眼科学教学课件：Conjunctival disease

Conjunctivaldisease1.Generalintroduction1.1Summary

palpebralconjunctivaconjuctiva

bulbarconjunctiva

fornixconjunctiva

conjunctivitis:themostcommonconjunctivaldisease1.2EtiologicalfactorMicroorganismsinfectionPhysicalorchemicaldamageAllergicfactorsMalnutrition,etc1.3Classification

Etiological：infectional、immune、chemical、secondary、system、noreasonspeed：

hyperacute、acute（<3W）、subacute、chronic（>3w）appearance：

Papillarhypertrophy、Follicle、Membranesorpseudomembranes、scar、Granulomas1.4ClinicalmanifestationSymptom(症状)“Foreignbody”sensation,异物感Scratchingorburningsensation,烧灼感

Itching,痒Ifcorneabeinvolvedineyeache,眼痛Tearing,流泪Photophobia,

畏光Blur视物模糊Signs(体征)Hyperemia

充血Threetype：conjunctivalcongestionciliarycongestionmixedcongestionconjunctivalcongestion（结膜充血）ciliarycongestion（睫状充血）originconjunctivalposterior

arterysanteriorcilliaryarterypositionzoneofthefornixCorneallimbusappearanceReticulate,morevascularbranch,brightredradiate、lessvascularbranch,darkredmobilityMovablewithconjunctivaNon-movablewithconjunctivaReponsetoADExtinctfastExtinctmildlyChemosis

水肿

secretion分泌物根据分泌物性质判断病因Bacterial：呈无定形的浆液、粘液或脓性Allergical：呈粘稠丝状viral：呈水样或浆液性gonococcal：大量脓性分泌物

分泌物涂片、培养可明确病因接触传染subconjunctivalhemorrhage结膜下出血Papillarhypertrophy乳头增生NonspecificFollicle滤泡Focallymphoidhyperplasia,roundedavascularwhiteorgraystructure（5）乳头增生、滤泡形成乳头增生Papillarhypertrophy滤泡形成Follicle分布睑结膜或角结膜缘上睑结膜，或下穹窿结膜，或角结膜缘外观扁平状或圆顶状，多为天鹅绒样外观，大于1mm为巨大乳头多为0.5-2mm，白色或灰白色圆形隆起的外观成因增生肥大的上皮皱叠或隆凸而成，为非特异性体征淋巴细胞反应引起特点中心有扩张的毛细血管到达顶端，成轮辐状散开中央无血管，小血管从其边缘绕行常见病上睑：春季结膜炎，或结膜对异物刺激的反应下睑：过敏性结膜炎病毒衣原体寄生虫等结膜炎；或为生理性改变（儿童青少年）Membranes膜orpseudomembranes假膜：formedbyfibriousexudationandcoherewithpalpebralconjunctiva,theformerbindingwithconjunctivastronglyandcanbestrippeddifficultly,butthelatterlooselyandeasily.pseudomembranesMembranesConjunctivalscar:结膜瘢痕onsetonlywhenconjunctivalmatrixwasdamaged.

Granulomas肉芽肿Preauricularlymphadenopathy

耳前淋巴结肿大usuallyappearinviralconjunctivitis，PseudoptosisinfiltrationofMuller’smuscle

假性上睑下垂1.5CheckinganddiagnosisClinicalexaminationCytologicalexaminationBacterialconjunctivitis:polymorphonuclearleukocytes,Viralconjunctivitis:mononuclearandlymphocyte,Chlamydial（衣原体性）conjunctivitis:neutrophilandlymphocyte,Allergicalandvernalconjunctivitis:EosinophiliaandbasophilEtiologicalexamination

themicroscopic

examinationofconjunctivalsecretionsmearandscrapings（分泌物涂片、结膜刮片）,whennecessary,fractionalcultivationandantibioticsensitivitytestsaredesirable1.6Treatment

Dependingonmicrobiologicagent.Topicaltherapyiscapitalandassistswithsystemictherapy

TopicaltherapyEyedrops:Thecapitalrouteofadministration。Itshouldbeusedfrequentlyinacutetimeanddecreasedfrequencywhenstateimproving。

Eyeointment:apersistenttherapeuticaction,butitcanmakepatientfeelfoggedvision–medicationatbedtimeConjunctivalsacflushing:whenconjunctivalsecretioniscopious,flushingisnecessarywithnon-stimulaterinse,suchas3%boricacidsolution、1-2timeseveryday.WrappingisinhibittedinacuteconjunctivitissystemicdrugsItisnotnecessaryincommonconjunctivitis,butingonococcal（淋菌性）andchlamydial（衣原体）conjunctivitisit’snecessary1.7PrognosisandpreventionMostconjunctivitiscanbecuredandhasnosequelae,insomesevereorchroniccases,symblepharon（睑球粘连）ordryeyecanoccur.Medicalmembersshoudwashhandsaftercheckingpatients,thewashingutensilofpatientsshouldbeseparatedandsteriled,inaddition,healthfuladministrationofpublicplaceshouldbestrengthened

2.Bacterialconjunctivitis

inflammationandpurulentexudation

hyperacute---purulent(<24h)acutemucopurulentorsubacute(severalhourstodays)chronic(severaldaystoweeks)分类发病快慢病情常见病原菌超急性（24小时内）重度奈瑟淋球菌奈瑟脑膜炎球菌急性或亚急性（几小时至几天）中至重度流感嗜血杆菌肺炎链球菌Koch-Week杆菌慢性（数天至数周）轻至中度金黄色葡萄球菌Morax-Axenfeld双杆菌变形杆菌大肠杆菌假单胞杆菌Hyperacute

Pathogenisis:Neisseriagonorrhoeae淋球菌ormeningococcus脑膜炎球菌

Characteristic:stronginfectivity,Destructiveness;

profusepurulentexudateincubationperoidseveralhours，2-3days,developrapidlyClinicalsymptomsandsigns

symptoms:pain,photophobia,tearingsigns:eyelidsedema,conjunctivalhyperemia

chemosis

conjunctivacanprotrudeoutoflidfissurewhenchemosisstronglySecretion:fromserousorhematodestopurulent,andflowfromlidfissurecontinually。After10daysorseveralweeks,purulentexudatedecreasegradually。

Severecornealdamage,perforationorlossofeye

Preauricularlymphadenopathy耳前淋巴结肿大Septicemia败血症ormeningitis脑膜炎。AcuteorsubacuteconjunctivitisPathogenicbacteria

streptococcuspneumoniae,Koch-weeksbacillus,hemophiliesinfluenzae,staphylococci,etc。流感嗜血杆菌,Koch-Week杆菌,肺炎链球菌characteristicoftenoccursinepidemicformandiscalled“pinkeye”;acuteonset;botheyesinvasionorseparatedby1-3days;symptoms:tearing,foreignbodysensation,burningsensationSigns:

Secretion

iscopious,sothelidsareoftenfirmlystucktogetheronwakingHyperemia:especiallyinfornixandbulbarconjunctivaPseudomembraneormembraneChronicHyperemiamildlyandlittlemucoussecretionSymptoms:Itching,foreignbodysensation,eyestrain（眼疲劳）.Signs:hyperemia,littlepapillaryhypertrophyandfollicle

SystemictherapyisasimportantastopicaltherapyTopicaltherapy:conjunctivalsacflushingfrequentlywithsalineor1：10000liquorpotassicpermanganate（高锰酸钾）or3%boricacidwhenconjunctivalsecretionisprofuse.Eyedropsandeye-ointment：properantibioticapplicationcanshortencourseofdisease,eyedropsapplicationfrequentlyTreatmentmentSystemictherapy:systemicantibioticapplicationisemphasizedinNeisseriabacteriaPreventionHygiene卫生Patientsinacutephaseseparated隔离Cleanse消毒Protecthealthfuleye,etc.保护健眼3.Chlamydialconjunctivitis

衣原体性结膜炎TrachomaAchronicinfectivekeratoconjunctivitisEpidemicbeforethe1950sinourcountry,anditisthefirstcauseofblindnessDropobviouslyafterthe1970sandonlyappearinremoteareanow.Etiologicalfactorchamydia

(antigenictypeA、B、C、orBa）Inclusionconjunctivitis包涵体性结膜炎1.chamydia（D－K型）。2.Adult：潜伏期1－2周，症状可轻可重，但结膜体征明显：以乳头增生和滤泡形成为主其结膜肥厚和滤泡可持续存在3－6个月。可有结膜瘢痕，但无角膜瘢痕。可伴其他部位衣原体感染；Infant：潜伏期为生后5－14天，有胎膜早破者生后1天即可出现，多为双眼，大量脓性分泌物，持续2－3月后可出现白色光泽滤泡，重者可有伪膜形成及芥末斑痕化，并可有角膜瘢痕及新生血管出现，可伴全身其他部位衣原体感染。3.Dignosis：根据临床表现容易诊断。实验室检查：在结膜上皮的胞浆内检出嗜碱性包涵体，有助于鉴别诊断。4.

Treatment：强调局部治疗与全身治疗结合。5.Prenosis加强卫生宣教；提高产前护理质量，加强生殖道衣原体感染的控制和治疗；药物预防：如1％硝酸银、0.5%红霉素、2.5%聚烯吡酮碘等。4.ViralconjunctivitisAdenovirusconjunctivitis

AcutefollicularconjunctivitisStronginfectiveAppearin2types

EpidemickeratoconjunctivitisPharyngoconjunctivalfeverEpidemickeratoconjunctivitisCausedbyadenovirustypes8,19,29and37(subgroupDofthehumanadenoviruses)Clinicalmanifestation

Incubationperoid:5-7days,usuallybilateral,thewholecoursecontinue3-4weeksSyptoms:foreignbodysensation,pain,photophobia,tearingSigns:eyelidsedema,obvioushyperemia,chemosis,muchfolliclesandsubconjunctivalhemorrhageoftenappearingwithin48h,Pseudomembraneormembrane,Preauricularlymphadenopathyischaracteristic,Corneal:epithelialkeratitis,roundsubepithelialopacities.流行性角结膜炎Treatment

thereisnospecifictherapyatpresent,topicaladministrationismainmethod,suchasantiviraleyedropsColdcompresses（冷敷）andangiotonica（血管收缩）willrelievesomesymptoms.EpidemichemorrhagicconjunctivitisCausedbyenterovirustype70,self-limitedStronginfective,epidemicwidelyin1971inourcountryClinicalmanifestion

symptoms:pain,photophobia,tearing,red,foreignbodysensationSigns:hyperemia,chemosis,copiousfollicles,subconjunctivalhemorrhage(onsetfromtheupperconjunctiva),preauricularlymphadenopathyTreatment:sametoepidemickeratoconjunctivitis5.ImmunologicconjunctivitisVernalconjunctivitis

it’sabilateralallergicdiseasethatusuallybeginsintheprepubertalyears（青春期）andlastsfor5-10y,moreoftenerinboysthaningirls.seasonal,repeated

Clinicalmanifestion

symptom:extremeitchingSigns:devidinginto3typesaccordingtodiseasedregionasfollowing:Tarsalconjunctivaltype