双语 眼睑病等

第四章眼睑病(Diseaseofeyelid)概述眼睑结构和功能复习处理眼睑病的注意事项

LidsReviewthestructureandfunctionofeyelids.Theeyelidsareimportantpartoffacialappearance.Weshouldconsideritintheprocedureofpalpebraldisease.

眼睑炎症(Palpebralinflammation)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、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Hordeolumacuteinflammationofeyelidcharactericedwithpain,noduleandpurulence.mostlycausedbyinfectionofstraphylococcusaureus.inner—tarsalgland;external—Moll’sorZeis’sglandClinicfinding:red,swelling,hot,pain.Treatment:localwarmcompression,whenabscessformate,incisionanddrainageshouldbedone.睑腺炎(hordeolum)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ChalazioncystomaofMeibomaingland.It’salipogranulomatousinflammationcausedbyblockageofexcretoryductsoftarsalglands.Clinicfinding:palpebralsubcutaneousroundmasswithdifferentsizes,noadhesionwithskin,abiteofelasticity.Treatment:Toinciseinconjunctivalsurfaceanddischargecontentandtoextractitscapsule.睑板腺囊肿(chalazion)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(squamousblepharitis)溃疡性睑缘炎(ulcerativeblepharitis)眦部睑缘炎(angular

blepharitis)睑缘炎(blepharitis)病毒性睑皮炎单纯疱疹病毒性睑皮炎（herpessimplexpalpebraldermatitis）带状疱疹病毒性睑皮炎（herpeszosterpalpebraldermatitis）眼睑位置、功能和先天异常

眼睑的正常位置眼睑紧贴眼球睑缘保持弧度，睫毛向前眼睑能紧密闭合上睑能上举上、下泪点贴泪阜Theeyelidscloselycontactwiththesufaceoftheglobe.Eyelashesofbotheyelidsareupwardanddownwardseparatelyintidyarrangement.Thesuperioreyelidcanelevate.Thesuperiorandinferiorpunctasituatedatanteriorlipofpalpebralmarginsininnercanthus眼睑位置、功能和先天异常

倒睫(trichiasis)与乱睫(aberrantlashes)睑内翻(entropion)睑外翻(ectropion)眼睑闭合不全(hypophasis)上睑下垂(ptosis)先天异常(congenitalabnormal)Entropion病因：瘢痕、先天、老年痉挛性临床表现：刺激症状、相应角、结膜损伤诊断治疗：手术

Etiology:cicatricialcontractionoftheconjunctivaortarsusbecauseoftrachomaandburn;seniledegenerationofpalpebraltissue.Clinicalfindings:photophobia,tearing,stabbingpain,palpebralspasm.Inseverecase,corneaandconjunctivalepitheliumbeexfoliated,evenconealstromabeopacity.Treatment:mostneedsurgery.Ectropion病因：瘢痕、老年性、麻痹性、机械性表现：溢泪、角结膜损伤，严重时伴闭合不全诊断治疗：手术睑外翻Etiology:scarformationonthepalpebralskin;paralysisoffacialnerveorsenilelaxationoforbicularisoculimuscleClinicalfindings:tearing,dry,severecasescausecorneaepitheliumdamage,andlagophthalmosTreatment:mostneedsurgeryPtosis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:排除重症肌无力治疗:手术Etiology:congenitalandacquiredClinicalfindings:Theupperlidcan’tbeelevatedandcoverupperpartofcornea>3mm;faceupword.Treatment:directedtoitsvariouscauses;congenitalptosisneedssurgery眼睑肿瘤(Palpebraltumor)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）

眼睑分裂痣黄色瘤基底细胞癌泪器病(DiseaseoftheLacrimalapparatus)流泪(lacrimation)溢泪(epiphora)泪液排出系统疾病

泪道阻塞和狭窄(stenosisoflacrimalpassage)新生儿泪囊炎(neonataldacryocystitis)慢性泪囊炎急性泪囊炎

急性泪囊炎(Acutedacryocystitis)Acutedacryocystitistakeplaceonthebasisofchronicdacryocystitis;areainthelacrimalsacappears:red,swollen,hot,pain.Whenpus-punctumappears,draingeisneededtodo.Wheninfectioniscontrolled,todooperationasthatofchronicdacryocystitis慢性泪囊炎

(chronicdacryocystitis)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,chronicrhinitis,nasalpolyp,hypertrophyofnasalconchaeClinicalfinding:epiphor,whencompressionalargeamountofmueopurulentsecretionrefluxfromthepunctaorlacrimalia.Clinicalmeaning:Chronicdacryocystitisasanocularfocusmakesconjunctivalsacinpollutedcondition,oncetheglobeisinjuriedoroperatedon,infectionbecomeseasy,severecomplicationwilltakeplace.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

Diseaseofsecretorysystem1)Dacryoadenitis:lesscommon2)Tumoroflacrimalgland眼表疾病

(ocularsurfacedisorder)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（tearfilm)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

Ocularsurface:AlltheexterapparatuswhichattendtomaintainahealthyprotectivesystemoftheglobeTear:includinglipidlayer,aqueouslayer,mucuslayer.Function:tomakethecorneaasmoothopticalsurfacebyabolishingminutesurfaceirregularitiesofitsepithelium;towetthesurfaceofthecornealandconjunctivalepithelium,preventingdamagetotheconjunctivalepithelialcell;toinhibitthegrowthofmicroorganismsontheconjunctivalandcorneabymechanicalflushingandtheantimicrobialactionofthetearfluid.Ocularsurfacedisorder(OSD):Generallyrefertothediseasesofimpairingnomalstructureandfunctionofcornealandconjunctivalsurface.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）

(dryeyesyndrome)

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。Clinicalfinding:scratchyorsandysensation,itchingorburningandphotosensitivity;rednessandpain,cornealandconjunctivalepitheliumdamage.Schirmertest:meartearsecretionTearfilmbreak-uptime:tomearthemucincontent.Twokinds:deficientproduction--aqueoesteardeficiency,ATD;overevaporation--meibomainglanddysfunction,MGDTreatment:ATD—artificialtear;;MGD—ophthalmicvehiclesofhighmolecularweight干眼症分类泪液生成不足(deficientproduction)(aqueoesteardeficiency,ATD)蒸发过强(overevaporation)(meibomainglanddysfunction,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（visualdisplaytermminal）结膜病(DiseaseoftheConjunctiva)

细菌性结膜炎

(bacterialconjunctivitis)

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

bacterialconjunctivitisHyperacutebacterialconjunctivitis:Etiology:Neisseriagonorrhoeae.Inadult,autoinfectionbyurethritis;innewbornbythebirthcanal.Clinicfinding:seroussecretion,purulent,thesymptomdevelopsquickly,corneaulcerformandevenperforation.Treatment:washingthoroughly,penicillinisdropedintotheeyebacterialconjunctivitisAcutebacterialconjunctivitisEtiology:diplococuspneumoniae,Koch-Weeksbacillusstaphylococcusandsoon.Clinicfinding:mostlybotheyesaffected,symptoms:tearing,sandysensation,burning,eyelidswellen,butnofolliclorpapillaryhyperplasia.Treatment:asthesameasaboveintroduced.Chronicconjunctivitis

Etiology:bacterialinfection,trichiasis,blepharitis,physicalandchemicalstimulation.Clinicfinding:itching,sandysensation,burning,secretionisn’tmuchmucous.Treatment:removethecause,treataccordingdifferentcause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

Trachomaisachronic,bilateralcicatrizingkeratoconjunctivitiscausedbychlamyditrachomatis.Clinicfinding:acuteperiod:tearing,photophobia,sandingsensation;sign:hyperemia,papillaryhyperplsia,follicles,cornealepithelitis.chronicperiod:hyperemiadecrease,papillaryhyperplsia,folliclesformation,graduallyscarformatnasalsulcusofupperpalpebralconjunctiva.Classification:stage1:Profressivestage,papillaeandfolliclesarecoexisted,theconjunctivaltissueofupperfornixisblurred,thereiscornealpannus.stage2:Regressivestage,fromthediscoveryofscartoalmostchangedintoscar,thereisonlyalittleactivelesion.stage3:Completecicatricialstage,cativelesiondisappearedcompletelyinsteadofscar,noinfectiviy.Complications:Entropionandtrichiasis,Symblepharon,Blepharoptosis,Parechymatousxerosisofconjunctiva,Chronicdacryocystitis,CornealulcerTreatment:antibioticsdropsfortropicaltreatment,forcomplicationsneedsurgery.病毒性结膜炎

(viralconjunctivitis)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:adenovirus8,19and37Clinicalfinding:palpe