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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