37英文-眼睑病、泪器病.、眼表疾病 pptx(2022年-2023年)..ppt
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37英文-眼睑病、泪器病.、眼表疾病 pptx(2022年-2023年)..ppt
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TheSecondClinicalCollegeofChongqingMedicalUniversity眼科学科室/教研室:
眼科学授课教师:
许燕副主任医师硕士生导师眼睑病、泪器病、眼表疾病TheSecondClinicalCollegeofChongqingMedicalUniversity目录CONTENTS0102眼表疾病Ocularsurfacedisease泪器病Lacrimalapparatusdisease03眼睑病EyeliddiseaseTheSecondClinicalCollegeofChongqingMedicalUniversity眼睑病EyeliddiseaseTheSecondClinicalCollegeofChongqingMedicalUniversityCASE一:
Patient,female,26yearsoldThelowereyelidofthelefteyewasswollenandpainfulfor3daysNofever,headacheorothersymptoms,alwaysingoodhealthPalpation:
SclerosisandtendernessmaybepalpableatthelesionofthelowereyelidNoretroauricularlymphnodeswereenlargedTheSecondClinicalCollegeofChongqingMedicalUniversity病例二:
Patient,male,36yearsoldRighteyeuppereyelidmasswasfoundhalfmoon,foreignbodysensationwasobviousfor3daysSmalllumpsdisappearedspontaneouslyinthepastandwerenottakenseriouslyPalpation:
asmooth,painlesssubcutaneousmasswithtoughtexturecouldbepalpableatthelesionoftherightuppereyelidLimitationsofconjunctivalhyperemiaTissuestructure3glands3muscles
(1)theskin
(2)LooseconnectivetissueMollglandZeisgland(3)muscularisTheorbicularisoculimuscleisthelevatoroftheuppereyelidMullermuscle(4)Connectivetissue(5)Fibrouspalpebrae(glandular)Orbitalseptum(6)palpebralconjunctivaStructureoftheeyelidTheeyelidisinclosecontactwiththesphereDirectionofeyelashgrowthLoweranduppertearssmallerpositionTheeyelidfissureiswidewhenlookingattheheadTheuppereyelidmargincoveredthecorneaby12mm,whichwas710mmNormalposition7-107-10StructureandfunctionofeyelidSkin,glands,eyelashesMuscles,bloodsupply,nervesCompleteandbeautiful,normalpositionProtecttheeyeballandblinkInflammation:
blepharitis,blepharitis,eyelidglandcyst,contactdermatitis,etcAbnormalposition:
eyelidentropion,eyelidectropion,trichiasis,loweruppereyelidDroop,eyelidincompleteness,eyelidadhesion,ciliarydisorder,etcEyelidtumors:
benignandmalignanttumorsEyeliddiseaseTheSecondClinicalCollegeofChongqingMedicalUniversityInflammationoftheeyelidsCase二:
Case一:
Howisitdiagnosed?
Howisittreated?
HordeolumChalazionblepharitisViralpalpebraldermatitisContactdermatitis睑腺炎hordeolum(麦粒肿)Definition:
Bacterialinfectionoftheeyelidglands,acutesuppurativeinflammationPathogen:
mostlystaphylococcusaureusinfectionClinicalfeatures:
acuteonset,redness,swelling,heatandpain,Abscessformation,ruptureandwithdrawal(withinaweek)hordeolumOutereyelidhordeolum-sebaceousglands(Zeisglands)andsweatglands(Mollglands)PustusspotsappearedonthelocalskinInternaleyelidhordeolum-eyelidgland(Meibomiangland)YellowpusontheconjunctivalsurfacehordeolumTreatmentPhysicaltherapy:
coldcompressdetumescencehotcompressdispersionAntibiotics:
routinelocalweightofthewholebodyTreatmentSurgicalincisionanddrainage:
hordeolumExternalhordeolum-TheskinsurfaceisparalleltotheeyelidtominimizescarringEndoblepharonhordeolum-theverticalalignmentoftheconjunctivalsurfacetothepalpebralmarginreducesdamagetothepalpebralglandductsTheSecondClinicalCollegeofChongqingMedicalUniversityEyelidcellulitisLowresistance,pathogenicbacteriastrongtoxicityFulleyelidrednessandswelling,difficultyinopeningeyesThetouchishardandthetendernessisobviousBulbarconjunctivalreactiveedemaFever,chills,headachesandothersystemicsymptomsUntimelyhandlingSepsisorcavernoussinusthrombosisendangerlifeBeforetheabscessforms,Dontcut,dontsqueeze!
hordeolum睑板腺囊肿chalazion(霰粒肿)Definition:
IdiopathicasepticchronicgranulomatousinflammationoftheeyelidglandCauses:
Obstructionofthemouthoftheeyelidgland,retentionofsecretions,Chronicirritation,formingcystschalazionClinicalcharacteristics:
youngandmiddle-agedpronetoslowonset,mildsymptoms,easytorelapsePainlessmass:
subcutaneouseyelid,noredness,nopain,noadhesionNon-infectiousinflammatorymanifestations:
purplishredorgrayishredlesionsontheconjunctivalsurfaceEarlyhotcompresstopromoteabsorptionSurgicalexcision(conjunctivalverticaleyelidincision)*TreatmentA72-year-oldfemalepatientpresentedwithrecurrentpainlessmassoftheuppereyelidoftherighteyefor1year.Hewasdiagnosedasgraupelswellinginanotherhospitalandunderwentgraupelcurettageforthreetimes.Onthisvisit,therewasapainlessmassinthemiddleoftheuppereyelidoftherighteyeWhatdoesdiagnosisandtreatmentneedtopayattentionto?
Whendoyouneedtodopathologicalexamination?
Whyshouldmakepathologicalexamination?
pProlonged,recurrent,atypicalpEspeciallyelderlypatientswithrelapsespPalpebraladenocarcinomawasexcludedChalazionHordeolumvsChalazionpathogenbacterialIdiopathic,aseptic,chronicgranulomatousinflammationmorbidityurgentSlowsymptomsRed,swelling,heatandpainNopain,secondaryinfectionsignsLimitationsofconjunctivacongestion,yellowpus,tenderness,scleromaSmallmass,conjunctivaLocalfuchsiatreatmentCuttheabscessSelf-absorption,hotcompress,surgical重点*DifferentialdiagnosisandtreatmentofinternalandexternalHordeolumthinking*HordeolumvsChalazionAbnormaleyelidpositionandfunctionTrichiasisEyelidinsufficiencyAbnormalpositiondysfunctionDamagetotheeyeEntropionectropionptosisCicatricialentropion睑内翻(entropion)CongenitaleyelidvarusInvoluntaryentropion:
SpasticentropionoftheeyelidSenileeyelidvarus【Classificationandetiology】睑内翻(entropion)【clinicalpicture】Symptoms:
photophobia,tearing,blepharospasmSigns:
Curlingoftheeyelidtowardtheeyeball,cornealepithelialextirpation,cornealulcers,cornealneovascularization【treatment】LocalinjectionofBotoxSurgicalcorrectionTreatmentofprimarydisease:
acutespasmodicinflammationshouldbeactivelycontrolled麻痹性睑外翻睑外翻(ectropion)Thepalpebralmarginturnsoutwardsawayfromtheeyeball,oftencombinedwithpalpebralfissureincompleteclosure瘢痕性睑外翻老年性睑外翻先天性睑外翻机械性睑外翻【Classificationandetiology】【clinicalpicture】Light:
destroythecapillarysiphoneffectofeyelidandsphereTearsoverflowHeavy:
conjunctivalcongestion,dry,rough,hypertrophyExposurekeratitis睑外翻(ectropion)【treatment】Targetingcauses,improvingsymptomsandpreventingcomplicationsThesurgicaltreatment【Cause】FacialparalysisCicatricialectropionTheorbitalvolumeisoutofproportiontotheeyeballGeneralanesthesiaorseverecoma【clinicalpicture】Mild:
LowerbulbarconjunctivaexposedSevere:
cornealexposure眼睑闭合不全(lagophthalmus)【treatment】EffectivelyprotectthecorneabeforeremovingtheetiologyAetiologicaltreatment眼睑闭合不全(lagophthalmus)Moist:
ArtificialtearsfrequentlypointeyesSleepwitheyeointment(AntibioticsorSodiumHyaluronate)Protect:
BuildawetroomeyemaskAvoid:
eyelidsuture,avoidexposureRevision:
SurgicalcorrectionTheSecondClinicalCollegeofChongqingMedicalUniversity泪器疾病LacrimalapparatusdiseaseCaseThepatient,a55-year-oldfemale,hadtearsandoccasionalpusinherlefteyefor3yearsDiagnosis?
Treatment?
LacrimalapparatusstructureTearsecretionsystem:
lacrimalglands
(1),accessorylacrimalglands,Conjunctivalgobletcells,etc-Inflammation,tumorsTeardrainagesystem(lacrimalduct):
upperandlowerlacrimalpoints
(2),upperandlowerlacrimalcanalicules(3),commonlacrimalduct,lacrimalsac(4)andnasolacrimalduct(5)-Obstruction,infectionLacrimalapparatusdiseaseLacrimalapparatusdiseaseThemainsymptomoflacrimalorgandiseaseiswateryeyesTheseincludelacrimation(increasedsecretionofthelacrimalglands)andacrimatorrhea(obstructionofthelacrimalduct)ANALYSISOFEPIGRIMATORRHEA泪液排出系统疾病泪道冲洗证明泪道阻塞或狭窄泪囊炎慢性泪囊炎急性泪囊炎泪小管炎鼻泪管阻塞泪道肿瘤泪道冲洗证明泪道通畅下泪点位置异常下睑外翻等泪囊吸力不足泪囊病变、面N麻痹等ANALYSISOFLACRIMATION泪液分泌系统疾病泪腺炎急性泪腺炎慢性泪腺炎泪腺肿瘤中枢性:
新生儿、癔症性神经性:
刺激三叉N,如外伤、炎症、青光眼等ExaminationoflacrimalapparatusVisualexaminationoflacrimalapparatus:
sizeandlocationoflacrimaldots,skininlacrimalsacareaandlacrimalglandareaPalpationoflacrimalapparatus:
compressthelacrimalsacareatoobserveforrefluxMeasurementoftearvolume:
SchirmertestLacrimalductflushingLacrimalductexplorationTheSecondClinicalCollegeofChongqingMedicalUniversity泪道冲洗泪道冲洗针头垂直插入泪点12mm,转水平方向向鼻侧进35mm,轻推冲洗液表麻药润湿棉片麻醉泪点拉下睑暴露泪小点泪小点扩张(非必需)FlushingoflacrimalductLacrimalpassageunimpeded:
pharynxhaswaterflownextlacrimalpassagenarrow:
passbutnotsmooth,havereturnflow由白色混浊物由泪点返出:
慢性泪囊炎上泪点返流,无水入咽:
泪总管阻塞上泪点返流,部分入咽:
鼻泪管狭窄下泪点返流:
下泪管阻塞慢性泪囊炎chronicdacryocystitis【Pathogenesis】Thecommonpathogenicbacteriaarepneumococcus,streptococcusandstaphylococcusMorewomenthanmenItisrelatedtotrauma,trachomaandrhinitisChronicdacryocystitis【Clinicalfeatures】Mainsymptoms:
lacrimalskineczemaSqueezethelacrimalsacarea:
mucousorpurulentsecretionsoverflowfromthelacrimaldotLacrimalductirrigation:
lacrimalductobstruction,visiblemucousorpurulentsecretionsflowbackThisisamucinouscystofthedacryocystChronicdacryocystitisThepatient,male,68yearsold,hasahistoryofchronicdacryocystitisintherighteyefor3years.Canheperformcataractextractionintherighteye?
Whyisthat?
Whethercanthepatientdothecataractextirpateoflefteye?
Whyisthat?
AninfectivelesionoftheeyePathogenicbacteriainthelacrimalsacflowbacktotheconjunctiva,leavingtheconjunctivainalong-termbacteria-carryingstateWhenthecorneaisinjured,itiseasytoleadtocornealulcerationPurulentendophthalmitiscanbeeasilycausedbyoculartraumaorintraocularsurgerychronicdacryocystitis1.Medication(temporaryrelief)Afterrinsingthelacrimalductwithnormalsalineorsqueezingthelacrimalsac,injectantibioticliquidorantibioticeyeliquidintotheeyes2.ThesurgicaltreatmentKey:
OpentheobstructednasolacrimalductCommonoperationtype:
dacryocystnasalanastomosisTheanastomoticoperationcannotbeperformedforvariousreasonsFeasibledacryocystextirpateTreatment眼表疾病OcularSurfaceDiseases50(ocularsurfacediseases,OSD)nIntrductionsnOSDnTreatmentofOSDsnDryeye51TheOcularSurfaceThesurfaceoftheareabetweenupperandlowerlidmargins,includingthecorneaandconjunctivaNormalfunctionrelieson:
NormalanatomicalocularstructureNormalcornealandconjunctivalstemcellsLossoflimbalstemcellsleadstofailureofcornealepithelializationNormaltearfilmIntrductions52TearFilm7-10mmthick,coveringcorneaandconjunctivaFunctionsSmoothingoutepithelialirregularitiesforgoodopticpropertyMoisteningcorneaandconjunctivaInhibitinggrowthofmicroorganismProvidingnutritionIntrductions53TearFilm3layersLipid(Meibomianglands):
retardwaterevaporationWater(Lacrimalglands):
containswater-solublesaltsandproteinsMucin(Gobletcells):
provideshydrophilicsurfaceforaqueoustearDryeyeDefi
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