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沙眼(Trachoma)查法课件_1

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沙眼Trachoma 沙眼ppt课件
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 沙眼(trochoma) § 是由沙眼衣原体引起的一种慢性传染性 结膜角膜炎 § 沙眼衣原体感染后潜伏期5-14d § 幼儿患沙眼后,症状隐匿,可自行缓解,不留 后遗症 § 成人沙眼为亚急性或急性发病过程,早期 即出现并发症 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 沙眼的临床表现 § 乳头肥大:睑结膜充血,状粗糙 § 滤泡形成:初期为细微的黄白色圆点,典型 滤泡大小不一,圆形或不规则形状 § 瘢痕:首先表现在睑结膜上出现粗糙不等 的灰白色网状瘢痕,网状瘢痕是沙眼的典 型变化 § 角膜血管翳:是沙眼的特有表现 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 我国沙眼(Trachoma)分期法 § Ⅰ期:上穹窿部和上睑结膜有活动性病变 (血管模糊、充血、乳头增生、滤泡形成 )轻度:活动性病变占上睑结膜面积小于 1/3;中度1/3-2/3;重度大于2/3 § Ⅱ期:有活动性病变,同时出现瘢痕。轻 度:活动性病变占上睑结膜面积小于1/3; 中度1/3-2/3;重度大于2/3 § Ⅲ期:仅有瘢痕而无活动性病变 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 沙眼的并发症与合并症 § 上睑下垂:睑结膜及结膜下组织、睑板充 血、水肿、增生肥厚使上睑重量增加 § 睑内翻与倒睫:瘢痕收缩所致 § 角膜混浊与角膜溃疡 § 慢性泪囊炎:沙眼病毒侵入泪囊上皮 § 睑球后粘连 § 眼干燥症:结膜杯状细胞和副泪腺被破坏, 同时泪腺的开口因结膜瘢痕而闭锁 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 翼 状 胬 肉 § 病因不明,与紫外线照射、烟尘等有关 § 临床表现:多双眼发病,以鼻侧多见,当病 变接近瞳孔区时,可有角膜散光或视力下 降 § 治疗:小而静止时不需治疗,但应减少风沙 、阳光的刺激;进行发展侵及瞳孔区时需 手术治疗 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 角膜病概述 功能 1.角膜与巩膜共同构成眼球的外壁 2.重要的屈光介质:屈光力+43D,占眼球全部 屈光力的3/4 3.角膜没有血管,保持透明,免疫学上处于相 对的免疫赦免 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 组织学共分五层 § 上皮层:占角膜厚度的1/10,损 伤后可再生 § 前弹力层:不能再生 § 基质层(实质层):占角膜全部的 90%,损伤后由瘢痕组织修复填 补,角膜失去透明 § 后弹力层:由内皮细胞分泌构成 § 内皮层:由单层排列的六角型细 胞构成,细胞数随年龄增长而丢 失,不能再生 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 角 膜 炎 症 病 因 § 感染性:细菌、真菌、病毒、棘阿米巴 § 内源性:自身免疫性疾病如类风湿关节炎 ; 全身病如维生素A缺乏 § 局部蔓延:临近组织的炎症波及角膜如结 膜炎、巩膜炎、虹膜睫状体炎等 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 角膜炎的病理分期 § 浸润期:致病因子侵袭角膜,引起角膜缘血管 网充血、渗出、炎症细胞浸润,形成局限性灰 白色混浊灶 § 溃疡形成期:坏死的角膜上皮和基质脱落形成 角膜溃疡 § 溃疡消退期:致病因子得到控制,溃疡边缘浸 润减轻,有新生血管进入角膜 § 愈合期:溃疡区上皮再生,基质层由瘢痕组织 修复 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 愈 合 期 § 角膜云翳:浅层的瘢痕性混浊薄如云雾状, 透过混浊部分仍能看清后面的虹膜纹理 § 角膜斑翳:混浊较厚,略呈白色,但仍可透见 虹膜 § 角膜白斑:混浊很厚呈瓷白色,不能透见虹 膜 § 粘连性角膜白斑:角膜白斑的瘢痕组织中 嵌有虹膜组织,提示有角膜穿破史 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临 床 表 现 § 症状: 眼痛、畏光、流泪、眼睑痉挛、眼 部分泌物、视力下降 § 体征:睫状充血、角膜浸润混浊、角膜溃 疡形成 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治 疗 § 去除病因 § 控制感染 § 促进愈合 § 减少瘢痕 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 细菌性角膜炎 病因 § 角膜外伤 § 致病菌感染 § 局部及全身因素 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临 床 表 现 § 症状:发病急、眼痛、畏光、流泪、眼睑痉 挛、视力障碍、大量脓性分泌物 § 体征:眼睑及球结膜水肿、睫状或混合充血 、角膜溃疡及水肿 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 绿脓杆菌性角膜炎 § 发病急剧、病情迅猛 § 多有角膜异物取出或戴角膜接触镜病史 § 剧烈眼痛及刺激症状 § 角膜溃疡,角膜溶解、坏死,角膜穿孔 § 前房积脓 § 眼内容脱出或全眼球炎 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治 疗 § 药物治疗:高浓度的抗生素滴眼液点眼,胶原 酶抑制剂抑制溃疡形成,维生素有著于溃疡 愈合 § 手术治疗:穿透性角膜移植 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 真菌性角膜炎 病因 § 角膜外伤史 § 机体抵抗力降低 § 真菌感染 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临 床 表 现 § 症状 异物感,疼痛、畏光、流泪,视力下降 § 体征 睫状或混合充血 角膜溃疡干燥、微隆起、免疫环 伪足或卫星灶 内皮层斑状沉着物 粘稠的前房积脓 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 诊 断 § 植物外伤史 § 角膜病灶的特征 § 角膜涂片查菌丝或真菌培养 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治 疗 药物治疗: § 抗真菌药物频繁点眼 § 结膜下注射抗真菌药物:两性霉素B 0.1mg § 全身抗真菌药 手术治疗: § 清创术 § 结膜瓣遮盖术 § 角膜移植术 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 单纯疱疹病毒性角膜炎 严重的世界性致盲性眼病 § 病原学:HSV-1引起角膜感染 § 发病机制: HSV-1感染三叉神经支配的体表并潜伏 § 复发机制:机体抵抗力减低时,潜伏在神 经节内的病毒可活化,引起复发感染 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 临床表现 § 原发感染:常见于幼儿, 全身发热和耳前淋巴结 肿大 § 复发感染: 树枝状或地图状角膜炎 :异物感、畏光、流泪 、视物模糊,角膜树枝 状或地图状浸润 角膜基质炎:角膜中央 基质呈盘状水肿、角膜 上皮水肿、KP With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 角 膜 炎 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 治 疗 § 树枝状和地图状角膜炎:无环鸟苷、碘苷 § 盘状角膜炎:应用抗病毒药物的同时应用糖 皮质激素 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 角 膜 炎 的 护 理 § 护理上要执行各种用药治疗并在结膜囊细菌 培养、药敏试验的指导下用药 § 治疗操作或检查时切勿加压于眼球,特别是较 深的溃疡,防止角膜穿孔 § 患眼戴眼带,防止光线刺激及感染加重 § 如有前房积脓,脓沉不易吸收,可在无菌条件下 行前房穿刺 § 根据病人眼部分泌物细菌培养结果进行隔离 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 白 内 障 的 定 义 § 解剖学上:凡晶状体表面或晶状体内任何部 位混浊,或功能上影响视力的混浊均称为白 内障 § 生化学上:可证实的不可逆蛋白凝固,或色 素性结晶性积聚,以及纤维组织变性等 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 白 内 障 的 分 类 § 根据病因分外伤性、并发性、代谢性、药 物及中毒性、发育性、后发性 § 根据发生年龄分:先天性、婴儿性、青年性 、成年性、老年性 § 根据混浊部位分:皮质性、核性、囊下性、 囊性 § 根据混浊程度分:初发期 、未熟期(肿胀 期)、成熟期、过熟期 § 根据是否进展分:静止性和进行性 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 老年性白内障 § 分类:皮质性、核性和后囊膜下 § 病因:可能为环境、营养、代谢和遗传等 多种因素对晶状体长期综合作用的结果 § 过多的紫外线照射、过量饮酒、吸烟、妇 女生育多,心血管疾病、高血压等与白内 障的形成有关 § 常双眼发病,但有先后,表现为渐进性、无 痛性视力减退 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 皮质性白内障的分期 § 初发期:晶状体皮质楔形放射状混浊 § 膨胀期:又称未熟期,晶状体混浊继续加重,晶 状体吸收水分,肿胀,将虹膜向前推移,前房变 浅,可诱发急性闭角型青光眼。该期视力明 显减退 § 成熟期:晶状体完全混浊,视力降至眼前手动 或光感,为手术的最佳时机 § 过熟期:数年后,晶状体水分丢失,体积缩小, 核下沉,视力可突然提高 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 糖尿病性白内障 § 分类:真性糖尿病性白内障和糖尿病患者 的年龄相关性白内障 § 病因:糖尿病时血糖增高,晶状体内葡萄糖 增多,葡萄糖转化为山梨醇,山梨醇不能透 过晶状体囊膜,在晶状体内大量积聚,使晶 状体内渗透压增加,吸收水分,肿胀变性,导 致混浊 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 糖尿病性白内障的临床表现 § 糖尿病患者的年龄相关性白内障较多见, 与无糖尿病的年龄相关性白内障相似,但 发生较早,进展较快,容易成熟 § 真性糖尿病性白内障多发生在30岁以下, 双眼发病,进展迅速,晶状体在数天、数周 或数月内全混浊 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 手足搐搦性白内障 § 病因:又称低钙性白内障,由于血清钙过低 引起如先天性甲状旁腺机能不足或甲状腺 手术中甲状旁腺受损或营养障碍,使血清 钙过低,低钙增加了晶状体囊膜的渗透性, 影响晶状体代谢 § 临床表现:手足搐搦,骨质软化和白内障 § 治疗:补钙、手术 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 白内障手术前检查 § 全身:血压;血糖(150mg%以下);心电图、 胸片、肝功等检查排除严重的心、肺和 肝疾病;血尿常规及凝血功能 § 眼部:视功能检查:视力、光定位;裂隙灯 检查:检查角膜,除外虹膜炎症;散瞳后裂 隙灯检查:晶状体混浊情况; 眼压;测量角膜曲率和眼轴长度,以计算 IOL度数;眼部超声 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society § 糖尿病性白内障一定要将空腹血糖值降 至7.2mmol/L(130mg%)左右方可手术。 如果糖尿病控制不良,手术时容易破囊、 前房出血、玻璃体出血、继发性青光眼 、后发性白内障、尤其是增殖性视网膜 病变的发生。若血糖控制不理想,术后视 力显著不佳 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 白内障手术的术式 § 白内障囊内摘除术 § 白内障囊外摘出术 § 人工晶体植入术 § 超声乳化白内障吸除术 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 人 工 晶 体 的 优 点 § 物像放大小,可用于单眼无晶体眼 § 术后迅速恢复视力,可建立双眼单视及立 体视觉 § 周边视野正常,无环形暗区 § 不需戴入,摘出等操作 § 儿童外伤障可预防弱视 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 小切口白内障手术的定义 § 白内障摘除方法及所需的切口 :ECCE:11.0mm;PEA:2.5-3.2mm § 人工晶体植入术所需的切口:常规 PMMA:6.0-7.0mm,小直径PMMA5.0-5.5mm, 折叠人工晶体2.8-4.0mm § 小切口:PEA+小直径IOL或F-IOL的手术切 口,即5.5mm以下的切口 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 小切口白内障手术的优点 § 切口小、愈合快、早期恢复视功能 § 减少术后散光的发生 § 近于闭合式手术,减轻术后炎症 § 操作方便,节省时间 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 术 后 护 理(一) § 饮食:术后给易消化的软食,禁食大虾、 螃蟹等食物,并保持大便通畅 § 术后第一日开始术眼用Mydrin-P散瞳,以 活动瞳孔,每日早晚各一次。每次点药后 要压迫泪囊部3-5分钟,点药后20分钟要 观察瞳孔有无散大.一个月后视眼部情况 可改为每日一次,直至三个月 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 术 后 护 理(二) § 术后第一日开始用抗生素及激素类眼药水交 替点眼,每日各4-6次,共2周,以后逐渐减量约 1个月,视炎症反应情况适当延长或缩短用药 时间 § 术后一个月内,避免眼部外伤,睡前戴眼罩 § 根据眼压情况决定是否用降眼压药物 § 术后早期注意有无眼内感染 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 术 后 护 理(三) § 术后一周内每日观察,若无异常5-7天可 出院,出院后一周应复查一次,以后半个 月、一个月、三个月、半年各复查一次, 如有异常随时来诊 § 术后两周内不允许洗头,一个月内不准剪 头,洗脸时注意不要将水溅入眼内 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 青光眼(Glaucoma) § 定义:当眼球内的压力 (眼压)超过了眼球内 部组织特别是视神经 所能承受的压力,引起 的视神经萎缩和视野 缺损 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 眼 压(IOP) § 是眼球内容物作用于眼球壁的压力 § 正常眼压的范围: 1.47-2.79kpa(11-21mmHg) § 高眼压症和正常眼压性青光眼 § 高眼压并不都是青光眼,正常眼压也不能 排除青光眼
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