双语 眼睑病等课件

1、第四章 眼睑病(Disease of eyelid) 概 述眼睑结构和功能复习处理眼睑病的注意事项 LidsReview the structure and function of eyelids. The eyelids are important part of facial appearance.We should consider it in the procedure of palpebral disease. 眼睑炎症(Palpebral inflammation)睑腺炎(hordeolum)定义：是眼睑腺体的急性、痛性、化脓性、结节性炎症病变 内、外病因：葡萄球菌临床表现：红、肿

2、、热、痛等诊断与治疗：早期抗炎和热敷，脓肿形 成切开排脓，内外类型切口方向不同Hordeolumacute inflammation of eyelid charactericed with pain, nodule and purulence. mostly caused by infection of straphylococcus aureus.innertarsal gland; externalMolls or Zeiss glandClinic finding: red, swelling, hot, pain. Treatment: local warm compression,

3、 when abscess formate, incision and drainage should be done. 睑板腺囊肿(chalazion) 定义：睑板腺的特发性慢性肉肿性炎症 病因：睑板腺堵塞临床表现：无痛性肿块、生长缓慢诊断注意：复发性或老人注意除外睑板腺癌治疗：手术刮除Chalazioncystoma of Meibomain gland. Its a lipogranulomatous inflammation caused by blockage of excretory ducts of tarsal glands.Clinic finding: palpebral

4、subcutaneous round mass with different sizes, no adhesion with skin, a bite of elasticity.Treatment: To incise in conjunctival surface and discharge content and to extract its capsule. 睑缘炎 (blepharitis)是指睑缘表面、睫毛毛囊及其腺组织的亚急性或慢性炎症鳞屑性睑缘炎(squamous blepharitis)溃疡性睑缘炎(ulcerative blepharitis)眦部睑缘炎(angular b

5、lepharitis)睑缘炎 (blepharitis)病毒性睑皮炎单纯疱疹病毒性睑皮炎（herpes simplex palpebral dermatitis）带状疱疹病毒性睑皮炎（herpes zoster palpebral dermatitis ）The eyelids closely contact with the suface of the globe. Eyelashes of both eyelids are upward and downward separately in tidy arrangement. The superior eyelid can elevate.

6、 The superior and inferior puncta situated at anterior lip of palpebral margins in inner canthus 眼睑位置、功能和先天异常 倒睫(trichiasis)与乱睫(aberrant lashes)睑内翻(entropion)睑外翻(ectropion)眼睑闭合不全(hypophasis)上睑下垂(ptosis)先天异常(congenital abnormal) Etiology: cicatricial contraction of the conjunctiva or tarsus because o

7、f trachoma and burn; senile degeneration of palpebral tissue. Clinical findings: photophobia, tearing, stabbing pain, palpebral spasm. In severe case, cornea and conjunctival epithelium be exfoliated, even coneal stroma be opacity. Treatment: most need surgery.Ectropion病因：瘢痕、老年性、麻痹性、机械性表现：溢泪、角结膜损伤，严

8、重时伴闭合不全诊断治疗：手术睑外翻Etiology: scar formation on the palpebral skin; paralysis of facial nerve or senile laxation of orbicularis oculi muscleClinical findings: tearing, dry, severe cases cause cornea epithelium damage, and lagophthalmosTreatment: most need surgeryPtosis病因：先天性和获得性临床表现：上睑遮盖角膜3mm,代偿头位诊断:排除

9、重症肌无力治疗:手术Etiology: congenital and acquired Clinical findings: The upper lid cant be elevated and cover upper part of cornea 3mm; face upword. Treatment: directed to its various causes; congenital ptosis needs surgery眼睑肿瘤 (Palpebral tumor)良性肿瘤(benign:血管瘤、色素痣、黄色瘤）恶性肿瘤(malignant:基底细胞癌、鳞状细胞癌、皮脂腺癌） 黄色瘤基

10、底细胞癌泪器病(Disease of the Lacrimal apparatus)流泪(lacrimation)溢泪(epiphora)泪液排出系统疾病 泪道阻塞和狭窄(stenosis of lacrimal passage)新生儿泪囊炎(neonatal dacryocystitis)慢性泪囊炎急性泪囊炎 急性泪囊炎(Acute dacryocystitis)Acute dacryocystitistake place on the basis of chronic dacryocystitis; area in the lacrimal sac appears: red, swolle

11、n,hot,pain. When pus-punctum appears, drainge is needed to do. When infection is controlled, to do operation as that of chronic dacryocystitis 慢性泪囊炎(chronic dacryocystitis)病因：鼻泪管狭窄或堵塞伴发细菌感染临床表现：溢泪、溢浓 眼部感染病灶 治疗：手术 Etiology: trachoma, chronic rhinitis, nasal polyp, hypertrophy of nasal conchae Clinica

12、l finding: epiphor, when compression a large amount of mueopurulent secretion reflux from the puncta or lacrimalia. Clinical meaning: Chronic dacryocystitis as an ocular focus makes conjunctival sac in polluted condition, once the globe is injuried or operated on, infection becomes easy, severe comp

13、lication will take place.泪液分泌系统疾病 泪腺炎(dacryoadenitis)泪腺肿瘤无泪症泪液分泌过多 Disease of secretory system 1) Dacryoadenitis: less common 2) Tumor of lacrimal gland眼表疾病(ocular surface disorder)概述 眼表：参与维持眼球表面健康的防护体系中的所有外眼附属器泪膜（tear film)结构和功能眼表疾病(OSD):泛指损害角结膜眼表正常结构与功能的疾病 Ocular surface: All the exter apparatus w

14、hich attend to maintain a healthy protective system of the globe Tear: including lipid layer, aqueous layer, mucus layer. Function: to make the cornea a smooth optical surface by abolishing minute surface irregularities of its epithelium; to wet the surface of the corneal and conjunctival epithelium

15、, preventing damage to the conjunctival epithelial cell; to inhibit the growth of microorganisms on the conjunctival and cornea by mechanical flushing and the antimicrobial action of the tear fluid. Ocular surface disorder(OSD): Generally refer to the diseases of impairing nomal structure and functi

16、on of corneal and conjunctival surface. 眼表疾病治疗原则 提供上皮细胞生长所需的、相对健康的基质和基底膜，以及有活力的上皮干细胞来源应用药物减轻炎症反应和抑制排斥反应改善干眼症状 角结膜干燥症（干眼症）(dry eye syndrome) 定义：任何原因引起的泪液质和量异常或动力学异常、导致泪膜稳定性下降，并伴有眼部不适，引起眼表病变为特征的多种病症的总称。Clinical finding: scratchy or sandy sensation, itching or burning and photosensitivity; redness and

17、pain, corneal and conjunctival epithelium damage.Schirmer test: mear tear secretionTear film break-up time: to mear the mucin content.Two kinds: deficient production-aqueoes tear deficiency,ATD; over evaporation - meibomain gland dysfunction,MGDTreatment: ATDartificial tear; MGDophthalmic vehicles o

18、f high molecular weight 干眼症分类泪液生成不足(deficient production) (aqueoes tear deficiency,ATD)蒸发过强(over evaporation) (meibomain gland dysfunction,MGD)干眼症临床表现与诊断：症状、泪液分泌不足和泪膜不稳定、眼表上皮的损害、泪液渗透压增加、泪液分泌试验、泪膜破裂时间、泪液蕨类试验干眼症治疗ADT：消除诱因、替代疗法、减少泪液排出、促进泪液分泌MGD：物理清洁、抗生素、局部药物VDT（visual display termminal）结膜病(Disease of t

19、he Conjunctiva) 细菌性结膜炎(bacterial conjunctivitis) 超急性细菌性结膜炎（淋球菌、脑膜炎球菌）:可累及角膜急性或亚急性细菌性结膜炎（肺炎双球菌等）慢性结膜炎细菌性结膜炎的诊断、治疗和预防 bacterial conjunctivitisHyperacute bacterial conjunctivitis: Etiology: Neisseria gonorrhoeae. In adult, autoinfection by urethritis; in newborn by the birth canal.Clinic finding: serou

20、s secretion, purulent, the symptom develops quickly, cornea ulcer form and even perforation. Treatment: washing thoroughly, penicillin is droped into the eye bacterial conjunctivitisAcute bacterial conjunctivitis Etiology: diplococus pneumoniae, Koch-Weeks bacillus staphylococcus and so on. Clinic f

21、inding: mostly both eyes affected, symptoms: tearing, sandy sensation, burning, eyelid swellen, but no follicl or papillary hyperplasia.Treatment:as the same as above introduced.Chronic conjunctivitis Etiology: bacterial infection, trichiasis, blepharitis, physical and chemical stimulation. Clinic f

22、inding: itching, sandy sensation, burning, secretion isnt much mucous.Treatment: remove the cause, treat according different cause 衣原性结膜炎 （沙眼 ）(trochoma)病因：沙眼衣原体临床表现：急性期、慢性期、晚期诊断与分期治疗 Trachoma is a chronic, bilateral cicatrizing keratoconjunctivitis caused by chlamydi trachomatis. Clinic finding: ac

23、ute period: tearing, photophobia, sanding sensation; sign: hyperemia, papillary hyperplsia, follicles, corneal epithelitis. chronic period: hyperemia decrease, papillary hyperplsia, follicles formation, gradually scar form at nasal sulcus of upper palpebral conjunctiva.Classification: stage 1: Profr

24、essive stage, papillae and follicles are coexisted, the conjunctival tissue of upper fornix is blurred, there is corneal pannus. stage 2: Regressive stage, from the discovery of scar to almost changed into scar, there is only a little active lesion. stage 3: Complete cicatricial stage, cative lesion

25、 disappeared completely instead of scar, no infectiviy. Complications: Entropion and trichiasis, Symblepharon, Blepharoptosis, Parechymatous xerosis of conjunctiva, Chronic dacryocystitis,Corneal ulcer Treatment: antibiotics drops for tropical treatment, for complications need surgery.病毒性结膜炎(viral c

26、onjunctivitis) 腺病毒性角结膜炎（EKC）病因：腺病毒8、19、29、37型临床表现：结膜、角膜、全身表现；可散发可流行治疗：冷敷、抗病毒药物、抗菌素、激素流行性出血性结膜炎 Etiology: adenovirus 8,19and 37Clinical finding: palpebral redness and swellen, hyperemia, edema,after follicles, 5-7days, conjunctivitis subsides, superficial punctuate keratitis appear. Treatment: interf

27、eron drops, antibiotic, prednisolone is effective for superficial punctuate keratitis.免疫性结膜炎(immunologic conjunctivitis)春季角结膜炎(vernal keratoconjunctivitis)过敏性结膜炎(allergic conjunctivitis)巨乳头性结膜炎 （giant papillary conjunctivitis）泡性角结膜炎 (phlyctenular keratoconjunctivitis)春季角结膜炎泡性角结膜炎过敏性结膜炎变性性结膜病 翼状胬肉(pt

28、erygium)睑裂斑(pingueculae)结膜结石(conjunctival concretion)翼状胬肉(pterygium)结膜下出血角膜病(Disease of Cornea) 角膜炎(keratitis)病因及分类：感染性、内源性、局部蔓延病理：浸润期、溃疡形成期、溃疡消退期、愈合期临床表现：症状、体征诊断：临床表现、实验室的病因学诊断治疗原则：积极控制感染，减轻炎症反应，促进溃疡愈合，减少瘢痕形成 keratitisKeratitis occupies an important place in keratopathy, is one of main cause of bli

29、ndness,.Almost all keratitises are caused by external infections.细菌性角膜炎(bacterial keratitis) 淋球菌葡萄球菌绿脓杆菌 匐形性角膜溃疡绿脓杆菌性角膜溃疡角膜脓肿Serpiginous corneal ulcerwith acute onset, photophobia, tearing, severe blurred vision; conjunctiva hyperemia and edema, grey-yellow infiltrative focus surrounding corneal ede

30、ma; it extends and creeps deep, severe case has iridocyclitis and hypopyon Pseudomonas cornea ulceris a severe purulent keratitis caused by pseudomonas aeruginosa. Acute onset with pain, tearing, hypopsia. Palpebral swellen, hyperemia and edema, white-yellow necrotic focus occurred on the cornea, hy

31、popyon appears with much quantity even cornea perforation ocurre in 1-2 days. 真菌性角膜炎(fungal keratitis)病因：致病菌、外伤史、局部或全身抵抗力下降临床表现：症状、溃疡表现、前房积脓诊断：病史、病灶特点、实验室找到真 菌或菌丝治疗：抗真菌药、散瞳、角膜移植Fungal keratitisthe disorder often occurs after agriculturel corneal injuries. Commonly with chronic onset and long course.

32、 Symptoms are less severe than those of bacterial keratitis, the ulcer is in white tint, a little elevated on surface with satellite focus. Hypopyon is ofter existed and cheesy, thick. Treatment: antifungal medicine for topical and system use with dilating the pupl.单纯疱疹病毒性角膜炎(herpes simplex keratiti

33、s) 病因：HSV感染临床表现：原发、复发 树枝状或地图状 角膜基质炎诊断：病史、体征治疗：病灶清除、抗病毒、激素、手术病毒性角膜溃疡Herpes simplex keratitsit commonly is the recurrence after primary infection. Suffering flu, malaria, pyreticosis, or using of cortiocosteroid may be the inducement. Dendritic keratitis is typical type, small punctuate opacity of cornea epithelium, then to form small blisters. Inflammation develops with edema of cornea stroma, Desc