2眼科学课件corneadisease单击此处编辑母版标题

1、Corneal DiseasesXu Lingjuan 徐玲娟Department of Ophthalmology, Tongji Hospital1Professor Xie Lixin(谢立信) ，Academician of the Chinese academy of engineering, famous expert of corneal diseases2The eyes are the windows of the soulThe cornea is glass of the window!3角膜在裂隙灯显微镜下的成像4OCT: optical coherence tomog

2、raphy5section plan Introduction Anatomygross appearance slice61. 上皮层上皮层 Epithelium2. 前弹力膜前弹力膜 Bowmans membrane3. 基质层基质层 Stroma4. 后弹力膜后弹力膜Descemets membrane5. 内皮细胞层内皮细胞层 endothelium7EpitheliumregenerateBowmansmembraneNOT regeneratestromaNOT regenerateDescemets membraneregenerateendotheliumNOT regener

3、ate81. Epithelium2. Bowmans membrane3. Stroma4. Descemets membrane5. endothelium6. Dua 膜？膜？New progressHarminder DuaDua膜Why is the cornea transparent ? “pump” function by the endotheliumBarrier function of the endothelium and epithelium De-turgescence Avascularity (no vessels) There are no blood ves

4、sels in the cornea 1112 symblepharoncloudybarrierrefractionsensationIntroduction physiology 13 Sampling survey for the disabled, 29 provinces 1987 blind person 0.43 % Corneal blindness 15.38 % Corneal blindness is the second leading cause of blindnessEpidemiology14introduction炎症炎症 inflammation变性和营养不

5、良变性和营养不良Degeneration and dystrophy肿瘤肿瘤 tumor先天异常先天异常 congenital anomalies Contentsintroductionthree important types15KeratitisKeratitis16Etiology and classification Etilogy： 1 outside： corneal epithelium damage + pathogenic microorganism infection 2 inside： autoimmune disease, graft versus host dise

6、ase 3 Local spread: conjunctivitis, scleritis, rainbow nasociliary inflammation 17 Classification: 1 Cause: bacterial, viral, fungal, immunity, exposure, etc 2 Morphology : dendritic, maps, disk keratitis, etc 。 3 Region: borderline keratitis, shallow keratitis, Corneal endotheliitis, stromal kerati

7、tis18Clinical Manifestation 19 SignsRed, swell, fever, pain, dysfunction u 睫状充血睫状充血 Ciliary injection u 混合充血混合充血 Mixed injectionu 角膜浸润角膜浸润 Corneal infiltrationu 角膜溃疡角膜溃疡 Corneal ulceru前房积脓前房积脓 Hypopyon20Symptoms1.疼痛疼痛 pain2.异物感异物感 foreign body sensation3. 视力下降视力下降decreased vision4.畏光畏光 photophobia5.

8、 流泪流泪 tearing6. 眼红眼红 redness7. 分泌物增加分泌物增加 discharged secretions21 Etiology p Infectionp systemic diseasep local ocular disease 22Protective factorseyelids & eyelashestear flow tear film intact epitheliumdestroyed?231. InfectionContact lens hypoxia increase corneal temperature decrease tear flow

9、trauma weaken protection24bacteria fungiAmoeba virus252. Systemic diseaseskeratoconjunctivitis sicca角结膜干燥症角结膜干燥症(patients with Rheumatoid )263. Local ocular diseasestrachomaConjunctiva:InjectionFolliclesPapillary hyperplasia Cornea:Epithelial keratitisInfiltration of corneal epitheliumVascular pannu

10、s (血管翳血管翳)27 Pathology transparent, smooth, healthy white , opacity ?28p Progressive infiltration stage 浸润期浸润期p Active ulceration stage 溃疡形成期溃疡形成期p Regression stage 溃疡消退期溃疡消退期p Healing stage 愈合期愈合期29Process：病理过程病理过程Stage 1: Progressive infiltration stage30Infectious agents invasioncongestioninfiltra

11、tion( Infectious agents invade cornea )(The vessel of corneal limb congest ) ( The inflammatory cells infiltrate into the epithelium and stroma )31病理过程病理过程Stage 2: Active ulceration stage32necrosissloughingulcer+There is necrosis and sloughing of epithelium and stroma, which creates a corneal ulcer.

12、 33If the ulcer penetrate deeper into the cornea, what will happen? 34病理过程病理过程perforation35descemetocele后弹力层膨出后弹力层膨出iris prolapse虹膜脱出虹膜脱出36病理过程病理过程Stage 3: Regression stage37Infectious agents eliminated progression of ulcer stoppedVascularization occur38病理过程病理过程Stage 4: Healing stage39Corneal nebula

13、角膜云翳角膜云翳Corneal macula角膜斑翳角膜斑翳Corneal leucoma角膜白斑角膜白斑40Corneal nebulaCornealmaculaCornealleucoma41Adherent leucoma 粘连性角膜白斑粘连性角膜白斑The iris sticks to the corneal scar Corneal perforation Iris was washed out to the hole of cornea heal42Corneal staphyloma 角膜葡萄肿角膜葡萄肿Intraocular pressure may rise greatly

14、Adherent leucoma will bulge outward 43角膜浸润 角膜溃疡 角膜瘢痕 角膜穿孔 角膜瘘眼球萎缩 进展 进展愈合 进展愈合浸润吸收进展过程44Diagnosisucase history.important for etiological diagnosisuclinical manifestation.easyu laboratory testcorneal scrapinguMorphologic diagnosis of corneal lesionsexperience45uA history of trauma, foreign bodies and

15、 abrasion (BK and FK)uThe keratitis of herpes simplex infection is often recurrent (HSK)uA history of contact lenses wearing (Acanthamoeba kertitis)46corneal scraping 角膜刮片角膜刮片dropping some dicaine in the eye waiting for about 5 minutes using a surgical blade to scrape the corneal lesion The corneal

16、smears are stained with Gram and Giemsa 12344712434849confocal microscopy共焦显微镜共焦显微镜50hyphaeTreatment p controlling infectionp reducing inflammatory reactionp promoting ulcer healingp inhibiting scar proliferation 51 Controlling infection (antimicrobial drugs)Topical therapySubconjunctival injectionS

17、ystemictherapy 52Topical administration is efficient to deliver drugs to the cornea ophthalmic solutionqid, q2h, q1hointmentqn, bid53 reduce inflammatory reactionp Corticosteroid used to reduce inflammatory reactionp Double-blade swordp Infection well controlled, Low-dose topical corticosteroids can

18、 be usedp Cant be used for patients with acute bacterial keratitis and fungal keratitis p reduce inflammatory reactionpromote the spread of infections 54p Surgical therapy Corneal transplantationSometimes the medical treatment failed and the corneal perforation occurred. And then the surgical manage

19、ment may be required.55Corneal debridement 角膜清创术56Corneal transplantation57细菌性角膜炎细菌性角膜炎 Bacterial keratitis真菌性角膜炎真菌性角膜炎 Fungal keratitis病毒性角膜炎病毒性角膜炎 Herpes simplex keratitis阿米巴性角膜炎阿米巴性角膜炎 Amoeba keratitis58Bacterial keratitisp Risk factorsp local ocular diseasesp systemic diseasesp Protective factor

20、sp eyelids p tear flow, tear filmp intact epithelium59Pseudomonasaeruginosa Staphylococcusepidermidis Staphylococcusaureus 绿脓杆菌表皮葡萄球菌金黄色葡萄球菌p The main bacterial species caused keratitis in China 60 1. onsetacute2. symptomsvariety3. signs ulcer formation hypopyon corneal perforationp Clinical manifes

21、tation61G+G-代表代表细菌细菌肺炎球菌肺炎球菌铜绿假单胞菌（绿脓杆菌）铜绿假单胞菌（绿脓杆菌）临床临床表现表现局灶性脓肿局灶性脓肿匐行性角膜溃疡匐行性角膜溃疡液化坏死性角膜溃疡液化坏死性角膜溃疡Pseudomonas aeruginosa Pneumococcal62p Treatmentp Diagnosisclinical manifestation+corneal scraping+ culturesAntibiotics1% atropineOther drugsSurgery 63Case informationPersonal information： Male，27y，

22、peasantAdmission time： June , 3th, 2016Main complaints： Something got into his left eye when he was working on the farm one day. The left eye was pain and red. 64Case informationPhysical examinationA chaff 糠糠 on the corneaCiliary injection 65Case informationDiagnosis:角膜异物角膜异物corneal foreign bodyTrea

23、tment : remove foreign bodyantibiotics66Case informationAdmission time 10 days laterClinical appearanceMain complaintsVision decreased greatlyBlack eye turned into white 67Case information laboratory examination corneal scraping fungi68Case informationdiagnosisFungal keratitis (FK)真菌性角膜炎真菌性角膜炎69真菌感染

24、角膜真菌感染角膜无功而返无功而返借窝下蛋借窝下蛋植物性外伤是真菌性角膜炎植物性外伤是真菌性角膜炎最常见的诱因！最常见的诱因！70Characteristics of corneal lesionulcer（溃疡）（溃疡）pseudopod （伪足）（伪足）immune ring（免疫环）（免疫环）Satellite lesion（卫星灶）（卫星灶）71Treatment Anti-fungal drugs reducing inflammation response 1% atropine solution Corneal transplantation72单纯疱疹病毒性角膜炎单纯疱疹病毒性角膜炎Herpes simplex keratitisp The corneal ulcer is like a branch of a treep This kind of keratitis can cause serious visual impairment p The blindness rate is No 1 in corneal