side has pain in the head and back of the eye. The patient often complains that he can hear continuous rumble. If the examiner puts the stethoscope on the eye and orbit, he can also hear the same sound.

III Intermittent exophthalmos

(1) the cause of intermittent exophthalmos is unilateral, and the incidence rate of left eye is higher than that of the right eye. Male patients are more common. Exophthalmos are mostly caused by congenital or acquired orbital veins, especially the supra orbital varices.

(2) Clinical manifestations}

1. Transient exophthalmos is an important feature of the disease. The degree of exophthalmos can increase or decrease with the change of head position, with varying duration, often or occasionally. When the patient lowers his head, exhales hard, compresses the jugular vein or twists to the side of the neck, it can arouse transient exophthalmos, and also show: ptosis, eyelid swelling and bulbar conjunctiva Hyperemia and edema, mydriasis, retinal varicose veins, blurred boundary of optic papilla, eye movement disorder and elevated intraocular pressure.

2. During the attack, there is tension in the eyes, occasional diplopia and temporary vision loss, and systemic symptoms such as dizziness, ice pain, nausea, vomiting and tinnitus, or ipsilateral temporal and facial vein dilation.

3. After the attack, the eyeball returns to its original position, and all the above symptoms subside, but it often shows eyeball invagination, which is caused by vasodilation and atrophy caused by long-term compression of orbital adipose tissue. [treatment]: purging fire, nourishing Yin, cooling blood and promoting blood circulation , purple pudding 15 Mint 9 Scutellaria baicalensis 10 Sichuan lian8 red peony 9 raw land 12 Scrophularia 10 Ophiopogon 9 bamboo Ru 8 Corydalis 9 coix seed 18 woody incense 8 Patrinia 15

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. Abstract: exophthalmos is one of the main symptoms of orbital diseases. The normal position of the eyeball in the orbit is composed of various tissues in the orbitMaintained by interaction between. For example, the blood vessels and fat in the retrobulbar tissue and the normal tension of the oblique muscle tend to move the eyeball forward; The orbital diaphragm and its smooth muscle, the tension of the four rectus muscles and the medial and lateral canthus ligaments can prevent the protrusion of the eyeball., Exophthalmos or enophthalmos refers to the abnormal position of the eyeball in the orbit, which should be distinguished from those caused by too large or too small eyeballs. Exophthalmos can be measured with an exophthalmometer. The degree of exophthalmos in Chinese normal people is about 12 ~ 14 mm, and the difference between the two eyes is generally 0.5 ~ 2 mm. If the difference is too large, it is morbid The distance between the outer edges of bilateral bony orbit is called orbital distance, and the average distance in normal cases is 95 mm. The direction of exophthalmos can be different, which mainly depends on the location and nature of orbital lesions. Clinically, the location of orbital lesions and the way to guide surgery can be inferred according to the direction of exophthalmos. Exophthalmos can be divided into unilateral and bilateral. Bilateral protrusion is mostly caused by systemic diseases. Such as endocrine exophthalmos. Unilateral protrusion is often caused by orbital and intracranial diseases. However, systemic diseases such as leukemia and lymphoma can also be caused. Exophthalmos can be divided into true and false. Pseudoexophthalmos is usually caused by ocular diseases, such as corneal staphyloma, axial high myopia and congenital glaucoma. True exophthalmos can be divided into inflammatory, endocrine, vascular, neoplastic, traumatic and rare parasitic. I. endocrine exophthalmos endocrine exophthalmos is also known as Basedow disease or Graves disease or exophthalmos goiter. Exophthalmos is one of its main symptoms. The etiology of this disease is not fully understood. It is generally believed that it is closely related to pituitary thyroid dysfunction. Clinically, the disease can be divided into thyrotoxic exophthalmos caused by hyperthyroidism and thyrotropin produced by pituitary gland.      (1) Thyrotoxic exophthalmos: the onset of this disease is fast, and it is common in female patients. Bilateral or unilateral exophthalmos protrude to the front. The mechanism of exophthalmos is considered to be autoimmune disorder. The extraocular muscles swell due to the infiltration of lymphocytes and plasma cells, reducing the force of pulling the eyeball backward. On the other hand, due to the excitation of sympathetic nerve, Muller smooth muscle spasm makes the eyelid retract , the eyeball moves forward, the palpebral fissure increases obviously, and the eyeball looks straight forward in a staring state; Eyelid swelling and hypertrophy, difficulty in upper eyelid turnover: when the patient looks down, the upper eyelid does not droop with the eyeball, and the upper limbus of cornea and upper sclera are exposed; Blink movement decreased and the ability of convergence decreased; Hypotonia of extraocular muscles and different degrees of eye movement disorders and diplopia; The pupils on both sides can be unequal in size. The pupils are sensitive to adrenaline drops and are easy to disperse. The degree of exophthalmos is not as good as thyrotropin exophthalmos. Pressing the exophthalmos with fingers can make it return to its original position. Only a few more serious cases can cause exposure keratitis, retinopathy and optic neuropathy.      (2) Thyrotropin exophthalmos: this disease is also called malignant exophthalmos or pituitary exophthalmos. The ocular symptoms are more significant than the poisoning symptoms of the whole body, and most middle-aged male patients. Its pathogenesis and symptom characteristics can be divided into three categories: 1. Lack of thyroid endocrine hormone and increase of compensatory thyrotropin. Exophthalmos, eyelid and conjunctival edema, and the basic metabolic rate is lower than normal 。     2. Thyroid endocrine hormone increased and basic metabolism was hyperactive. Under normal circumstances, the balance between thyroxine and thyrotropin is achieved through feedback. After partial thyroidectomy, its function decreases, weakens the inhibitory effect of thyrotropin on the anterior pituitary, and is replaced by an increase in thyrotropin. Exophthalmos, eyelid swelling, conjunctival edema, extraocular muscle paralysis, basal metabolic rate changed greatly before and after operation, and often decreased significantly after operation.     3. Thyroid endocrine hormone and thyrotropin increased at the same time. There were symptoms of thyroid poisoning and severe exophthalmos, and the basic metabolic rate was higher than normal. Due to edema of retroocular tissue, hypertrophy and degeneration of extraocular muscles, infiltration of round cells and increase of intraorbital pressure, the disease pushes the eyeball forward and cannot return to its original position. Ocular symptoms are significantly worse than thyroxine exophthalmos, often accompanied by exposure keratitis, retinal and optic nerve edema, and symptoms such as tears, photophobia, burning sensation, eye swelling pain and diplopia, but the disease has a trend of self-healing. II Pulsatile exophthalmos (1) Etiology pulsatile exophthalmos is common in internal carotid artery and cavernous sinus vascular fistula. Because the internal carotid artery passes through the cavernous sinus, it is the common site of arteriovenous fistula. The causes of the disease can be divided into two categories: 1. Traumatic: it can be seen in skull base fracture or penetrating injury. 2. Idiopathic: it is rare and occurs in congenital or acquired internal carotid aneurysm or arteriosclerosis Patients, mostly unilateral.      (2) Clinical manifestations: 1. Exophthalmos on the affected side, pulsating with pulse and accompanied by murmur. 2. Exophthalmos can be reduced by pressing the eyeball or ipsilateral common carotid artery with fingers. 3. Eyelid and conjunctiva are swollen and congested with diplopia. 4. Paralytic keratitis can be caused when the first branch of the V cranial nerve is involved. 5. It is above the orbit due to varicose veins And a soft swelling can be touched on the inside. 6. Fundus examination often found optic papilledema, retinal vein tortuosity and retinal hemorrhage. The degree of vision loss varies. 7. The disease suddenly occurs, and the affected side has pain in the head and back of the eye. The patient often complains that he can hear continuous rumble. If the examiner puts the stethoscope on the eye and orbit, he can also hear the same sound. III Intermittent exophthalmos (1) the cause of intermittent exophthalmos is unilateral, and the incidence rate of left eye is higher than that of the right eye. Male patients are more common. Exophthalmos are mostly caused by congenital or acquired orbital veins, especially the supra orbital varices. (2) Clinical manifestations} 1. Transient exophthalmos is an important feature of the disease. The degree of exophthalmos can increase or decrease with the change of head position, with varying duration, often or occasionally. When the patient lowers his head, exhales hard, compresses the jugular vein or twists to the side of the neck, it can arouse transient exophthalmos, and also show: ptosis, eyelid swelling and bulbar conjunctiva Hyperemia and edema, mydriasis, retinal varicose veins, blurred boundary of optic papilla, eye movement disorder and elevated intraocular pressure. 2. There is tension in the eyes during the attack, occasionallyDiplopia and temporary vision loss, with general symptoms such as dizziness, ice pain, nausea, vomiting and tinnitus, or ipsilateral temporal and facial vein dilatation. 3. After the attack, the eyeball returns to its original position, and all the above symptoms subside, but it often shows eyeball invagination, which is caused by vasodilation and atrophy caused by long-term compression of orbital adipose tissue. [treatment]: purging fire, nourishing Yin, cooling blood, promoting blood circulation, purpurea pudding, 15 mint, 9 Scutellaria baicalensis, 10 Chuanlian, 8 red peony, 9 raw land, 12 Scrophularia, 10 Ophiopogon japonicus, 9 bamboo Ru, 8 Corydalis, 9 coix seed, 18 wood fragrance, 8 Patrinia villosa, 15

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