Ophthalmology Shen Jiaquan Dept. of Ophthalmology Shandong Provincial Hospital

Introduction to Ophthalmology Deal with optic organ including: eyeball adenexa visual pathway visual center onset 、 treatment preventiopnof eye diseases

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

Eyewall: A. External layer: fibrosa Ant. Cornea: 1 、 epithelium 2 、 Bowman’s or ant elastic 3 、 stroma 4 、 Descement membrane 5 、 endothelium Post. Sclera:

B. Middle layer: uvea ant. iris, pupil 2.5~4mm mid. ciliary body, post. choroid, C. Inner layer: retina

Contents of the eye : aqueous humor anterior chamber lens posterior chamber vitreous body

Adenexa A. Eyelid skin subcutineous muscular fibrous conjuntiva

B. Conjunctiva palpebral conj. bulbar conj. fornical conj.

C. Lacrimal apparatus secretory: lacrimal gland excretory: lacrimal punctae lacrimal canaliculi lacrimal sac nasolacrimal duct

D. Extraocular muscles superior rectus inferior rectus medial rectus lateral rectus superior obliqual inferior obliqual

E. Orbit frontal lacrimal sphenoid maxillary zygomatic palatine ethmoid

Visual pathway light reflex direct, indirect near reflex accommodation convergence

Chapter 2. Diseases of eyelids Hordeolum(sty) Etilogy: mostly infection of staphylococcus tarsal gland > internal Moll’s and Zeis’ > external

Clinical findings: redness(hyperemia) swelling heat pain (tenderness)

Treatment: local hot compress antibiotics incision & drainage vertical for internal parallel for external

Chalazion Etiology: lipogranulomatous inflammation caused by blockage of excretory ducts of tarsal glands

Blepharitis 3 types A. Squamous B. Ulcerative C. Angular Treatment: wash with 3% boric acid antibiotics 0.5% ZnSO4 VitB

Entropion A. congenital B. spastic C. cicatricial

Ectropion A. cicatricial B. senile C. paralytic

Trichiasis Lagophthalmos Epicanthus Blepharoptosis ptosis of upper eyelid, palpebral fissure narrowed A. congenital B. aquired

1. mechanic 2. myogenic 3. Neurogenic

Chapter 3. Diseases of lacrimal apparatus Secretory Excretory

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

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.

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;

B. Endogenous: often with systemic disoders; dermatitis; allergic; C. Local spreading Clinical manifestation Symptoms: secreations, discharges, foreign body sensation, burning, tearing or itching;

Signs: conjunctival hyperemia, edema, papillary hyperplasia, follicles, pseudomembrane, subconjunctival hemorrhage, preauricular lymphadenectasis

Baterial conjunctivitis A. Hyperacute conjunctivitis Etilogy : mostly by gonococus or meningitis cocus; Clinical findings: rapid progression; symptoms and signs severe; purulent ( pus leakage); pseudomembrane;

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.

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.

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;

palpabral or fornical hyperemia; subconjunctival hemorrahage; 3~5 days –peak, then subside, recover in about 2 weeks Complications: catarrhal marginal corneal infiltration or ulcer.

Treatment: Eyedrops : 0.25 % chloramycin 0.4 % gentamycin 15 % S.C 0.3% tobramycin, etc. Ointment: erythromycin, etc.

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

Clinical manifestations: mainly secretion, hyperemia, itching, FB sensation, asthenopia; Treatment: remove causes; antibiotics eyedrops; ointment;

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;

follicles, papillae hyperplasia; Stage I: progressive(active) II: regressive III: scar formation Sequlae 1. entropion & trichiasis 2. ptosis 3. symblepharon

4. parenchymatous exrosis 5. chronic dacryocystitis 6. corneal ulcer Diagnosis: follicles of upper eyelid; panus; typical scar; Herbert; Lab: scraching, etc.

Differential diagnosis: 1.chronic follicular conjunctivitis 2. vernal conjunctivitis 3. inclusion conjunctivitis 4. giant papillary conjunctivitis

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:

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.

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;

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.

Treatment: 1. early stage: observe 2.surgery

Chapter 5. Diseases of cornea General discription window refractive media pump avascular immune exemptiom

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.

Pathology corneal ulcer corneal nebula corneal macula corneal leucoma

descemetocele corneal fistula adherent leucoma corneal staphyloma

Bacterial keratitis Etiology: staphylococus, streptococus, etc. after injury of cornea, FB removal; dry eye, trichiasis, CL wearing, diabetis, severe burn, coma, etc.

Clinical findings: symptoms: acute onset after injury in 24~48 hrs pain, vision reduction, photophobia, tearing, spasm of eyelid, pus;

signs: edema of eyelid and conjunctiva, ciliary or mixed congestion, epithelial ulcer, infiltration, later deeper ulcer, hypopyon, panophthalmitis,

Treatment: hign concentration antibiotics eyedrops, ointment in the evening, hot compress Vit B, C if perforation, cornea transplatation

Fungal keratitis Etiology: infected with fungus: such as fusarium, candida, aspergillus, penicillium,etc. mostly in harvest season, eye injuried by plant,wheat,etc.

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

Diagnosis: history of plant injury; characteristic of corneal focus; scraching for Gram & Giemsa stain; culture + drug sensitivity test;

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.

4. 1% Atropine for dilatation of pupil; 5. Contraindicated for steroid 6. Penetrating keratoplasty or cornea transplantation;

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

Treatment: 1. Antiviral agents: 0.5% acyclovir, trifloridine, cyclocydine, idoxuridine; 2. Systemic agents: acyclovir 0.25, qid 3. Mydriosis; 4. Contraindicated for steroid

Episcleritis Etiology : unknown Clinical findings: pain, congestion of epislera, nodule