结 膜 病结 膜 病

Basic Knowledge The conjunctiva is a thin, translucent mucous membrane that lines the posterior surfaces of eyelids and covers the noncorneal portion of the anterior segment of the eye. Bulbar conjunctiva Palpebral conjunctiva Superior and inferior fornices

结 膜

结膜炎 conjunctivitis Epidemiology one of the most frequent eye disorders. Etiology of conjunctivitis Infectious cause: bacterium, virus, fungal, parasite, chlamydia Noinfectious cause: chemical, mechanical, irritative, allergic...

conjunctivitis Clinical manifesitation Symptoms of conjunctivitis Ocular discomfort Itching Foreign-body sensation Burning Photophobia Lacrimation Pain

conjunctivitis Clinical manifesitation Signs of conjunctivitis 1.injection and chemosis 2.increase of exudates (purulent, mucopurulent, stringy…) 3.subconjunctival hemorrhage 4.papillary hyperplasia 5.follicle formation. (lymphatic hypertrophy) 6.membrane or pseudomembrane formation 7.swollen lymph nodes

睑结膜充血

结膜水肿

结膜滤泡

脓性分泌物

膜性结膜炎

结膜充血与睫状充血鉴别 结膜充血 睫状充血 结膜血管 角膜缘深层血管网 鲜红色 暗红色 近穹隆部明显 近角膜缘明显 手指推动结膜可移动 手指推动结膜不可移动 0.1‰ 肾上腺素 → 充血消失 0.1‰ 肾上腺素 → 充血不消失 结膜炎 角膜炎，虹睫炎， 急闭青， etc

conjunctivitis Examination and Diagnosis 1.history and clinical examination 2.laboratory exam: Epithelial scraping Smear of exudates 细菌感染 → 中性粒细胞 病毒感染 → 单核细胞 ↑ ，淋巴细胞为主 衣原体感染 → 包涵体, 中性粒细胞和淋巴细胞等量 过敏性 → 嗜酸性粒细胞或嗜碱性粒细胞 ↑

conjunctivitis Treatment 1.Remove the cause 2.Eyedrops 3.Ophthalmic ointment 4.Clearing conjunctival sac 5.Systemic treatment Don’t cover in acute stage

1. Bacterial Conjunctivitis Classification based on the course of disease. Hyperacute conjunctivitis (<24h) Acute or subacute conjunctivitis (xh~xd) Chronic conjunctivitis (xd~xw)

Hyperacute bacterial conjunctivitis Etiology: gonococcal meningococcus Symptoms and Signs: very frequenty encountered (10h~3d) injection and chemosis, purulent exudates, pseudomembrane, keratitis ， corneal perforation. （ severe case ）

淋菌性结膜炎

Hyperacute bacterial conjunctivitis Diagnosis: Manifestation Smear of exudates (only in severe, uncertain, or persistant cases) Treatment: Local: NS, 1:10000kMnO4, antibiotic eyedrops. Systemic: broad-spectum antibiotic (PG. ceftriaxone etc.)

Actue or subacute conjunctivitis Etiology: pneumococcus, staphylococcus, streptococcus. Symptoms and Signs: Frequently encountered (1~3d) Injection and chemosis. Mucopurulent exudates. severe case : Pseudomembrane, subconjunctival hemorrhage, keratitis, systemic symptoms.

Actue or subacute conjunctivitis Diagnosis: manifestation smear of exudates or epithelial scraping Treatment: local: clearing conjunctival sac, eyedrops, ointment. Systemic: antibiotics

Chronic Conjunctivitis Etiology: Infectious: bacterial Noinfectious: 1.Smoke, chemical fumes and smog 2.Exposure to wind and sun,inadequate ocular protection from ultraviolet 3.Uncorrected refractive errors and ocular muscle imbalance 4.Prolonged topical instillation of drugs 5.Unenough sleeping etc.

Chronic Conjunctivitis Symptoms and Signs: Symptoms: Itching, foreign-body sensation, fatigue Signs: conjunctival redness, papillary hyperplasia and follicle formation, white-foam exudates. Treatment: (difficult) Remove the causes Eyedrops or ophthalmic ointment

2. Chlamydial conjunctivitis Trachoma Inclusion conjunctivitis

Trachoma Trachoma is a chronic, bilateral, epidemic conjunctivitis caused by chlamydia trachomatis. Epidemiology Warm moist climate Poor standard of living Poor hygiene

Trachoma Clinical Manifestation Acute stage: same as acute conjunctivitis with swollen lymph nodes. Chronic stage: mild irritative symptoms Signs: conjunctiva thickness, papillary hyperplasia, follicle formation (palpebral conjunctiva of upper lids) corneal pannus, trachomatoun cicatrisation, and complications.

角膜血管翳

睑结膜滤泡及瘢痕

结膜瘢痕

Trachoma Complications: 1.cicatrical entropion and trichasis 2.ptosis 3.symblepharon 4.xerosis of the conjunctiva and cornea 5.chronic dacryocystitis 6.corneal scarring

Trachoma Diagnosis: 2 of them 1.papillary and follicle on the upper lids 2.corneal pannus 3.trachomatous cicatrisation 4.complications Laboratory exam: epithelial scraping.

Trachoma Stage I ( 进行活动期 ): papillary, follicle, pannus Stage II( 退行期 ): partial cicatrization Stage III( 完全瘢痕期 ): complete cicatrisation

Trachoma Differential Diagnosis 均无角膜血管翳 Chronic follicular conjunctivitis 儿童, 少年 下穹隆 Vernal keratoconjunctivitis 乳头大扁平， 嗜酸性粒细胞 Inclusion conjunctivitis 下穹隆，下睑结膜 Giant papillary conjunctivitis. GPS 角膜接触镜配戴史

巨大乳头性结膜炎

Trachoma Treatment Chlamydia organisms are sensitive to sulfonamides, tetracycline and erythromycine. Local: eyedrops and ointment (3~4m) Systemic: antibiotics (3~4w) Complications:

3. Viral conjunctivitis Epidemic keratoconjunctivitis Epidemic hemorrhagic conjunctivitis

Viral conjunctivitis Epidemic Epidemic hemorrhagic keratoconjunctivitis conjunctivitis Etiology 腺病毒 肠道病毒 Signs 急性滤泡性结膜炎 急性滤泡性结膜炎 + + 耳前淋巴结肿大 耳前淋巴结肿大 + + 角膜浸润 结膜下出血 Smear 单核细胞增多 单核细胞增多 Treatment 抗病毒，对症支持 抗病毒，对症支持

4. Immunolgic conjunctivitis vernal keratoconjunctivitis Epidemiology Seasonal, Recurrent, <20y Male Etiology 致敏原

vernal keratoconjunctivitis Clinical Manifestation Symptom: intolerable itching Signs: 1. palpebral form 2. limbal form 3. mixed form

春季性结角膜炎 vernal keratoconjunctivitis Diagnosis 1. 男性青少年多见，季节性反复发作，奇痒 2. 上睑结膜乳头粗大，呈铺路石样改变，角膜 缘胶样结节 3. 嗜酸性粒细胞 Treatment 1.Eyedrops (corticosteroid, cromolyn sodium, etc) 2.Cold compress, change the environment.

Pterygium A pterygium is a wing-shaped fibrovascular connective tissue overgrowth encroaching on the cornea from the conjunctiva in the interpalpebral fissure. Etiology the cause is unknown. Related to irritation of sun and wind, outdoor workers.

翼状胬肉

思 考 题 结膜炎的常见症状及体征。 沙眼的临床表现、诊断及分期。 沙眼的后遗症和并发症。 细菌性结膜炎、衣原体性结膜炎、病毒 性结膜炎及免疫性结膜炎的区别。

结膜下出血