Differentiating External and Internal Oculopathy
External oculopathy, a genernal term of pathological changes in the parts of fresh, blood, qi and wind orbiculi (palpebra, canthus, the white and black parts of eye), is usually caused by the six exopathogenic factors (wind,cold, heat, dampness, dryness and fire) or by traumas. It may also be caused by indigestion, noxious dampness and phlegm-fire and is characterized by abrupt onset, rapid changing and obvious external symptoms. The internal oculopathy generally refers to the diseases of pupil (water obiculus), including the pathological changes occurring in the pupil and all the ocular tissues behind it, often with visual changes. It is often caused by the injury of seven emotions, too much visual work or overwork, or by the dysfunction of viscera, meridian, qi and blood.
Differentiating Common Symptoms and Signs
Differentiating Pain and Itching
Ophthalmalgia caused by external oculopathy with the manifestations of astringing pain, coarse pain and twinge pertains to yang syndrome while ophthalmalgia caused by internal oculopathy with the manifestations of distending pain, referred pain and pain of the deep eyeball pertains to yin syndrome.
Redness and coarse pain of the eye with massive mucopurulent secretion is often due to exopathic wind; eyelid hyperemia with pain and swelling accompanied with constipation is usually due to excessive fire in yangming meridian; slight redness and pain of the sclera with a dry and uncomfortable sensation is usually due to deficiency of kidney and blood; dull distending pain of the eyeball is usually due to yang hyperactivity and yin asthenia; severely distending pain of the eyeball is usually due to upstirring of qi and fire; ocular distension after long time's visual work is usually due to spleen and kidney deficiency which leads to the failure of upward transmission of essence or is due to yang hyperactivity; and pain in the deep eyeball is usually due to stagnation of liver qi or to yin deficiency which leads to fire hyperactivity.
Ocular itching may be caused by pathogenic wind, fire and dampness and by deficiency of blood, but pathogenic wind is often the main cause in clinic. Redness and itching of eye which becomes severe with wind blowing often pertains to the type of exopathic wind-heat; blephariffs marginalis with mucopurulent secretion or swollen granules and itching like insect-moving pertains to the type of damp-heat in the spleen and stomach mingled with pathogeic wind; itching with astringent and uncomfortable sensation occurring now and then pertains to the type of endopathic wind due to blood asthenia; and itching and pain occurring alternatively pertains to the type of invasion of excessive toxin.
Poor vision, hyperemia of bulbar conjunctiva and nebula are often caused by exopathic wind and heat or by flaming fire of the liver and gallbladder; subjective dim eyesight but normal external conditions of eye is often caused by deficiency of both the liver and kidney as well as fire hyperactivity due to asthenia or by stagnancy of liver qi; sudden diminution of vision without redness and pain in the eye is caused by head-wind and phlegm-fire or by hyperemia due to blood heat or qi disorders; long-term internal oculopathy with blurred vision or light perception is caused by asthenia of both qi and blood; poor eyesight during dawn or twilight and contraction of visual field is caused by deficiency of kidney yang or by impairment of liver-kidney essence; myopia is caused by asthenia of yang; and dizziness after squaring is caused by deficiency of essence, qi and blood.
Differentiating Redness and Swelling
Hyperemia of bulbar conjunctiva with tears and mucopurulent secretion pertains to the type of exopathic wind-heat; flame-like redness of the white of eye pertains
to the type of excessive heat of lung meridian; faint redness pertains to the deficient heat of lung meridian; hyperemia of bulbar conjunctiva and photophobia with tears pertains to the type of excessive heat of liver and gallbladder; slight redness and blurred vision with tears pertains to the type of fire hyperactivity due to yin deficiency.
Cherry-like swollen eyelid with burning pain often pertains to the type of noxious heat accumulation of spleen and stomach; sudden swelling of eyelid with slight redness and massive tears pertains to the type of exopathic wind; ball-like swelling of eyelid with bright surface and no pain pertains to the type of upward hyperactivity of kidney qi due to yang deficiency of the spleen and stomach; palpebral erosion with watery exudation pertains to the type of fumigation by internal damp-heat accumulation; and livid distension of eyelid pertains to the type of stagnation of qi and blood.
Nebula refers to the pancorneal opacity or cloudiness occurring on the black part of eye. It may be in the shapes of punctuation, arborization, geography, insect-bite and so on. The terms for nebula vary with its form, colour and depth, but what must first be done in clinic is to determine whether it is a new or an old case and then, in the light of other symptoms, to differentiate its syndrome.
Differentiating Secretion and Tears
Massive eye secretion is a common concomitant symptom of external oculopathy and often pertains to heat syndrome. Thin eye secretion is due to asthenia heat of
lung meridian; massive and hard eye secretion is due to sthenia heat of lung meridian massive yellow thick secretion is due to excessive noxious heat; and mucopurulent
secretion is due to damp-heat.
The category of new nebula is white pancorneal opacity which is obscurely bounded, with coarse surface, the trend to develop and symptoms of ocular redness, pain,photophobia and lacrimation. In most cases, new nebula in the black part of eye is caused by the six exogenous pathogenic factors, progresses easily and often involves the iris and pupil. So syndrome differentiation must be correct in clinic. New nebula in mild case, after recovery, can disappear, but in severe case it may turn into old nebula.
The category of old nebula is pancorneal opacity clearly bounded, with smooth surface and no further developing trend and without redness, pain and lacrimation.
It is classified in clinic as cloudiness, spot nebula and cataract according to its thickness.
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