Tim mạch - Nội tiết - Máu - Những bệnh lý liên quan đến mắt không thể chủ quan

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30-07-2018 10:17 Share

Tim mạch - Nội tiết - Máu - Những bệnh lý liên quan đến mắt không thể chủ quan

Việc khám mắt không những cho phép phát hiện những tổn thương tại mắt do bệnh toàn thân mà còn giúp xác định chẩn đoán bệnh, tiên lượng bệnh hoặc đánh giá kết quả điều trị bệnh toàn thân.

Một số căn bệnh thường gặp ảnh hưởng tới mắt như: bệnh nhiễm trùng, bệnh virus, bệnh tim mạch, bệnh máu, bệnh nội tiết, bệnh behcet.

★     Bệnh tim mạch:

Tổn thương mắt có thể gặp trong nhiều bệnh như:  tăng huyết áp, bệnh xơ vữa động mạch, bệnh van tim, viêm màng trong tim. Gây tổn thương ở võng mạc, hắc mạc và thị thần kinh.

Võng mạc gồm các tế bào thị giác có chức năng chuyển năng lượng ánh sáng thành thị lực và gửi thông tin ngược về não qua những dây thần kinh thị giác. Nó được nuôi dưỡng bằng các mạch máu, chính vì thế những tổn thương ở mạch máu bằng cách trực tiếp hoặc gián tiếp đều ảnh hưởng đến thị lực của chúng ta.

Tăng huyết áp kéo dài hoặc đột ngột sẽ gây xơ cứng thành mạch và co mạch khiến các thành phần của máu thoát ra khỏi mạch máu. Xuất huyết, dịch thoát ra trên võng mạc gây phù võng mạc, lipid thoát ra trên võng mạc tạo thành xuất tiết. Đồng thời, mạch máu co lại gây thiếu máu ở võng mạc, thần kinh thị giác. Tất cả những tổn thương này dẫn đến mờ mắt. Những dấu hiệu trên đây chỉ được phát hiện bằng cách soi đáy mắt.

Tăng huyết áp và tổn thương ở mắt thường chia thành 4 giai đoạn.

Giai đoạn I: Bệnh nhân bị tăng huyết áp kéo dài, chưa có triệu chứng gì, tim và thận chưa bị ảnh hưởng. Khám đáy mắt chỉ thấy có động mạch co nhỏ.

Giai đoạn II: Huyết áp cao hơn, chức năng tim thận vẫn còn tốt. Mắt có tiểu động mạch thu nhỏ, lệch hướng tĩnh mạch ở đoạn bắt chéo

Giai đoạn III: Huyết áp khá cao và kéo dài, tim và thận đã bị suy giảm chức năng.  Soi đáy mắt có:

-   Tiểu động mạch thu nhỏ như sợi dây đồng.

-   Dấu hiệu Salus Gunn: TM thu nhỏ nhọn đầu, lệch vuông góc với đoạn bắt chéo động mạch.

-   Kèm theo xuất huyết hình ngọn nến, xuất tiết mềm dạng bông, xuất tiết cứng.

Giai đoạn IV: Được xem là tăng huyết áp ác tính, huyết áp rất cao đi kèm với tổn thương nặng ở não, tim, thận và võng mạc. Khi soi đáy mắt, dấu hiệu của giai đoạn III, kèm theo động mạch thu nhỏ như sợi dây bạc và phù gai thị.

Ngoài ra, bệnh tăng huyết áp có thể dẫn đến các biến chứng: bong võng mạc thanh dịch, phình mạch, tắc tĩnh mạch hoặc động mạch trung tâm võng mạc ( đó là những bệnh nặng, cần cấp cứu trong chuyên khoa mắt)

Bên cạnh đó còn có một số bệnh tim mạch khác như bệnh xơ vữa động mạch, bệnh van tim, viêm màng trong tim có thể tạo thành cục nghẽn mạch hoặc làm hẹp đường kính mạch máu, dẫn đến những biến chứng ở mắt như: mù thoáng qua, tắc động mạch trung tâm võng mạc hoặc tĩnh mạch trung tâm võng mạc.

Lời khuyên:

Theo JNC 7 năm 2017 thì tăng huyết áp được chẩn đoán khi HA tâm thu >=140mmHg hoặc HA tâm trương >=90mmHg. Vậy nếu bạn đã mắc tăng huyết áp thì phải “kiểm soát huyết áp” bằng chế độ sinh hoạt và thuốc điều trị khi có chỉ định của bác sĩ.

Nếu tăng huyết áp từ lâu hoặc các bệnh van tim, xơ vữa mạch máu thì cần có những đợt kiểm tra định kỳ thường xuyên, khoảng 6 tháng một lần để xem có biến chứng hay chưa. Dĩ nhiên soi đáy mắt thì không thể thiếu, vì nó là cơ quan tổn thương đầu tiên.

★     Bệnh nội tiết:

Các tuyến nội như tuyến tụy, tuyến giáp, tuyến cận giáp, tuyến yên liên quan trực tiếp đến mắt. Nổi bật nhất là biến chứng mắt của bệnh đái tháo đường

Tăng đường máu trực tiếp gây tổn thương và phá hủy các mạch máu ở võng mạc, vì vậy bệnh võng mạc được coi là biến chứng đặc hiệu của ĐTĐ. Ngoài ra, các bệnh nhân ĐTĐ cũng có nguy cơ cao bị các bệnh mắt khác như đục thủy tinh thể, glaucoma, tắc động mạch võng mạc... Biến chứng mắt tuy không gây chết người nhưng lại cực kỳ nguy hiểm vì thường gây tàn phế và làm mất khả năng lao động.

Bệnh võng mạc do đái tháo đường:  Bệnh thường không có triệu chứng và người bệnh chỉ phát hiện khi thị giác đã bị ảnh hưởng. Tùy thuộc vào mức độ tổn thương các mạch máu ở võng mạc mà người ta chia bệnh võng mạc ở BN ĐTĐ làm 2 giai đoạn:

-Bệnh võng mạc không tăng sinh (chưa có các mạch máu mới): Các mao mạch phồng lên làm tắc nghẽn các mạch máu nuôi võng mạc. Chất dịch lỏng thấm qua thành mạch làm sưng điểm vàng (trung tâm võng mạc) gây phù hoàng điểm. Giai đoạn này, mắt bị mờ và có khả năng mất thị lực. Người bệnh đái tháo đường phát hiện bệnh và điều trị sớm có cơ hội cao sẽ phục hồi thị lực.

-Bệnh võng mạc tăng sinh (đã có các mao mạch mới): Các mạch máu nuôi võng mạc bị tắc nghẽn nên kích thích gia tăng sự hình thành mạch máu mới. Những mạch máu này rất dễ vỡ, gây ra xuất huyết và bong võng mạc dẫn đến mất thị lực. Bệnh võng mạc tăng sinh ở người đái tháo đường có thể điều trị hiệu quả bằng phẫu thuật chiếu laser khi chưa xảy ra xuất huyết. Với trường hợp bong võng mạc phức tạp, có thể phẫu thuật loại bỏ thủy dịch.

Đục thủy tinh thể mắt sẽ mờ như có màn sương mù phía trước khiến bạn nhìn không rõ. Với người đái tháo đường, khả năng đục thủy tinh thể khoảng 60%. Trước kia, bệnh đục thủy tinh thể thường gặp ở người cao tuổi, tuy nhiên ngày nay có xu hướng xuất hiện ở cả người trẻ tuổi.

Nếu đục thủy tinh thể ở mức độ nhẹ, bạn nên thường xuyên đeo kính râm khi ra ngoài trời. Bên cạnh đó, loại mắt kính thuốc bạn đeo nên có lớp chống chói để bảo vệ mắt. Nếu mắt nhìn ngày càng kém, bạn có thể hỏi ý kiến bác sĩ và điều trị bằng cách phẫu thuật thay thủy tinh thể.

Tăng nhãn áp: Người bệnh đái tháo đường có nguy cơ mắc cao hơn người bình thường khoảng 40%. Người bệnh càng lâu năm thì khả năng biến chứng xảy ra càng cao. Nguyên nhân là do thủy dịch trong mắt dẫn lưu kém làm tăng áp lực lên mắt. Áp lực này gây tắc nghẽn các mạch máu nuôi dưỡng võng mạc và các dây thần kinh thị giác khiến tầm nhìn của người bệnh đái tháo đường giảm dần.

Các triệu chứng của tăng nhãn áp bao gồm: nhức đầu, đau mắt, chảy nước mắt, mờ mắt, nhìn thấy quầng sáng trước mắt… Bệnh tăng nhãn áp ở người bệnh đái tháo đường có thể điều trị bằng cách uống thuốc giúp giảm áp lực trong mắt hoặc được phẫu thuật, tùy theo chỉ định của bác sĩ.

Lời khuyên:

Biến chứng thường không biểu hiện triệu chứng nên người bệnh đái tháo đường cần khám mắt toàn diện ít nhất một lần mỗi năm.

Phụ nữ bị đái tháo đường khi mang thai nên khám mắt sớm và kiểm tra mắt trong suốt thai kỳ.

Nếu tầm nhìn của bạn xuất hiện các đốm đen, lóa sáng hoặc bị mờ thì ngay lập tức đi khám chuyên khoa mắt

Phải “kiểm soát glucose huyết” ở mức an toàn, uống thuốc theo hướng dẫn của bác sĩ.

Thường xuyên tập thể dục thể thao, duy trì chế độ ăn uống lành mạnh cũng giúp ngăn ngừa tình trạng giảm thị lực.

★     Bệnh máu:

Bệnh máu cũng là một căn bệnh không thể không nhắc đến khi gây ra tổn thương cho mắt bạn. Phần lớn các bệnh máu đều gây ra tổn thương tại mắt, chủ yếu là tổn thương võng mạc.

-  Bệnh thiếu máu sẽ làm cho kết mạc nhợt nhạt, võng mạc và hệ thống máu nhạt màu, thiếu máu nặng có thể dẫn đến teo thị thần kinh.

- Bệnh đa hồng cầu làm cho võng mạc sẫm màu hơn, có thể tắc tĩnh mạch trung tâm võng mạc.

-  Bệnh hồng cầu hình liềm có nguy cơ gây bong võng mạc.

Bản thân mỗi người không nên chủ quan với những bệnh lý tưởng chừng như không nguy hiểm và nếu hiếm khi đi khám mắt, bạn có thể đang bỏ lỡ cơ hội quan trọng để bảo toàn thị giác và ngăn chặn những bệnh nghiêm trọng. Hãy giữ gìn và bảo vệ để có một đôi mắt sáng.

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I'm interested in ou acheter du levitra en france Israel has been carefully watching the Syrian conflict since it erupted in March 2011. While it has been careful not to take sides in the civil war, Israel has repeatedly said it would take action to prevent what it calls ‘‘game-changing’’ weapons, including chemical weapons and advanced guided missiles, from reaching Hezbollah or other militant groups. Syrian President Bashar Assad is a key backer of Hezbollah.