眼结膜疾病课件.ppt

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1、Conjunctival diseases医学课件园 The anatomy of conjunctiva nPalpebral 睑结膜睑结膜nBulbar 球结膜球结膜nFornical 穹隆结膜穹隆结膜医学课件园 Histology 组织学组织学 不角化的鳞状上皮不角化的鳞状上皮 上皮层上皮层 杯状细胞杯状细胞黏液黏液粘膜粘膜 腺样层腺样层浆液浆液krause&Wolfring 固有层固有层 （血管、淋巴）纤维层（血管、淋巴）纤维层滤泡滤泡 医学课件园 Conjunctivitis nCause:Microorganism：病毒、细菌、衣原体病毒、细菌、衣原体Others:化学、物理、化学

2、、物理、过敏过敏医学课件园 The comparison of ciliary congestion and conjunctival congestionnciliary congestion角膜缘深层血管网角膜缘深层血管网深红色深红色固定固定近角膜缘明显近角膜缘明显0.1%肾上腺素不变肾上腺素不变角膜、前房疾病角膜、前房疾病nconjunctival congestion表面的结膜血管表面的结膜血管鲜红色鲜红色可推动可推动近穹隆部明显近穹隆部明显0.1%肾上腺素消失肾上腺素消失结膜、眼睑疾病结膜、眼睑疾病医学课件园 Diagnosis and Manipulations 医学课件园 Hyp

3、eracute bacteril conjunctivitisnCause:淋球菌：生殖器眼或生殖器手眼淋球菌：生殖器眼或生殖器手眼脑膜炎球菌：血源脑膜炎球菌：血源nManifestation:双眼，症状重，进展快双眼，症状重，进展快畏光流泪、眼睑红肿畏光流泪、眼睑红肿结膜充血、水肿、炎性假膜、脓漏眼结膜充血、水肿、炎性假膜、脓漏眼淋巴结、角膜穿孔淋巴结、角膜穿孔其他部位化脓炎症其他部位化脓炎症医学课件园 Acute&subacute conjunctivitis(Acute catarrhal conjunctivitis)nCause:肺炎链球菌、肺炎链球菌、Koch-Weeks杆菌、流感

4、嗜血杆菌、金葡杆菌、流感嗜血杆菌、金葡nManifestation:“红眼病红眼病”，春秋，散发或流，春秋，散发或流行行急、双眼、急、双眼、全身症状全身症状流泪、异物、灼痛，粘液或流泪、异物、灼痛，粘液或脓性分泌物脓性分泌物假膜：肺炎链球菌、假膜：肺炎链球菌、Koch-Weeks杆菌杆菌角膜浸润：流感嗜血杆菌角膜浸润：流感嗜血杆菌医学课件园 nIn acute conjunctivitis the epithelium is edematous and infiltrated by polymorphonuclear leukocytes.(Inset)Bilateral acute conj

5、unctivitis with purulent exudate医学课件园 Acute&subacute conjunctivitis(Acute catarrhal conjunctivitis)nDiagnosis:分泌物涂片或结膜刮片分泌物涂片或结膜刮片nTreatment:self limitG+:氯霉素、利福平、氯霉素、利福平、磺胺醋酰钠、红霉素磺胺醋酰钠、红霉素G-:庆大霉素、环丙沙星、氧氟沙星庆大霉素、环丙沙星、氧氟沙星Prevention 预防：预防：医学课件园 Viral conjunctivitisnAcute follicular conjunctivitis：流行性角结

6、膜炎流行性角结膜炎流行性出血性结膜炎流行性出血性结膜炎咽结膜热咽结膜热单疱病毒性结膜炎单疱病毒性结膜炎nSubacute&chronic conjunctivitis传染性软疣传染性软疣水痘带状疱疹性水痘带状疱疹性麻疹性角结膜炎麻疹性角结膜炎医学课件园 Epidemic hemorrhagic conjunctivitisnCause:70型肠病毒偶为型肠病毒偶为A24柯撒奇病毒柯撒奇病毒nEpidemiology:爆发流行，自限爆发流行，自限nManifestation:24小时发病，持续小时发病，持续10天天畏光、流泪、眼红、异物感、疼畏光、流泪、眼红、异物感、疼眼睑、结膜充血，水肿，滤泡

7、，淋巴结，结膜下出眼睑、结膜充血，水肿，滤泡，淋巴结，结膜下出血，角膜炎，全身不适血，角膜炎，全身不适nDiagnosis:nTreatment:抗病毒眼药水，敷抗病毒眼药水，敷nPrevention 医学课件园 Chlamydial conjunctivitisnTrachoma沙眼沙眼（沙眼衣原体抗原型（沙眼衣原体抗原型A,B,C,Ba）n包涵体性结膜炎包涵体性结膜炎(沙眼衣原体抗原型沙眼衣原体抗原型DK)n性病淋巴肉芽肿性结膜炎性病淋巴肉芽肿性结膜炎(沙眼衣原体抗原型沙眼衣原体抗原型L1,L2,L3)医学课件园 TrachomanDefinition:沙眼衣原体引起的慢沙眼衣原体引起的慢

8、性传染性角结膜炎性传染性角结膜炎(接触接触)nIntroduction:汤非凡，张晓楼汤非凡，张晓楼nManifestation:nAcute stage:n流泪、眼红、疼、异物感、粘液流泪、眼红、疼、异物感、粘液脓性分泌物脓性分泌物n淋巴结，乳头，滤泡淋巴结，乳头，滤泡（部位）（部位）nChronic stage:n乳头，滤泡乳头，滤泡,结膜肥厚，白色线样结膜肥厚，白色线样瘢痕，角膜浸润，血管翳瘢痕，角膜浸润，血管翳医学课件园 Complications nEntropion内翻倒睫内翻倒睫nPtosis上睑下垂上睑下垂nAdhension 睑球粘连睑球粘连nXerophthalmia 实质

9、性实质性角膜干燥症角膜干燥症nChronic Dacryocystitis n慢性泪囊炎慢性泪囊炎nCorneal opacity 角膜角膜混浊混浊医学课件园 Diagnosisn符合其中符合其中2项：项：上睑结膜滤泡上睑结膜滤泡角膜缘滤泡及后遗症角膜缘滤泡及后遗症（herbert 小凹）小凹）睑结膜瘢痕睑结膜瘢痕角膜缘上方血管翳角膜缘上方血管翳n实验室：实验室：包涵体包涵体n分期：分期：I进行活动期进行活动期II退行期退行期III瘢痕期瘢痕期医学课件园 Differentiation diagnosisnChronic follicular(conjunctivial folliculosi

10、s)nvernal nInclusion nGiant papillary 医学课件园 Immunologic conjunctivitisnVernal keratoconjunctivitisnAllergic conjunctivitisnPhlyctenular keratoconjunctivitisnAutoimmunologic conjunctivitisSjgren syndrome结膜类天疱疮结膜类天疱疮Stevens-johnson syndrome医学课件园 vernal conjunctivitisn春季卡他，反复，春季卡他，反复，20岁岁以下以下nCause:IgE

11、介导介导I型变态反应型变态反应nSign:itchnManifestation:睑结膜：铺路石睑结膜：铺路石角膜缘型角膜缘型混合型混合型角膜角膜医学课件园 TreatmentnSelf limitationn血管收缩剂联合抗组血管收缩剂联合抗组胺药胺药n冷敷冷敷n细胞膜稳定剂细胞膜稳定剂n非甾体类消炎药非甾体类消炎药n糖皮质激素糖皮质激素医学课件园 Dry eye syndromen上皮性上皮性(xerosis epithelialis)Vit ANight blindnessBitots spotsTreatment：补充补充Vit A，防感染，防感染n实质性（实质性（xerosis par

12、enchymatous）睑球结膜广泛瘢痕睑球结膜广泛瘢痕沙眼、烧伤、膜性结沙眼、烧伤、膜性结膜炎、类天疱疮膜炎、类天疱疮Treatment：人工泪，封闭泪小点，人工泪，封闭泪小点，腮腺管移植，软性角膜腮腺管移植，软性角膜接触镜接触镜医学课件园 Bitots spots医学课件园 Pterygium 翼状胬肉翼状胬肉n真真nCause:紫外线、气候、紫外线、气候、风尘、户外活动风尘、户外活动nManifestation:n头、颈、体头、颈、体nstagen假假nCause:化学、热烧伤或化学、热烧伤或炎症炎症nManifestation:nNon原发病原发病n散光、视力障碍散光、视力障碍nTre

13、atment：切除转位或移植用药：切除转位或移植用药医学课件园 Carcinoma in situ in conjunctivanCarcinoma in situ in conjunctiva at limbus.(B)Carcinoma in situ in conjunctiva at limbus(hematoxylin and eosin x 40).Epithelium with cellular atypia involves the full thickness of the epithelium.Notice the fibrovascular core in the upp

14、er left hand corner of the photomicrograph;cores such as these produced the papillomatous appearance seen clinically in A.医学课件园 Squamous cell carcinomaNeoplasm arises from conjunctival epithelium and invades cornea(on right)and subepithelial tissue.Transition area from normal conjunctival epithelium

15、 on left to thickened(acanthotic),dysplastic epithelium on right.Conjunctival epithelium completely replaced by atypical cells(loss of polarity)and subepithelial tissue superficially invaded.Clinical appearance医学课件园 Conjunctival nevus without visible pigment.医学课件园 SummerynThe anatomy of conjunctivan

16、The comparison of ciliary congestion and conjunctival congestionnThe cause,manifestation and treatment of acute conjunctivitis caused by bacterial and virusnThe manifestation of vernal conjunctivitis and Phlyctenular keratoconjunctivitisnThe cause,prevalence,manifestation diagnosis,differentiation and treatment of trachomanThe classification and treatment of xerosis and Pterygium 医学课件园 My hopenI hope you enjoy yourself this afternoon.nI hope my class be useful in your examination and your daily life.nYou can contact me at any moment,with any question by email:医学课件园