裂隙灯使用操作PPT课件.ppt

裂隙灯的操作使用,1,裂隙灯简介,裂隙灯：全称“裂隙灯显微镜”是眼科使用最频繁的一种光学设备。通过裂隙灯显微镜可以清楚地观察眼睑、结膜、巩膜、角膜、前房、虹膜、瞳孔、晶状体及玻璃体前1/3，可确定病变的位置、性质、大小及其深度。若配以附件，其检查范围将更加广泛。因而裂隙灯不仅是眼科医生检查的重要设备，也成为配镜验光人员的必备和必须掌握的仪器。,2,裂隙灯显微镜的原理,裂隙灯：顾名思义就是灯光透过一个裂隙对眼睛进行照明。由于是一条窄缝光源，因此被称之为“光刀”。将这种“光刀”照射于眼睛形成一个光学切面，即可观察眼睛各部位的健康状况。其原理是利用了英国物理学家丁达尔的“丁达尔现象”。,3,裂隙灯显微镜的原理,裂隙灯显微镜又称活体显微镜，简称裂隙灯唯一能观察活体切片的仪器是眼科一种重要的检查工具强烈而集中的光源和双目显微镜的放大相配合，不仅能使表浅的病变观察得十分清楚，并且可以利用裂隙光带通过眼球各部的透明组织，形成一系列光学切面，使深部组织的病变也能清楚地显示出来,4,HydronQibeiOptometryEliteInstitute,结构和原理,裂隙灯显微镜,功能部件,辅助部件,投照系统,观察系统,托架,调焦手柄,控制板,5,12/11/201911:56AM,5,裂隙灯显微镜,6,6,7,8,9,10,11,HydronQibeiOptometryEliteInstitute,测试前准备测试者充分洗手适当降低室内光线亮度将裂隙光线投照于调焦棒分别调节双眼目镜的焦距手轮，使焦平面清晰调整目镜间距，使测试者得以双眼同时观察目标,12,12/11/201911:56AM,12,HydronQibeiOptometryEliteInstitute,调试裂隙灯显微镜目镜,13,12/11/201911:56AM,13,HydronQibeiOptometryEliteInstitute,使被测试者取舒适坐姿（可适当升降座椅或操作台）面部向前，将额部和颏部紧附额托和颏托,14,12/11/201911:56AM,14,HydronQibeiOptometryEliteInstitute,调整颏托手轮使被检查者的外眦部与托架纵杆眼位刻度线相平,15,12/11/201911:56AM,15,HydronQibeiOptometryEliteInstitute,3.基础调试旋动裂隙宽度手轮，将裂隙宽度调整至窄裂隙,16,12/11/201911:56AM,16,HydronQibeiOptometryEliteInstitute,调整灯臂，使基础投射角度保持大致30左右,17,12/11/201911:56AM,17,HydronQibeiOptometryEliteInstitute,旋动亮度手轮，使基础投照亮度保持中低度,18,12/11/201911:56AM,18,HydronQibeiOptometryEliteInstitute,旋动倍率手轮，设置基础倍率为10,19,12/11/201911:56AM,19,HydronQibeiOptometryEliteInstitute,调整滤镜掣，设置基础滤镜为散热光栅旋动裂隙长度手轮，将裂隙长度设置为最长、倾斜度垂直,20,12/11/201911:56AM,20,HydronQibeiOptometryEliteInstitute,4.投照和观察技术,弥散投照法,直接投照法,间接投照法,背面投照法,镜面反射投照法,全内反射投照法,滤光式投照法,常用投照和观察技术,21,12/11/201911:56AM,21,HydronQibeiOptometryEliteInstitute,弥散投照法（diffuseillumination）观察方法光源加覆磨砂滤光镜裂隙宽度调整为宽大放大倍率610投照亮度为高度滤镜调整为无光栅弥散透照法的观察视野较大,22,12/11/201911:56AM,22,HydronQibeiOptometryEliteInstitute,弥散投照法观察方法,23,12/11/201911:56AM,23,HydronQibeiOptometryEliteInstitute,观察内容外眼各部：眼睑、睑缘、睫毛、球结膜、睑结膜、泪小点、泪液角膜、角巩膜缘部、前房、虹膜、瞳孔和部分晶状体角膜接触镜配适的动态评估：镜片的覆盖度、中心定位、移动度、下垂度、松紧度,24,12/11/201911:56AM,24,HydronQibeiOptometryEliteInstitute,软镜的配适,25,12/11/201911:56AM,25,HydronQibeiOptometryEliteInstitute,硬镜的配适,26,12/11/201911:56AM,26,HydronQibeiOptometryEliteInstitute,直接投射法（directillumination）观察方法投射轴与观察轴夹角3050裂隙宽度0.2mm-1.5mm或锥形光束放大倍率625投照亮度从中度逐渐调至高度滤镜调整为无光栅显微镜焦平面处在光源照亮的部位,27,12/11/201911:56AM,27,HydronQibeiOptometryEliteInstitute,直接投照法观察方法,3050,28,12/11/201911:56AM,28,HydronQibeiOptometryEliteInstitute,观察内容窄裂隙：称为光切片观察角膜弧度（如圆锥角膜），角膜厚度（如角膜水肿）角膜创伤的深度和异物的位置宽裂隙：观察上皮层（如疤痕）、基质层、内皮层的病变镜片表面的异物和沉淀物；镜片的移动度和松紧度锥形光束：观察房水闪辉现象,29,12/11/201911:56AM,29,HydronQibeiOptometryEliteInstitute,圆锥角膜,30,12/11/201911:56AM,30,HydronQibeiOptometryEliteInstitute,角膜厚度,31,12/11/201911:56AM,31,HydronQibeiOptometryEliteInstitute,角膜疤痕,32,12/11/201911:56AM,32,HydronQibeiOptometryEliteInstitute,镜片沉淀物,33,12/11/201911:56AM,33,HydronQibeiOptometryEliteInstitute,间接投照法（indirectillumination）观察方法投射轴与观察轴夹角4560裂隙宽度1.0mm2.0mm放大倍率1640投照亮度从中度调至高度，滤镜调整为散热光栅显微镜焦平面位于光源照亮的旁侧，借助角膜背面分散折射的光线照亮裂隙光旁侧的观察目标,34,12/11/201911:56AM,34,HydronQibeiOptometryEliteInstitute,间接投照法观察方法,4560,35,12/11/201911:56AM,35,HydronQibeiOptometryEliteInstitute,观察内容观察泪液的脂质成分氧代谢障碍诱发的角膜上皮微囊、微泡,36,12/11/201911:56AM,36,HydronQibeiOptometryEliteInstitute,上皮微泡,37,12/11/201911:56AM,37,HydronQibeiOptometryEliteInstitute,背面投照法（retroillumination）观察方法投射轴与观察轴夹角3050裂隙宽度1.5mm3.0mm放大倍率1625投照亮度低度逐渐调至中度,38,12/11/201911:56AM,38,HydronQibeiOptometryEliteInstitute,背面投照法又称后映法光源投射于显微镜焦平面后方的虹膜上利用虹膜组织发出的弥散反光从背面照亮角膜进行观察分为直接法和间接法直接法的观察目标以照亮的虹膜为背景间接法观察目标以照亮的虹膜旁侧的暗区为背景,39,12/11/201911:56AM,39,HydronQibeiOptometryEliteInstitute,背面投照法观察方法,直接法,间接法,3050,3050,40,12/11/201911:56AM,40,HydronQibeiOptometryEliteInstitute,观察内容直接法：观察角膜新生血管和角膜异物间接法：利用从背面照亮的角膜发出的弥散光为背景观察角膜浸润、角膜基质层的水肿皱纹和镜片表面的沉淀物,41,12/11/201911:56AM,41,HydronQibeiOptometryEliteInstitute,角膜新生血管,42,12/11/201911:56AM,42,HydronQibeiOptometryEliteInstitute,角膜疤痕,43,12/11/201911:56AM,43,HydronQibeiOptometryEliteInstitute,脂质沉淀物,44,12/11/201911:56AM,44,HydronQibeiOptometryEliteInstitute,镜面反射投照法（mirrorreflectionillumination）方法调整显微镜与灯臂的位置使眼轴与投射轴的夹角和眼轴与观察轴的夹角相等投射轴与观察轴夹角60裂隙宽度1.5mm2.0mm放大倍率1640投照亮度中度至高度,45,12/11/201911:56AM,45,HydronQibeiOptometryEliteInstitute,镜面反射投照法又称平行光切法移动裂隙光，使之与投射光在角膜表面上的反光点相重合可观察到角膜后弹力层如同镜面一样的的反射光使显微镜的焦平面落在反射光上即可透过透明的后弹力层观察到角膜内皮细胞层,46,12/11/201911:56AM,46,HydronQibeiOptometryEliteInstitute,镜面反射投照法观察方法,60,47,12/11/201911:56AM,47,HydronQibeiOptometryEliteInstitute,观察内容角膜内皮细胞的病理性改变和泪液层的质量,角膜内皮细胞层,48,12/11/201911:56AM,48,HydronQibeiOptometryEliteInstitute,全内反射投照法（totalinternalillumination）观察方法投射轴与观察轴夹角4560裂隙宽度1.0mm2.0mm放大倍率1016投照亮度从中度调至高度滤镜调整为无光栅,49,12/11/201911:56AM,49,HydronQibeiOptometryEliteInstitute,全内反射投照法又称角膜缘分光法使光裂隙集中投照角膜边缘光线在角膜上皮层和内皮层之间反复折射投照成功的标准时角巩膜缘形成弥散光环显微镜焦平面则观察角膜中央至另一侧,50,12/11/201911:56AM,50,HydronQibeiOptometryEliteInstitute,全内反射投照法观察方法,51,12/11/201911:56AM,51,HydronQibeiOptometryEliteInstitute,观察内容角膜基质层的水肿皱纹瘢痕、上皮损伤异物和浸润等镜片的不透明沉淀物,52,12/11/201911:56AM,52,HydronQibeiOptometryEliteInstitute,角膜上皮浸润,53,12/11/201911:56AM,53,HydronQibeiOptometryEliteInstitute,滤光式投照法（filteredillumination）观察方法裂隙宽度调整为宽大放大倍率610投照亮度为高度采用钴兰光源、磨砂滤光镜、黄色滤光镜、1%荧光素钠,54,12/11/201911:56AM,54,HydronQibeiOptometryEliteInstitute,观察内容角膜和结膜损伤染色的形态和深度透气硬镜的配适评估等,55,12/11/201911:56AM,55,HydronQibeiOptometryEliteInstitute,角膜上皮损伤,56,12/11/201911:56AM,56,HydronQibeiOptometryEliteInstitute,角膜塑形镜静态配适,57,12/11/201911:56AM,57,HydronQibeiOptometryEliteInstitute,配镜前眼部检查PerCheckingforContactlenses,58,12/11/201911:56AM,58,HydronQibeiOptometryEliteInstitute,1.观察方法嘱被检查者直视前方用弥散光投照法依次观察：眼睑、睑缘、睫毛、角膜、前房、虹膜、瞳孔、晶状体嘱被检眼水平转动在眼球左转和右转时充分观察侧方的球结膜、巩膜和泪阜,59,12/11/201911:56AM,59,HydronQibeiOptometryEliteInstitute,嘱被检眼向上看用拇指在紧靠下睑缘处撑开下眼睑观察下方的睑结膜、球结膜、巩膜和下泪点并沿睑缘颞侧向鼻侧推按泪囊，观察泪小点有无溢出液嘱被检查眼向下看用拇指和食指捏住上眼睑，轻轻提起并翻开上眼睑观察上方球结膜、睑结膜、巩膜和上泪点,60,12/11/201911:56AM,60,HydronQibeiOptometryEliteInstitute,外眼检查,61,12/11/201911:56AM,61,HydronQibeiOptometryEliteInstitute,翻开上眼睑的过程,62,12/11/201911:56AM,62,HydronQibeiOptometryEliteInstitute,以上检查先右眼后左眼，依次进行根据病史提示或遇到阳性体征时可进行其他投照技术的检查同时提高放大倍率进行观察,63,12/11/201911:56AM,63,HydronQibeiOptometryEliteInstitute,2.观察内容1）眼外观双眼突出或一眼突出突眼性甲状腺肿（exophthalmicgoiter）眼眶肿瘤（orbitaltumors）不宜配戴角膜接触镜,64,12/11/201911:56AM,64,HydronQibeiOptometryEliteInstitute,突眼性甲状腺肿,65,12/11/201911:56AM,65,HydronQibeiOptometryEliteInstitute,眼眶肿瘤,66,12/11/201911:56AM,66,HydronQibeiOptometryEliteInstitute,视线指向采用角膜映光试验评估被检双眼显性斜视（manifeststrabismus）眼球震颤（nystagmus）须考虑戴角膜接触镜能否获得满意的矫正视力,67,12/11/201911:56AM,67,HydronQibeiOptometryEliteInstitute,外显斜视,68,12/11/201911:56AM,68,HydronQibeiOptometryEliteInstitute,双睑静态对称瞬目对称眼睑下垂可妨碍戴镜和摘镜眼睑闭合不全易招至软镜脱水瞬目迟缓（少于10次/min）易引起眼干和软镜脱水上述情况均不宜配戴角膜接触镜先天性小睑裂应注意戴镜发生困难,69,12/11/201911:56AM,69,HydronQibeiOptometryEliteInstitute,眼睑下垂,70,12/11/201911:56AM,70,HydronQibeiOptometryEliteInstitute,先天性小睑裂,71,12/11/201911:56AM,71,HydronQibeiOptometryEliteInstitute,2）眼睑眼睑皮炎表现为眼睑皮肤水肿，潮红、干燥、瘙痕眼睑肿瘤表现为眼睑部肿块、结节麦粒肿（stye）表现为睑缘红肿、脓性包块,72,12/11/201911:56AM,72,HydronQibeiOptometryEliteInstitute,眼睑神经性皮炎,73,12/11/201911:56AM,73,HydronQibeiOptometryEliteInstitute,眼睑单纯性疱疹,74,12/11/201911:56AM,74,HydronQibeiOptometryEliteInstitute,麦粒肿,75,12/11/201911:56AM,75,HydronQibeiOptometryEliteInstitute,睑缘炎（blepharitis）表现为睑缘有超量皮脂溢出，并有皮屑、结痂、瘙痒睫毛倒生（trichiasis）表现为睫毛乱生或睑缘内翻，睫毛刺激角膜眼睑外翻表现为眼睑松驰，泪液外溢上述各症均不应配戴角膜接触镜,76,12/11/201911:56AM,76,HydronQibeiOptometryEliteInstitute,睑缘炎,77,12/11/201911:56AM,77,HydronQibeiOptometryEliteInstitute,倒睫,78,12/11/201911:56AM,78,HydronQibeiOptometryEliteInstitute,眼睑外翻,79,12/11/201911:56AM,79,HydronQibeiOptometryEliteInstitute,3）泪器采用弥散式投照法观察泪小点异位表现为被检眼瞬目时泪小点的位置不能纳入泪湖之内因而不能正常收纳眼液慢性泪囊炎（dacryocystitis）表现为压迫泪囊部有粘液性或脓性分泌物返溢不宜配戴角膜接触镜,80,12/11/201911:56AM,80,HydronQibeiOptometryEliteInstitute,慢性泪囊炎,81,12/11/201911:56AM,81,HydronQibeiOptometryEliteInstitute,泪小点异位,泪小点异物,82,12/11/201911:56AM,82,HydronQibeiOptometryEliteInstitute,4）泪液干眼症正常情况下少量泪液聚存于下睑缘用直接投照法窄裂隙光切片观察睑缘积泪呈三角形形似半个弯月，称为半月形泪线若半月形泪线0.25mm者诊为干眼症宜慎戴角膜接触镜,83,12/11/201911:56AM,83,HydronQibeiOptometryEliteInstitute,半月形泪线,84,12/11/201911:56AM,84,HydronQibeiOptometryEliteInstitute,干眼症,85,12/11/201911:56AM,85,HydronQibeiOptometryEliteInstitute,脂质泪用间接法投照角膜面有大量细小半透明颗粒在泪液中移动为脂质型泪液的表现易导致镜片上脂质沉淀物聚沉，使镜片干燥宜慎戴角膜接触镜,86,12/11/201911:56AM,86,HydronQibeiOptometryEliteInstitute,脂质型泪液,87,12/11/201911:56AM,87,HydronQibeiOptometryEliteInstitute,5）球结膜正常球结膜应为无色透明可见到层下的腺样层呈淡灰色球结膜发生炎性病变时可出现透明度下降、水肿、上皮增厚、血管充盈等体征,88,12/11/201911:56AM,88,HydronQibeiOptometryEliteInstitute,正常球结膜,89,12/11/201911:56AM,89,HydronQibeiOptometryEliteInstitute,结膜充血（conjunctivalcongestion）可分为周边部充血，为结膜炎的表现睫状充血，为角膜损伤、炎症或色素膜炎症的表现周边部充血与睫状充血二者同时存在时，称为混合性充血若充血局限于某一部位，则称为局限性充血,90,12/11/201911:56AM,90,HydronQibeiOptometryEliteInstitute,球结膜充血分型,91,12/11/201911:56AM,91,HydronQibeiOptometryEliteInstitute,发生结膜充血宜停戴角膜接触镜进行必要的治疗，直至充血完全消退后恢复戴镜查明招致结膜充血的原因，避免复发,92,12/11/201911:56AM,92,HydronQibeiOptometryEliteInstitute,球结膜周边充血,球结膜睫状充血,93,12/11/201911:56AM,93,HydronQibeiOptometryEliteInstitute,球结膜混合充血,94,12/11/201911:56AM,94,HydronQibeiOptometryEliteInstitute,急性结膜炎,95,12/11/201911:56AM,95,HydronQibeiOptometryEliteInstitute,睑裂斑（pinguecula）球结膜睑裂区黄白色三角形或椭圆形粗糙隆起斑块者通常对配戴角膜接触镜并无影响,96,12/11/201911:56AM,96,HydronQibeiOptometryEliteInstitute,睑裂斑,97,12/11/201911:56AM,97,HydronQibeiOptometryEliteInstitute,翼状胬肉（pterygium）眦角部有肥厚的结膜及结膜下组织呈条带状向角膜生长，多发于鼻侧若条带充血，角膜端隆起，有慢性角膜浸润不宜配戴角膜接触镜,98,12/11/201911:56AM,98,HydronQibeiOptometryEliteInstitute,翼状胬肉,99,12/11/201911:56AM,99,HydronQibeiOptometryEliteInstitute,泡性结膜炎（phlyctenularconjunctivitis）角膜缘见直径1mm2mm泡状隆起灶周边有明显炎性充血待治愈后方可配戴角膜接触镜,100,12/11/201911:56AM,100,HydronQibeiOptometryEliteInstitute,泡性结膜炎,101,12/11/201911:56AM,101,HydronQibeiOptometryEliteInstitute,球结膜下出血（subconjunctivalhemorrhage）球结膜下见斑片状鲜红色出血灶，没有明显症状宜待其自行吸收以后再配戴角膜接触镜,102,12/11/201911:56AM,102,HydronQibeiOptometryEliteInstitute,球结膜下出血,103,12/11/201911:56AM,103,HydronQibeiOptometryEliteInstitute,球结膜淋巴滤泡因结膜淋巴循环系统障碍在结膜面形成透明的小囊多可自行吸收，并反复出现对配戴角膜接触镜无影响,104,12/11/201911:56AM,104,HydronQibeiOptometryEliteInstitute,球结膜色素沉着球结膜见黑褐色斑片状沉着常为先天性或幼年即发现无症状、不发展增大对配戴角膜接触镜无影响,105,12/11/201911:56AM,105,HydronQibeiOptometryEliteInstitute,球结膜色素沉着,106,12/11/201911:56AM,106,HydronQibeiOptometryEliteInstitute,球结膜异生见半透明球结膜覆盖角膜缘伸入23mm异生的球结膜可见到新生血管荧光素染色阴性无疼痛和刺激症状对配戴角膜接触镜无影响,107,12/11/201911:56AM,107,HydronQibeiOptometryEliteInstitute,球结膜异生,108,12/11/201911:56AM,108,HydronQibeiOptometryEliteInstitute,球结膜瘤见角膜缘部球结膜增生为球状隆起瘤体表面可见到新生血管荧光素染色阴性由于瘤体障碍，不宜配戴角膜接触镜,109,12/11/201911:56AM,109,HydronQibeiOptometryEliteInstitute,球结膜瘤,110,12/11/201911:56AM,110,HydronQibeiOptometryEliteInstitute,6）睑结膜正常的睑结膜透明，呈淡红色可清晰地看到其下血管和睑板腺上睑结膜近内外眦部可见少数极小的滤泡和乳头,111,12/11/201911:56AM,111,HydronQibeiOptometryEliteInstitute,正常睑结膜,112,12/11/201911:56AM,112,HydronQibeiOptometryEliteInstitute,睑结膜炎水肿、充血透明度下降，血管影消失乳头增生、滤泡形成覆盖粘液性分泌物宜停戴角膜接触镜,113,12/11/201911:56AM,113,HydronQibeiOptometryEliteInstitute,睑结膜炎,114,12/11/201911:56AM,114,HydronQibeiOptometryEliteInstitute,巨乳头性结膜炎（giantpapillaryconjunctivitis）戴角膜接触镜引起直径1mm3mm增生乳头分布于睑板区或整个上睑结膜宜停戴角膜接触镜,115,12/11/201911:56AM,115,HydronQibeiOptometryEliteInstitute,巨乳头性结膜炎,116,12/11/201911:56AM,116,HydronQibeiOptometryEliteInstitute,沙眼（trachoma）发病率较高，配戴角膜接触镜必须认真甄别若无明显症状，且睑结膜无明显充血沙眼乳头和滤泡局限于穹窿结膜可酌情配戴角膜接触镜，注意控制戴镜时间严格护理镜片，定期复查，同时积极治疗沙眼,117,12/11/201911:56AM,117,HydronQibeiOptometryEliteInstitute,若有畏光、流泪、瘙痒、分泌物胶着等症状上睑结膜充血，血管影混浊或睑板腺轮廓消失沙眼乳头和滤泡分布于大部上睑结膜或上睑结膜出现灰白色网状瘢痕，发生内翻倒睫均不宜配戴角膜接触镜,118,12/11/201911:56AM,118,HydronQibeiOptometryEliteInstitute,沙眼乳头,119,12/11/201911:56AM,119,HydronQibeiOptometryEliteInstitute,沙眼疤痕,120,12/11/201911:56AM,120,HydronQibeiOptometryEliteInstitute,巨乳头性结膜炎与沙眼的比较,121,12/11/201911:56AM,121,HydronQibeiOptometryEliteInstitute,睑板腺囊肿（chalazion）眼睑见结节状隆起，硬质结节睑结膜见紫兰色包块，周边稍充血宜手术治愈后再戴角膜接触镜,122,12/11/201911:56AM,122,HydronQibeiOptometryEliteInstitute,睑板腺囊肿,123,12/11/201911:56AM,123,HydronQibeiOptometryEliteInstitute,结膜结石睑结膜下见圆形或不规则形细小白色斑点若位于睑结膜面浅表，可进行手术去除深在者则对配戴角膜接触镜无碍,124,12/11/201911:56AM,124,HydronQibeiOptometryEliteInstitute,结膜结石,125,12/11/201911:56AM,125,HydronQibeiOptometryEliteInstitute,7）角膜角膜的静态观察用裂隙灯显微镜直接投照法的窄裂隙观察角膜最前方的弧形线状反光为泪膜的界面反光其后的暗区为角膜上皮层角膜上皮层后细窄的白色光带为角膜前弹力层的界面反光其后大部分灰白色区域为角膜基质层角膜基质层后白色光带为角膜后弹力层和房水的界面反光,126,12/11/201911:56AM,126,HydronQibeiOptometryEliteInstitute,角膜的静态观察,127,12/11/201911:56AM,127,HydronQibeiOptometryEliteInstitute,角膜的动态观察将裂隙灯显微镜的裂隙光带沿着角膜面缓慢推移遇上皮缺如、基质浸润、异物、疤痕或新生血管等即可能表现为异常反光灶,128,12/11/201911:56AM,128,HydronQibeiOptometryEliteInstitute,角膜的动态观察,129,12/11/201911:56AM,129,HydronQibeiOptometryEliteInstitute,角膜上皮损伤可见灰白色的斑点状、点片状、蛛网状、地图状上皮粗糙区宜治愈后2天再戴镜,130,12/11/201911:56AM,130,HydronQibeiOptometryEliteInstitute,角膜上皮损伤,131,12/11/201911:56AM,131,HydronQibeiOptometryEliteInstitute,角膜上皮损伤,132,12/11/201911:56AM,132,HydronQibeiOptometryEliteInstitute,角膜浸润（cornealinfiltrate）距角膜缘2-3mm荧光素染色阴性角膜深层灰白色，团絮状，圆形，边界模糊球结膜不同程度混合充血宜治愈后再戴镜,133,12/11/201911:56AM,133,HydronQibeiOptometryEliteInstitute,角膜浸润,134,12/11/201911:56AM,134,HydronQibeiOptometryEliteInstitute,角膜异物（corneaforeignbody）角膜面见到斑点状、不透明异物异物边缘区角膜呈灰白浸润应及时手术去除宜角膜康复后戴角膜接触镜,135,12/11/201911:56AM,135,HydronQibeiOptometryEliteInstitute,角膜异物,136,12/11/201911:56AM,136,HydronQibeiOptometryEliteInstitute,新生血管（neovascularization）角膜基质层见异常血管伸入越过角膜缘2mm以上常发生于角膜上缘立即停戴角膜接触镜,137,12/11/201911:56AM,137,HydronQibeiOptometryEliteInstitute,角膜新生血管,138,12/11/201911:56AM,138,HydronQibeiOptometryEliteInstitute,角膜白斑、云翳（cornealnebula）角膜组织见白色、灰白色疤痕复习被检者过去史为陈旧性病灶荧光素染色阴性无论外伤史或患感染性角膜病变者均慎戴角膜接触镜角膜疤痕引起的不规则散光可考虑戴角膜接触镜利用泪液透镜形成球面屈光体系，但须监控安全,139,12/11/201911:56AM,139,HydronQibeiOptometryEliteInstitute,角膜白斑、云翳,140,12/11/201911:56AM,140,HydronQibeiOptometryEliteInstitute,圆锥角膜（Keratoconu）角膜中心部不同程度锥形隆起嘱被检眼向下注视下睑缘弯曲提示Munson征阳性可配戴专门矫正圆锥角膜的角膜接触镜,141,12/11/201911:56AM,141,HydronQibeiOptometryEliteInstitute,圆锥角膜裂隙灯检测,Munson征阳性,142,12/11/201911:56AM,142,HydronQibeiOptometryEliteInstitute,角膜不规则散光（Irregularastigmatism）角膜表面反光影不均匀使角膜失去统一的准球面屈光界面注意对照观察其验光后的矫正视力和戴角膜接触镜的视力,143,12/11/201911:56AM,143,HydronQibeiOptometryEliteInstitute,圆锥角膜裂隙灯检测,144,12/11/201911:56AM,144,HydronQibeiOptometryEliteInstitute,营养不良性角膜变性（cornealdystrophy）被检眼可见角膜瞳孔区有数量不等的乳白色的颗粒或由乳白色细线构成的网状混浊或由乳白色细线构成的放射状混浊，称为Fabry病为家族遗传性疾病，不宜配戴角膜接触镜,145,12/11/201911:56AM,145,HydronQibeiOptometryEliteInstitute,颗粒状角膜变性,Fabry角膜变性,146,12/11/201911:56AM,146,HydronQibeiOptometryEliteInstitute,蚕食性角膜溃疡（ulcurcornealrodens）角膜缘充血、灰白色角膜浸润，多点发生荧光素染色阳性缓慢发展溶解角膜自发性疼痛病因不明，不宜配戴角膜接触镜,147,12/11/201911:56AM,147,HydronQibeiOptometryEliteInstitute,蚕食性角膜溃疡,148,12/11/201911:56AM,148,HydronQibeiOptometryEliteInstitute,8）前房和房水前房深度采用直接投照法透照前房使焦平面会聚虹膜若见虹膜卷缩轮向前突出，提示前房较浅需测试眼压，排除闭角性青光眼（glaucoma）确诊青光眼不宜配戴角膜接触镜,149,12/11/201911:56AM,149,HydronQibeiOptometryEliteInstitute,虹膜卷缩轮,150,12/11/201911:5