Fengchichuangyi is an external eye disease that occurs on the skin of the eyelids and causes redness, swelling, pain, or papules, blisters, pustules, ulcers, erosions, and crusts. It is also known as damp-heat sores (Evidence and Treatment Standard), wind-red sores (Shen’s Zun Sheng Shu), and eye cell sores (Dictionary of Disease Sources).
The disease is mostly seen in middle-aged and elderly patients, but also involves adolescent patients. It can develop in one or both eyes. Some patients also have generalized or facial skin damage, and the duration of the disease varies. With proper treatment, the prognosis is good. However, if the lesion involves the black eye and pupil, forming a star point opacity or pupil tightness, pupil dryness, then vision is affected. In some cases, the sore is born in the spleen, and the lid is like a vermilion pearl. It is believed that the name is derived from the fact that the wind-heat is born in the organs, and it is also pointed out that the development of the disease can invade the black eyes and “gradually produce cataracts, blocking the pupils”. In the Ming dynasty, Wang Kentang’s “Zizhi Zhunqiang” and Fu Renyu’s “Xiyaohuan” classified the disease as “damp-heat-generated sores”, and the etiology of the disease was basically the same as that of wind-red sores, and the “Xiyaohuan” also proposed to treat the disease with internal “plus and minus four substances soup” and topical external application of The method of treating this disease by internal administration of the “Plus and Minus Four Herbs Soup” and topical application of Chinese medicine. The “Jinjian of Medicine”, compiled by Wu Qian of the Qing Dynasty, further clarified that the etiology of this disease is due to wind-heat attacking the spleen and advocated that “it is advisable to treat it urgently, for fear of developing cataracts and covering the pupils of the eyes for a long time. Shen Jin’ao’s “Shen’s Zun Sheng Shu” of the Qing Dynasty called this disease “wind-red sore disease” and believed that it occurred on the lids and was caused by wind-heat, “due to internal heat in the spleen, the two lids resemble vermilion sores”. In addition, Huang Yan’s “Ophthalmology” of the Qing Dynasty attributed this disease to “eyelid rot” caused by damp heat in the spleen and stomach. In recent times, various textbooks and monographs on Chinese ophthalmology have systematically compiled, summarized, and supplemented the theory, methods, and prescriptions of this disease, while also incorporating some of the relevant content of Western medicine, making the basic theoretical knowledge and clinical treatment of this disease more enriched and complete. In summary, the disease is not a single cause with a single clinical manifestation, but includes a variety of eyelid diseases with different causes and clinical symptoms in Western medicine, and should be treated according to the different causes and symptoms.
In Western medicine, herpes zoster of the eyelids, eczema of the eyelids, allergic eyelid dermatitis, eyelid dermatitis, herpes simplex virus lid dermatitis, impetigo of the eyelids, eyelid aspergillosis, eyelid parasitic infections, eyelid tuberculosis (tetanus), and eyelid infections. Infections of the eyelids, tuberculodem of the eyelids, common lupus of the eyelids, lepra of the eyelids, anthrax of the eyelids, and other disease processes may present with symptoms similar to those of this disease. Other related eyelid diseases can be treated with reference to this section.
Etiology and Pathology
Western medicine considers this disease to be caused by different viral infections. Herpes simplex virus blepharodermatitis is caused by herpes simplex virus infection. It often occurs as a result of respiratory infection from influenza, pneumonia, or during pregnancy and after exertion. ② Herpes zoster virus blepharodermatitis is caused by herpes zoster virus infection of the trigeminal meningeal nerve or the first branch of the trigeminal nerve. It occurs mostly in older people who are frail or have low resistance.
In Chinese medicine, this disease is considered to be a disease of the lid, which is an organ of the spleen. According to the “Shih Shih Medical Treatment”, this disease is “caused by wind-heat in the spleen.” The Ophthalmology Compilation considers this disease to be “caused by damp heat stagnating in the spleen and stomach.” It is believed that this disease is closely related to the dysfunction of the spleen and stomach and the immersion of wind, dampness and heat. It is usually caused by the accumulation of damp-heat in the spleen and stomach, or damp-heat in the spleen and stomach, followed by wind evaporation, which causes swelling and pain, blisters, and mucus oozing out of the lids; or by the application of certain medications, which cause toxins to impregnate the lids, or by the long-lasting impregnation of the lids with mucus and tears from pepper sores, corn sores, or lid sores, which cause the skin to ulcerate.
Clinical manifestations
1. Symptoms
Patients mostly have prodromal symptoms such as fever, malaise, and general malaise. The lesion area is characterized by severe neuralgia and loss of skin perception.
2.Signs
(1) Herpes simplex virus blepharitis: often occurs in the upper and lower eyelids, with the lower lid being the most common. The early lesions are edematous, with clusters of papules and translucent blisters surrounded by a halo of redness, which break easily and bleed yellow catarrhal fluid and gradually crust over. After debridement, no scarring is usually left. The lesions may invade the skin of the nose and the mouth and lips.
(2) Herpes zoster virus blepharitis: The prodromal symptoms include varying degrees of fever and malaise, followed by severe neuralgia, flushing and swelling of the skin, and formation of clusters of clear blisters in the area of the first branch of the trigeminal nerve. There is a redness at the base of the blisters and normal skin is visible between the blisters, followed by rupture of the blisters, crusting, hyperpigmentation or permanent scarring of the skin. The lesion often occurs on one side, with the midline of the face as the boundary. The lesion process is often combined with keratitis, iridocyclitis, etc.
3.Diagnostic criteria
(1) Herpes simplex virus blepharitis The lesion is usually on the lower eyelid, is less painful, breaks easily, and does not leave a scar after healing.
(2) Herpes zoster virus blepharitis: often occurs in elderly and frail individuals, with severe pain in the area of the first branch of the trigeminal nerve, flushing, swelling, hypoesthesia or loss of sensation, and the appearance of clusters of clear blisters with normal skin between the clusters, the lesion being confined to one side, with the middle of the face as the dividing line.
4. Differential diagnosis
Both diseases present with sudden redness and swelling of the eyelids, followed by papules, blisters, vesicles, and crusty flakes. However, eyelid eczema is more common in allergic individuals with a tendency to have recurrent episodes, often with a history of exposure to allergenic substances. The lesion area is itchy and burning. In subacute cases, the lesions appear as dark red patches of eyelid skin with crusting, scaling, a few papules, and oozing; in chronic cases, the onset of the disease is slow, with thickening of the eyelid skin and scaling.
Treatment
1. Chinese medicine treatment
In clinical practice, according to the degree of prevalence of the three evils and the severity of the disease, the main treatment is to remove wind and heat, or to remove heat and dampness, or to remove heat and toxicity, or to remove wind and heat and dampness at the same time. At the same time with the local external treatment of the eye, the treatment process pay attention to whether the lesion to the black eye, the pupil god transmission change.
(1) Identification and treatment
(1) Wind-heat of the spleen meridian
Symptoms: redness and redness of the eyelids with papules, small vesicles, stinging, burning, swelling and pain; mostly accompanied by fever and chills; thin yellow tongue coating and floating pulse.
Treatment: Drain wind and clear the spleen, accompanied by removing dampness to relieve itching.
Prescription: De-wind and clear the spleen (Chen Pi, Lian Qiao, Zhi Mu, Yuan Ming Powder, Scutellaria Baicalensis, Xuan Shen, Huang Lian, Thornbush, Rhubarb, Radix Platycodon grandiflorus, Radix et Rhizoma) plus or minus.
②Dampness and heat in the spleen and stomach
Symptoms: red, red, itchy, burning pain on the eyelids, herpes or pustules, ulceration and erosion, oozing mucus; mostly accompanied by stuffiness in the chest and constipation; red tongue, greasy tongue coating, slippery pulse.
Treatment: Clearing heat and eliminating dampness, accompanied by dispelling wind and relieving itching.
Prescription: Dampness Removal Soup (Ophthalmology Codex Lianxiao, Slippery Stone, Che Qianzi, Citrus aurantium, Scutellaria baicalensis, Radix Mouton, Poria cocos, Fenfeng, Thornbush, Chen Pi, Licorice) plus or minus.
(3) Wind-fire-heat poisoning
Symptoms: Redness and redness of the eyelids, herpes in clusters, severe pain, the herpes can also become pus and break down, finally forming scabs and scars, some cases can develop black eye opacities, pupil tightness, or even elevated eye pressure; red tongue, yellow dry coating, string pulse.
Treatment: Clearing heat and fire, dispelling wind and detoxifying.
Prescription: Puji Disinfectant Drink (Medical Formulas Collective Solution, Huang Lian, Huang Qin, Xuan Shen, Lian Qiao, Ma Bo, Pan Lan Gen, Licorice, Burdock, Sheng Ma, Peppermint, Stipula, Chai Hu, Chen Pi, Mandarin) plus or minus.
(2) External treatment
①Yunnan Baiyao and Liu Shen Wan with warm boiling water to make a paste and apply to the lesioned skin twice a day.
(2) Zijin ingots with warm water mixed into a paste and applied to the lesioned skin twice a day.
③For herpes zoster blisters and erythema, use 30g of each of Panax quinquefolium, Bai Xian Pi, Bitter Ginseng and Serpentine, decocted in water and wash the affected area twice a day. If the blisters are crusted and the erythema is eliminated but the pain is still obvious, use 30g each of Qiba Yizhihua, Paeonia lactiflora, Mentha arvensis and Aromatic Herb, decocted in water and removed from the dregs, and then wash the affected area twice a day.
(3) Staged treatment
(1) Blistering and erythema stage: the treatment is to remove wind, heat and dampness, and the formula is to add and subtract from Dampness Removal Soup.
(2) Blister and erythema receding stage: treatment is to clear heat and remove dampness, accompanied by promoting the flow of Qi and invigorating blood, with the formula of removing dampness and combining with Peach Red Four Elements Soup.
(3) Late stage: treating with promoting Qi and invigorating Blood, and adjuvant with removing dampness and detoxifying the toxin, using Peach and Red Four Elements Tang with addition.
(4) Specialized prescriptions and medicines
①Qingkailing injection, 30ml each time, add 250ml of 0.9% sodium chloride injection, intravenous drip, once a day. Or Qingkailin oral solution, 20m per time, 3 times a day.
②Shuanghuanglian needle powder, 3,6g each time, add 0,9% sodium chloride injection 250ml, intravenous infusion, once a day. Or Shuanghuanglian oral solution, 20ml each time, 3 times a day.
③In gardenia yellow injection, each time 20ml, add 0, 9% sodium chloride injection 250ml, intravenous drip, 1 time daily.
2.Western medicine treatment
(1) Local treatment
①Early stage: local application with Furfuryl Glycolate, 4 times a day, or local wet application with 10000/ml α-interferon solution, 4 times a day.
②If the herpes is not broken: use 1% brilliant green alcohol, apply to the lesioned skin, and then apply 1:60 sterilized starch paste to the herpes to promote the absorption of fluid in the herpes and prevent secondary infection.
③If the herpes breaks down without secondary infection, topical application of 3% acyclic guanosine ophthalmic ointment or 0.5% herpes net ophthalmic ointment should be applied to the affected area. If secondary infection occurs, antibiotic eye drops should be used in combination with wet compresses on the affected area.
④Physical therapy: treat the lesion area with helium-neon laser, audio electricity, frequency pulser, ultraviolet light or infrared therapy, etc., which has a better effect of pain relief and promotion of blister remission.
⑤ Pupil dilation: In cases with keratitis and iridocyclitis, ciliary muscle paralyzing agents should be used at the same time.
(2) Systemic treatment
(1) Systemic application of antiviral, antibiotic and glucocorticoid drugs can be used in severe cases.
(②Autologous blood therapy: use the patient’s own recovery whole blood, 20ml each time, intramuscular injection, once every other day, 2 to 3 times in total, which has the effect of shortening the course of the disease and preventing complications.
③Transfer factor, 1u each time, 1 time daily, subcutaneous injection in the upper arm, 10 times as a course of treatment.
④Analgesic agents: for those with obvious pain, choose to treat with pain relief tablets, anti-inflammatory pain, carbamazepine, mecamylguanidine and other drugs according to the degree of pain.
3.Integrated treatment of Chinese and Western medicine
Integrated treatment of wind and red sores is based on clinically proven effective treatment methods of Chinese medicine and the combined application of Western medicine, through the synergistic effect of Chinese and Western medicines, to achieve better treatment effects than those of Chinese medicine or Western medicine alone. Although antiviral and glucocorticoid drugs are effective in the treatment of wind and red sores, they are prone to adverse drug reactions and side effects and have contraindications to their use. It can reduce the dose and duration of glucocorticoid, antiviral and antibiotic drugs, reduce or avoid adverse drug reactions, and improve the clinical treatment effect.
Prognosis
The prognosis for herpes simplex virus blepharitis is good. Herpes zoster virus blepharitis can be broadly characterized as follows.
(1) Complete healing: seen in most patients.
(2) Permanent scarring or hyperpigmentation of the skin: mostly at the site of lesion damage.
(3) Some patients may have involvement of various tissues of the eye, including the cornea and iris, or even the whole eye, leading to blindness.
(4) Severe cases may cause meningitis, encephalitis or even death.
(5) Sequelae: pain. In some patients, the pain can last for months or even years.
Prevention and care
1. Pay attention to climate change and prevent colds.
2.Avoid mental stimulation and excessive mental tension, keep a comfortable mood.
3, pay attention to the combination of work and rest, avoid overexertion.
4, diet should be light, during the onset of the disease avoid eating fishy seafood, spicy Koo boiling cesspool to reach II