1、结膜病,Basic Knowledge,The conjunctiva is a thin, translucent mucous membrane that lines the posterior surfaces of eyelids and covers the noncorneal portion of the anterior segment of the eye. Bulbar conjunctiva Palpebral conjunctiva Superior and inferior fornices,结 膜,结膜炎conjunctivitis,Epidemiologyone
2、of the most frequent eye disorders. Etiology of conjunctivitisInfectious cause: bacterium, virus, fungal, parasite, chlamydiaNoinfectious cause: chemical, mechanical, irritative, allergic .,conjunctivitis,Clinical manifesitation Symptoms of conjunctivitisOcular discomfortItching Foreign-body sensati
3、onBurningPhotophobiaLacrimationPain,conjunctivitis,Clinical manifesitation Signs of conjunctivitis injection and chemosis increase of exudates (purulent, mucopurulent, stringy) subconjunctival hemorrhage papillary hyperplasia follicle formation. (lymphatic hypertrophy) membrane or pseudomembrane for
4、mation swollen lymph nodes,睑结膜充血,结膜水肿,结膜滤泡,脓性分泌物,膜性结膜炎,结膜充血与睫状充血鉴别,结膜充血 睫状充血结膜血管 角膜缘深层血管网鲜红色 暗红色近穹隆部明显 近角膜缘明显手指推动结膜可移动 手指推动结膜不可移动0.1肾上腺素充血消失 0.1肾上腺素充血不消失结膜炎 角膜炎，虹睫炎，急闭青，etc,conjunctivitis,Examination and Diagnosis history and clinical examination laboratory exam: Epithelial scrapingSmear of exudates
5、 细菌感染中性粒细胞 病毒感染单核细胞，淋巴细胞为主 衣原体感染包涵体,中性粒细胞和淋巴细胞等量 过敏性嗜酸性粒细胞或嗜碱性粒细胞,conjunctivitis,Treatment Remove the cause Eyedrops Ophthalmic ointment Clearing conjunctival sac Systemic treatmentDont cover in acute stage,1. Bacterial Conjunctivitis,Classification based on the course of disease.Hyperacute conjunct
6、ivitis (24h)Acute or subacute conjunctivitis (xhxd)Chronic conjunctivitis (xdxw),Hyperacute bacterial conjunctivitis,Etiology:gonococcal meningococcus Symptoms and Signs: very frequenty encountered(10h3d) injection and chemosis, purulent exudates, pseudomembrane, keratitis， corneal perforation. （ se
7、vere case ）,淋菌性结膜炎,Hyperacute bacterial conjunctivitis,Diagnosis:ManifestationSmear of exudates (only in severe, uncertain, or persistant cases)Treatment:Local: NS, 1:10000kMnO4, antibiotic eyedrops.Systemic: broad-spectum antibiotic (PG. ceftriaxone etc.),Actue or subacute conjunctivitis,Etiology:
8、pneumococcus, staphylococcus, streptococcus. Symptoms and Signs:Frequently encountered (13d)Injection and chemosis. Mucopurulent exudates.severe case : Pseudomembrane, subconjunctival hemorrhage, keratitis, systemic symptoms.,Actue or subacute conjunctivitis,Diagnosis:manifestationsmear of exudates
9、or epithelial scraping Treatment:local: clearing conjunctival sac, eyedrops, ointment.Systemic: antibiotics,Chronic Conjunctivitis,Etiology: Infectious: bacterial Noinfectious: Smoke, chemical fumes and smog Exposure to wind and sun ,inadequate ocular protection from ultraviolet Uncorrected refracti
10、ve errors and ocular muscle imbalance Prolonged topical instillation of drugs Unenough sleepingetc.,Chronic Conjunctivitis,Symptoms and Signs: Symptoms:Itching, foreign-body sensation, fatigue Signs:conjunctival redness, papillary hyperplasia and follicle formation, white-foam exudates. Treatment: (
11、difficult)Remove the causesEyedrops or ophthalmic ointment,2. Chlamydial conjunctivitis,Trachoma Inclusion conjunctivitis,Trachoma,Trachoma is a chronic, bilateral, epidemic conjunctivitis caused by chlamydia trachomatis. EpidemiologyWarm moist climatePoor standard of living Poor hygiene,Trachoma,Cl
12、inical Manifestation Acute stage: same as acute conjunctivitis with swollen lymph nodes. Chronic stage: mild irritative symptomsSigns: conjunctiva thickness, papillary hyperplasia, follicle formation (palpebral conjunctiva of upper lids)corneal pannus, trachomatoun cicatrisation, and complications .
13、,角膜血管翳,睑结膜滤泡及瘢痕,结膜瘢痕,Trachoma,Complications: cicatrical entropion and trichasis ptosis symblepharon xerosis of the conjunctiva and cornea chronic dacryocystitis corneal scarring,Trachoma,Diagnosis: 2 of them papillary and follicle on the upper lids corneal pannus trachomatous cicatrisation complicat
14、ionsLaboratory exam: epithelial scraping.,Trachoma,Stage I (进行活动期):papillary, follicle, pannus Stage II(退行期):partial cicatrization Stage III(完全瘢痕期): complete cicatrisation,Trachoma,Differential Diagnosis 均无角膜血管翳 Chronic follicular conjunctivitis 儿童,少年 下穹隆 Vernal keratoconjunctivitis 乳头大扁平， 嗜酸性粒细胞 In
15、clusion conjunctivitis下穹隆，下睑结膜 Giant papillary conjunctivitis. GPS 角膜接触镜配戴史,巨大乳头性结膜炎,Trachoma,TreatmentChlamydia organisms are sensitive to sulfonamides, tetracycline and erythromycine. Local: eyedrops and ointment (34m) Systemic: antibiotics (34w) Complications:,3. Viral conjunctivitis,Epidemic ker
16、atoconjunctivitis Epidemic hemorrhagic conjunctivitis,Viral conjunctivitis,Epidemic Epidemic hemorrhagickeratoconjunctivitis conjunctivitis Etiology 腺病毒 肠道病毒 Signs 急性滤泡性结膜炎 急性滤泡性结膜炎+ +耳前淋巴结肿大 耳前淋巴结肿大+ +角膜浸润 结膜下出血 Smear 单核细胞增多 单核细胞增多 Treatment 抗病毒，对症支持 抗病毒，对症支持,4. Immunolgic conjunctivitis,vernal ker
17、atoconjunctivitis EpidemiologySeasonal, Recurrent, 20y MaleEtiology致敏原,vernal keratoconjunctivitis,Clinical Manifestation Symptom:intolerable itching Signs: 1. palpebral form2. limbal form3. mixed form,春季性结角膜炎 vernal keratoconjunctivitis,Diagnosis 男性青少年多见，季节性反复发作，奇痒 上睑结膜乳头粗大，呈铺路石样改变，角膜缘胶样结节 嗜酸性粒细胞 T
18、reatment Eyedrops (corticosteroid, cromolyn sodium, etc) Cold compress, change the environment.,Pterygium,A pterygium is a wing-shaped fibrovascular connective tissue overgrowth encroaching on the cornea from the conjunctiva in the interpalpebral fissure. Etiologythe cause is unknown. Related to irritation of sun and wind, outdoor workers.,翼状胬肉,思 考 题,结膜炎的常见症状及体征。 沙眼的临床表现、诊断及分期。 沙眼的后遗症和并发症。 细菌性结膜炎、衣原体性结膜炎、病毒性结膜炎及免疫性结膜炎的区别。,结膜下出血,
