Ophthalmology Shen Jiaquan Dept. of Ophthalmology Shandong Provincial Hospital
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- Slide 1
- Ophthalmology Shen Jiaquan Dept. of Ophthalmology Shandong
Provincial Hospital
- Slide 2
- Introduction to Ophthalmology Deal with optic organ including:
eyeball adenexa visual pathway visual center onset treatment
preventiopnof eye diseases
- Slide 3
- 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
- Slide 4
- 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
- Slide 6
- Contents of the eye : aqueous humor anterior chamber lens
posterior chamber vitreous body
- Slide 7
- Adenexa A. Eyelid skin subcutineous muscular fibrous
conjuntiva
- Slide 8
- 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
- Slide 10
- D. Extraocular muscles superior rectus inferior rectus medial
rectus lateral rectus superior obliqual inferior obliqual
- Slide 11
- E. Orbit frontal lacrimal sphenoid maxillary zygomatic palatine
ethmoid
- Slide 12
- Visual pathway light reflex direct, indirect near reflex
accommodation convergence
- Slide 13
- Chapter 2. Diseases of eyelids Hordeolum(sty) Etilogy: mostly
infection of staphylococcus tarsal gland > internal Molls and
Zeis > external
- Slide 14
- Clinical findings: redness(hyperemia) swelling heat pain
(tenderness)
- Slide 15
- Treatment: local hot compress antibiotics incision &
drainage vertical for internal parallel for external
- Slide 16
- Chalazion Etiology: lipogranulomatous inflammation caused by
blockage of excretory ducts of tarsal glands
- Slide 17
- 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
- Slide 20
- Trichiasis Lagophthalmos Epicanthus Blepharoptosis ptosis of
upper eyelid, palpebral fissure narrowed A. congenital B.
aquired
- Slide 21
- 1. mechanic 2. myogenic 3. Neurogenic
- Slide 22
- Chapter 3. Diseases of lacrimal apparatus Secretory
Excretory
- Slide 23
- 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
- Slide 24
- 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.
- Slide 25
- 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;
- Slide 26
- B. Endogenous: often with systemic disoders; dermatitis;
allergic; C. Local spreading Clinical manifestation Symptoms:
secreations, discharges, foreign body sensation, burning, tearing
or itching;
- Slide 27
- Signs: conjunctival hyperemia, edema, papillary hyperplasia,
follicles, pseudomembrane, subconjunctival hemorrhage, preauricular
lymphadenectasis
- Slide 28
- Baterial conjunctivitis A. Hyperacute conjunctivitis Etilogy :
mostly by gonococus or meningitis cocus; Clinical findings: rapid
progression; symptoms and signs severe; purulent ( pus leakage);
pseudomembrane;
- Slide 29
- 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.
- Slide 30
- 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.
- Slide 31
- 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;
- Slide 32
- palpabral or fornical hyperemia; subconjunctival hemorrahage;
3~5 days peak, then subside, recover in about 2 weeks
Complications: catarrhal marginal corneal infiltration or
ulcer.
- Slide 33
- Treatment: Eyedrops : 0.25 % chloramycin 0.4 % gentamycin 15 %
S.C 0.3% tobramycin, etc. Ointment: erythromycin, etc.
- Slide 34
- 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
- Slide 35
- Clinical manifestations: mainly secretion, hyperemia, itching,
FB sensation, asthenopia; Treatment: remove causes; antibiotics
eyedrops; ointment;
- Slide 36
- 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;
- Slide 37
- follicles, papillae hyperplasia; Stage I: progressive(active)
II: regressive III: scar formation Sequlae 1. entropion &
trichiasis 2. ptosis 3. symblepharon
- Slide 38
- 4. parenchymatous exrosis 5. chronic dacryocystitis 6. corneal
ulcer Diagnosis: follicles of upper eyelid; panus; typical scar;
Herbert; Lab: scraching, etc.
- Slide 39
- Differential diagnosis: 1.chronic follicular conjunctivitis 2.
vernal conjunctivitis 3. inclusion conjunctivitis 4. giant
papillary conjunctivitis
- Slide 40
- 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:
- Slide 41
- 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.
- Slide 42
- 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;
- Slide 43
- 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.
- Slide 44
- Treatment: 1. early stage: observe 2.surgery
- Slide 45
- Chapter 5. Diseases of cornea General discription window
refractive media pump avascular immune exemptiom
- Slide 46
- 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.
- Slide 47
- Pathology corneal ulcer corneal nebula corneal macula corneal
leucoma
- Slide 48
- descemetocele corneal fistula adherent leucoma corneal
staphyloma
- Slide 49
- Bacterial keratitis Etiology: staphylococus, streptococus, etc.
after injury of cornea, FB removal; dry eye, trichiasis, CL
wearing, diabetis, severe burn, coma, etc.
- Slide 50
- Clinical findings: symptoms: acute onset after injury in 24~48
hrs pain, vision reduction, photophobia, tearing, spasm of eyelid,
pus;
- Slide 51
- signs: edema of eyelid and conjunctiva, ciliary or mixed
congestion, epithelial ulcer, infiltration, later deeper ulcer,
hypopyon, panophthalmitis,
- Slide 52
- Treatment: hign concentration antibiotics eyedrops, ointment in
the evening, hot compress Vit B, C if perforation, cornea
transplatation
- Slide 53
- Fungal keratitis Etiology: infected with fungus: such as
fusarium, candida, aspergillus, penicillium,etc. mostly in harvest
season, eye injuried by plant,wheat,etc.
- Slide 54
- 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
- Slide 55
- Diagnosis: history of plant injury; characteristic of corneal
focus; scraching for Gram & Giemsa stain; culture + drug
sensitivity test;
- Slide 56
- 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.
- Slide 57
- 4. 1% Atropine for dilatation of pupil; 5. Contraindicated for
steroid 6. Penetrating keratoplasty or cornea transplantation;
- Slide 58
- 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
- Slide 59
- Treatment: 1. Antiviral agents: 0.5% acyclovir, trifloridine,
cyclocydine, idoxuridine; 2. Systemic agents: acyclovir 0.25, qid
3. Mydriosis; 4. Contraindicated for steroid
- Slide 60
- Episcleritis Etiology : unknown Clinical findings: pain,
congestion of epislera, nodule