青光眼课件英文葛胜利

,Glaucoma,Definition,Glaucoma is an opitic neuropathy characterized by opitic disk cupping and visual field loss. It is usually associated with elevated intraocular pressure.,It is one of the inreversible cause of blindness eye disease It can occur among various ages Its clinic symptoms depend on the classification and the clinic stages,Characteristics,Epidemiologic feature,the incidence of glaucoma is 1% in our country,the incidence of glaucoma is 2%-2.5% among beyond 40 ages,it is the second causing blindness eye disease and the total of 10% among the blindness,the cause of disease is related to inheritance in a way,Common sign in glaucoma,the cupping of disc is to be enlarged (glaucoma cup) visual field loss of glaucoma the intraocular pressure is raised,Glaucoma cup,Common sign in glaucoma,the cupping of disc is to be enlarged (glaucoma cup) visual field loss of glaucoma the intraocular pressure is raised,Visual field defect in glaucoma,Common sign in glaucoma,the cupping of disc is to be enlarged (glaucoma cup) visual field loss of glaucoma the intraocular pressure is raised,Intraocular pressure IOP,the pressure acting on the eye is called IOP normal range,10-21mmHg the fluctuation in 24h should be less than 8 mmHg the difference between both eyes should be less than 5 mmHg,high IOPglaucoma nomal IOPglaucoma,(Intraocular hypertension) IOP exceed the upper limit of statistical normal pressure without impairment of the optic nerve and visual field in following up (Normal tension glaucoma NTG) Optic nerve and visual field imparment is quite obvious with normal IOP,Eyeball anatomy,The production and main passage of Aqueous humor outflow,Produced by Ciliary body posterior chamber pupilanterior chamber the trabecular meshwork Schlemms canal the collect tubes in sclera Aqueous veins Ciliary veins,Circulation route of the Aqueous humor,The passage of trabecular meshwork （8090） The passage of uvea and sclera（1020） absorbed by the crypt of iris surface（5） Discharged through vitreous and retina,Acute PACG Mechanism,Factors of IOP,The production rate of aqueous humor The outflow resistance through trabecular meshwork The pressure of superficial scleral vein,The Mechanism of optic nerve atrophy,The theory of mechanical The theory of blood vessel ischemia,IOP Anterior chamber Visual field Optic disc,Diagnosis,classification,1 Primary glaucoma,Angle -closure glaucoma,Open angle glaucoma,Acute angle-closure glaucoma,Chronic angle-closure glaucoma,2 Secondary glaucoma,3 Congenital glaucoma,( 6YO）,（630YO）,Congenital glaucoma with other congenital abnormalities,Juvenile glaucoma,Infantile glaucoma,开角型青光眼,闭角型青光眼,Primary acute angle-closure glaucoma,Characteristics,Mainly seen in senile over 50 YO Malefemale=12 One eye then the other is enrolled or onset at the same time in both eyes Sudden onset of IOP raising with symptoms and anatomical changes of anterior segment,Etiology,Anatomy factor Small eyeball Shallow anterior chamber Narrow angle Thicker lens Causative factor Reading，fatigue，exciting，prolonged stay in dark room and ache will induce the disease,Mechanism of raising IOP,Stage of the disease,Preclinical stage Premonitory stage Acute attack stage Intermittent stage Chronic stage Absolute stage,The clinical manifestation and treatment in every stages,1. Preclinical stage Symptoms: Without any clinical symptoms Signs: Family history Anatomy factors one eye is diagnosed IOP increase after dark room test Treament:surgery or laser iridectomy SPI or LPI,The clinical manifestation and treatment in every stages,2. Premonitory stage Symptoms: vision blur and iridization Light eye ache and pain of the forehead at homonymy aching sense in nose root and orbital and sicchasia the symptoms always disapear after rest Signs: Light ciliary congestion，slight edema of cornea epithelium, shallow anterior chamber,the pupil is slightly dilated,the IOP increase slightly. Treament:SPI or LPI,The clinical manifestation and treatment in every stages,3.Acute attack stage Symptoms : severe ophthalmalgia，aching in the fossa orbitalis and headache at homonymy photophobia,lacrimation,vision decrease, accompanied with sicchasia,vomiting,alvine flux.,The clinical manifestation and treatment in every stages,3.Acute attack stage Sign: the IOP isusually above 50mmHg edema of eyelid,mixed ocular injection or bulbar conjunctival edema Edema of cornea epithelium,keratic precipitate Shallow anterior chamber Dilated pupil with a vertical oval shape,without light traction. The angle is completely closed,Acute ACG in acute attack stage,Acute ACG in acute attack stage,Shallow anterior chamber in Acute PACG,The clinical manifestation and treatment in every stages,3.Acute attack stage Diagnosis :typical history shallow anterior chamber narrow angle of anterior chamber IOP,The clinical manifestation and treatment in every stages,3.Acute attack stage Differential diagnosis : 1、To differentiate with eye disease 1）acute iridocyclitis 2）acute conjunctivis 2、To differentiate with general disease 1)brain disease 2)acute gastroenteritis,The clinical manifestation and treatment in every stages,3.Acute attack stage Therapeutic principle : control IOP rapidly，lessen tissue damaging factor Emergency treatment ！ selecting operation to prevent from recurring,The clinical manifestation and treatment in every stages,3.Acute attack stage Therapeutic method : 1)Reduce IOP swiftly including drug treatment,puncture of anterior chamber, laser and operation treatment. 2)Optic nerve protection therapeutic.,Drug treatment,Deflating pupil Dcrease IOP Antiinflammatory Mitigate,Parasympathomimetic（miotic agent）,General all purpose of preparation：1%2% pilocarpine Mechanism of action：deflate pupil、to open the angle of anterior chamber、enhance the outflow of aqueous, prevent Goniosynechia. Its the basic medicine for ACG,Beta-adrenergic blockers,General all purpose of preparation ： 0.5% Timolol bid 0.25% betaxolol bid 2% carteolol bid 0.5% levobunolol bid Mechanism of action ：decreasing IOP，resulting in decreased aqueous production. Side effects：decreasing heart rate、arhythmia、decreasing BP、 inducing bronchial asthma.,Carbonic anhydrase inhibitor,General all purpose of preparation ： per os- Acetazolamide 0.25 bid Eye drop（2Azpot）bid Mechanism of action ：decreasing aqueous production Side effects ：nephric colic、ureteral calculus etc.,Hyperosmotic agent,General all purpose of preparation ： 50% glycerin（23ml/kg），per os 20%mannitol （12g/kg），intravenous drip swiftly. Mechanism of action ： raising osmotic pressure，decrease content of eye and IOP. Side effects ：anhydration、electrolyte disturbances,Operation therapeutics,LPI or SPI Trabeculectomy,Alleviating pupillary block,Preclinical stage Premoni