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おばあちゃん
おばあちゃん

下まぶたのたるみが気になったら「眼窩脂肪ヘルニア」を知ろう

おばあちゃん

 
最近下まぶたのたるみが気になるとお悩みではありませんか。下まぶたがたるんでいると老けて見えますよね。近頃の美魔女ブームで美容整形やサプリメントなどで対処しようとされる方も多いようです。しかし皮膚がたるんでいるのではないかもしれません。

こちらでは、下まぶたがたるむ病気「眼窩脂肪ヘルニア」をご紹介します。

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目の下のたるみ

おじさん

目の下のたるみは、なぜできるのでしょうか?そもそも、目は、周りを脂肪で囲まれ、保護されています。目の下の脂肪は、目の下の内側から外側にかけて、房状になって個別に存在していて、その脂肪の袋は、靭帯と呼ばれる支持組織によって支えられています。

そして、顔の筋肉や皮膚がそれらを被い、目から頬にかけての顔のラインを形造るのです。若くて健康な目の下の組織は、そのラインを張りのある若々しいラインに保っています。しかし、目の下のたるみは、次のような原因で現れてきます。

老化・疲労・むくみ・肥満・アレルギー・その他の病気

これらの原因で、目の下の靭帯や筋肉や皮膚がゆるみ、脂肪の房の圧力に耐え切れずに、目の下のたるみが形成されるのです。原因によっては、目の下に余計な脂肪の房ができてしまっていることもあります。その脂肪の房ができる病気を「眼窩脂肪ヘルニア」といいます。

眼窩脂肪ヘルニアとは

眼球、まぶたの後方はその大部分が脂肪組織ですが、眼窩隔膜とよばれる組織により、脂肪は前方に突出したり、脱出することはありません。しかし、加齢とともに隔膜の支持力が弱くなったり、脂肪組織自体が緩んでくると、前方に突出することがあります。

眼窩隔膜とともに前方移動するとき、「偽ヘルニア」とよび、まぶた・眼球などの手術や眼外傷の際に隔膜が破れて、突出したときは「ヘルニア」といいます。厳密に区別できないとき、「眼窩脂肪ヘルニア」と総称します。

眼窩脂肪ヘルニアの症状

症状は、ゴロゴロなどの異物感や、あまりに大きいと外側の視界を遮られる、などがあります。

眼窩脂肪ヘルニアの原因

加齢によって生じることがほとんどです。ほかに外傷,手術、テノンのう下への注射が原因になることがあります。

間違えられやすい病気

眼窩腫瘍はいろいろなものがありますが、数が多いものではありません。比較的多い腫瘍としては、成人では涙腺腫瘍、悪性リンパ腫、眼窩炎性偽腫瘍などがあり、小児では皮様嚢腫、リンパ管腫、横紋筋肉腫などがあります。

涙腺腫瘍
涙腺腫瘍は涙腺が腫大するため、上まぶたの外側(耳側)が腫脹します。無痛性または有痛性の上まぶたの外側(耳側)の腫脹、涙腺の腫大による眼球突出、物が二重に見える、軽度の眼瞼下垂などが起こります。疼痛は急速に増大する腫瘍で多くみられます。複視は、ゆっくりと増大する腫瘍では自覚しない場合もあります。一般に良性腫瘍は進行が遅く、悪性腫瘍は進行が早い傾向があります。

悪性リンパ腫
全身に広がっているリンパ組織内の細胞が悪性化し、次第に全身の臓器を侵していく病気です。ホジキンリンパ腫と、それ以外の非ホジキンリンパ腫に大別されますが、互いに似た経過をたどります。

横紋筋肉腫
腫瘍の顕微鏡所見や、腫瘍細胞に発現している蛋白質が、骨格筋(横紋筋)と共通の性質をもつ肉腫です。小児に発生する代表的な悪性腫瘍のひとつで、3分の2の症例は10歳以下に発生します。体中のあらゆる部分に発生しますが、最も多いのは眼のまわりや傍髄膜と呼ばれる脳の表面近くなど頭頸部で、全体の約35%を占めます。その他、膀胱や前立腺などの泌尿生殖器、次いで手足に発生します。

下まぶたのたるみの治療法

目のたるみ治療には、その状態に適したさまざまなアプローチ方法があります。大きく分けて下記の3つの手段があげられます。

3つの治療法

たるみを生み出す原因にアプローチする
レーザーや光治療器で皮膚の活性を高め、コラーゲンの産生を促す治療方法です。症状に合わせて、ヤグレーザーピーリングや目元専用のサーマクールで施術します。

たるみを目立たなくさせる
たるみの部分全体をふっくらさせることで、段差をカバーし、たるみを目立たなくさせる治療方法です。症状に合わせて、ヒアルロン酸注入、PRP(多血小板血漿)で施術します。

たるみの原因となる脂肪をとる
下まぶたの膨らみの原因である脂肪を、メスを使わずに取り除く治療方法です。症状に合わせて、下眼瞼脱脂術やメソセラピーで施術します。眼窩脂肪ヘルニアは外科手術での治療となります。

眼窩脂肪ヘルニアの治療法

炭酸ガスレーザーを用いる眼窩脂肪ヘルニア手術は,出血が少なく20分程と短時間で行うことができます。組織を蒸散させる効果があるため、出血を伴わない皮膚切開を行うことができます。局所麻酔で日帰り手術となります。まぶたは腫れやすい組織なので術後一時的に腫れたり、紫色に内出血することもありますが、1〜2週間で戻ります。

病気がみえる 〈vol.7〉 脳・神経 (Medical Disease:An Illustrated Reference)
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まとめ:下まぶたがたるむ病気「眼窩脂肪ヘルニア」を知ろう

目の下のたるみは目の下の靭帯や筋肉や皮膚がゆるみ、脂肪の房の圧力に耐え切れずに形成されます。こちらでおさらいしておきましょう。

眼窩脂肪ヘルニア

  • 目の下に余計な脂肪の房が突出したもの
  • 症状:ゴロゴロなどの異物感や、あまりに大きいと外側の視界を遮られるなど
  • 原因:加齢によって生じることがほとんど

自己判断は危険です。悪性の腫瘍の可能性もあるので、まずは病院に行ってくださいね。

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