ophthalmology shen jiaquan dept. of ophthalmology shandong provincial hospital
TRANSCRIPT
- Slide 1
- Ophthalmology Shen Jiaquan Dept. of Ophthalmology Shandong Provincial Hospital
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- Introduction to Ophthalmology Deal with optic organ including: eyeball adenexa visual pathway visual center onset treatment preventiopnof eye diseases
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- Chapter 1 Anatomy histology and physiology of the eye Globe sagittal D: 24 mm transverse D: 23.5 mm longitudinal D: 23.5 mm Protected by eyelid and orbit
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- Eyewall: A. External layer: fibrosa Ant. Cornea: 1 epithelium 2 Bowmans or ant elastic 3 stroma 4 Descement membrane 5 endothelium Post. Sclera:
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- B. Middle layer: uvea ant. iris, pupil 2.5~4mm mid. ciliary body, post. choroid, C. Inner layer: retina
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- Contents of the eye : aqueous humor anterior chamber lens posterior chamber vitreous body
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- Adenexa A. Eyelid skin subcutineous muscular fibrous conjuntiva
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- B. Conjunctiva palpebral conj. bulbar conj. fornical conj.
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- C. Lacrimal apparatus secretory: lacrimal gland excretory: lacrimal punctae lacrimal canaliculi lacrimal sac nasolacrimal duct
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- D. Extraocular muscles superior rectus inferior rectus medial rectus lateral rectus superior obliqual inferior obliqual
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- E. Orbit frontal lacrimal sphenoid maxillary zygomatic palatine ethmoid
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- Visual pathway light reflex direct, indirect near reflex accommodation convergence
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- Chapter 2. Diseases of eyelids Hordeolum(sty) Etilogy: mostly infection of staphylococcus tarsal gland > internal Molls and Zeis > external
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- Clinical findings: redness(hyperemia) swelling heat pain (tenderness)
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- Treatment: local hot compress antibiotics incision & drainage vertical for internal parallel for external
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- Chalazion Etiology: lipogranulomatous inflammation caused by blockage of excretory ducts of tarsal glands
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- Blepharitis 3 types A. Squamous B. Ulcerative C. Angular Treatment: wash with 3% boric acid antibiotics 0.5% ZnSO4 VitB
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- Entropion A. congenital B. spastic C. cicatricial
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- Ectropion A. cicatricial B. senile C. paralytic
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- Trichiasis Lagophthalmos Epicanthus Blepharoptosis ptosis of upper eyelid, palpebral fissure narrowed A. congenital B. aquired
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- 1. mechanic 2. myogenic 3. Neurogenic
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- Chapter 3. Diseases of lacrimal apparatus Secretory Excretory
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- Stenosis or obstruction of lacrimal duct Chronic dacryocystitis: epiphora, hyperemia of conj.; cystic mass, great amount of pus reflux from puncta Acute dacryocystitis Neonatal dacrycystitis
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- Chapter 4. Diseases of conjunctiva General discription : The conjunctiva directly contacts with outside, easy to be affected by physical and chemical factors, also easy to be infected by various pathogenic agents.
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- Etiology: mainly as follows A. Exogenous: Physaical: sand, smoke, dust, burning, ultraviolet; Chemical: drugs,acid,alkaline, toxic; Pathogenic: bacteria, chlamydia, virus, fungus; Parasites: thelazia,fly,maggot, mosquitos;
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- B. Endogenous: often with systemic disoders; dermatitis; allergic; C. Local spreading Clinical manifestation Symptoms: secreations, discharges, foreign body sensation, burning, tearing or itching;
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- Signs: conjunctival hyperemia, edema, papillary hyperplasia, follicles, pseudomembrane, subconjunctival hemorrhage, preauricular lymphadenectasis
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- Baterial conjunctivitis A. Hyperacute conjunctivitis Etilogy : mostly by gonococus or meningitis cocus; Clinical findings: rapid progression; symptoms and signs severe; purulent ( pus leakage); pseudomembrane;
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- Treatment: Local: wash with N.S or antibiotics, such as peniciline, 15 % S.C; Systemic: antibiotics injection. i.m or indrip, peniciline, ceftriaxone, spectinomycin, cefotaxime,etc.
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- B. Acute or subacute conjunctivitis Etiology: AC caused by bacterial infection is commonly seen in spring or autumn, sporadic or epidemic in primary schools nurseries kindergartens and other collective enviroments. Pathogens are diplococus pneumoniae Koch-Weeks bacillus hemophilus influenzae staphylococus and so on.
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- Clinical findings: Incubation period is about 1~3 days, with acute onset, both eyes may be affected, simutaneously or with 1~2 days interval. tearing FB sensation burning; secretion: mucus or purulent;
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- palpabral or fornical hyperemia; subconjunctival hemorrahage; 3~5 days peak, then subside, recover in about 2 weeks Complications: catarrhal marginal corneal infiltration or ulcer.
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- Treatment: Eyedrops : 0.25 % chloramycin 0.4 % gentamycin 15 % S.C 0.3% tobramycin, etc. Ointment: erythromycin, etc.
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- C. Chronic conjunctivitis Etilogy: causes are various, commonly: 1.bacterial infection 2.chemical +physical: dust,smog,etc 3.secondary to trichiasis, blepharitis, chronic dacryocystitis, dry eye, refractive error,etc
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- Clinical manifestations: mainly secretion, hyperemia, itching, FB sensation, asthenopia; Treatment: remove causes; antibiotics eyedrops; ointment;
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- Trachoma Etiology: A B C or Ba antigen trachoma chlamydia infection. Clinical findings: incubation period: 5~14d, Acute attack: red eye, pain, FB sensation, tearing, mucus discharge;
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- follicles, papillae hyperplasia; Stage I: progressive(active) II: regressive III: scar formation Sequlae 1. entropion & trichiasis 2. ptosis 3. symblepharon
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- 4. parenchymatous exrosis 5. chronic dacryocystitis 6. corneal ulcer Diagnosis: follicles of upper eyelid; panus; typical scar; Herbert; Lab: scraching, etc.
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- Differential diagnosis: 1.chronic follicular conjunctivitis 2. vernal conjunctivitis 3. inclusion conjunctivitis 4. giant papillary conjunctivitis
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- Treatment: 1. Systemic: for acute or severe trachoma, systemic antibiotics should be given; 2. Local: 0.1 % rimifon; 15 % S.C; etc; 3. Treatment for complication:
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- Vernal keratoconjunctivitis Etiology: still unkown seasonal recurrent usually in spring summer or autume; mediated by IgE Ab; type I allergy; IgG Ab and cell immunity also play; feather flower powder etc.
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- Clinical findings: symptom: specially itching; phtophobial; tearing; FB; signs: 3 types: 1. Palpabral : coble-stone like, mostly in upper part; 2. Limbal: yellow-brownish glue-like hyperplasia; 3. Mixed: both two above;
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- Pterygium Etiology: related to utraviolet exposure dry weather dust etc fishmen farmers are easy to affect Clinical findings: mild ailment, FB sensation; triangular proliferation from conjunctiva to cornea; in nasal part.
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- Treatment: 1. early stage: observe 2.surgery
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- Chapter 5. Diseases of cornea General discription window refractive media pump avascular immune exemptiom
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- Keratitis Etiology: 1. Exogenous(infectious) bacteria, fungus, virus, chlamydia.etc 2. Endogenous Vit A deficiency,autoimmune disorder 3. local spreading inflammation of conjunctiva, sclera, iris, ciliary body etc.
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- Pathology corneal ulcer corneal nebula corneal macula corneal leucoma
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- descemetocele corneal fistula adherent leucoma corneal staphyloma
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- Bacterial keratitis Etiology: staphylococus, streptococus, etc. after injury of cornea, FB removal; dry eye, trichiasis, CL wearing, diabetis, severe burn, coma, etc.
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- Clinical findings: symptoms: acute onset after injury in 24~48 hrs pain, vision reduction, photophobia, tearing, spasm of eyelid, pus;
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- signs: edema of eyelid and conjunctiva, ciliary or mixed congestion, epithelial ulcer, infiltration, later deeper ulcer, hypopyon, panophthalmitis,
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- Treatment: hign concentration antibiotics eyedrops, ointment in the evening, hot compress Vit B, C if perforation, cornea transplatation
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- Fungal keratitis Etiology: infected with fungus: such as fusarium, candida, aspergillus, penicillium,etc. mostly in harvest season, eye injuried by plant,wheat,etc.
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- Clinical manifestation: slow onset, early stage: FB sensation, then: pain, photophobia, tearing, etc. long period course focus : white-greyish in colour,dry, coarse, satellite focus hypopion
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- Diagnosis: history of plant injury; characteristic of corneal focus; scraching for Gram & Giemsa stain; culture + drug sensitivity test;
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- Treatment: 1. Eye drops: 0.25% Amphotericin B, 5% Natamycin, 0.5% Miconazole, 1% Flucytesine; 2. Subconj. Injection: amphotericin or miconazole; 3. Systemic: miconazole indrip.
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- 4. 1% Atropine for dilatation of pupil; 5. Contraindicated for steroid 6. Penetrating keratoplasty or cornea transplantation;
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- Herpes simplex keratitis Etiology: mostly type I HSV infection, sometime type II HSV, Clinical manifestation: 1. Superficial Punctal keratitis 2. Dendritic keratitis>geographic 3. Disciform keratitis or stromal
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- Treatment: 1. Antiviral agents: 0.5% acyclovir, trifloridine, cyclocydine, idoxuridine; 2. Systemic agents: acyclovir 0.25, qid 3. Mydriosis; 4. Contraindicated for steroid
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- Episcleritis Etiology : unknown Clinical findings: pain, congestion of epislera, nodule