雙語(yǔ) 眼瞼病等

第四章眼瞼病(Diseaseofeyelid)概述眼瞼結(jié)構(gòu)和功能復(fù)習(xí)處理眼瞼病的注意事項(xiàng)

LidsReviewthestructureandfunctionofeyelids.Theeyelidsareimportantpartoffacialappearance.Weshouldconsideritintheprocedureofpalpebraldisease.

眼瞼炎癥(Palpebralinflammation)瞼腺炎(hordeolum)定義：是眼瞼腺體的急性、痛性、化膿性、結(jié)節(jié)性炎癥病變內(nèi)、外病因：葡萄球菌臨床表現(xiàn)：紅、腫、熱、痛等診斷與治療：早期抗炎和熱敷，膿腫形成切開(kāi)排膿，內(nèi)外類(lèi)型切口方向不同Hordeolumacuteinflammationofeyelidcharactericedwithpain,noduleandpurulence.mostlycausedbyinfectionofstraphylococcusaureus.inner—tarsalgland;external—Moll’sorZeis’sglandClinicfinding:red,swelling,hot,pain.Treatment:localwarmcompression,whenabscessformate,incisionanddrainageshouldbedone.瞼腺炎(hordeolum)瞼板腺囊腫(chalazion)定義：瞼板腺的特發(fā)性慢性肉腫性炎癥

病因：瞼板腺堵塞臨床表現(xiàn)：無(wú)痛性腫塊、生長(zhǎng)緩慢診斷注意：復(fù)發(fā)性或老人注意除外瞼板腺癌治療：手術(shù)刮除ChalazioncystomaofMeibomaingland.It’salipogranulomatousinflammationcausedbyblockageofexcretoryductsoftarsalglands.Clinicfinding:palpebralsubcutaneousroundmasswithdifferentsizes,noadhesionwithskin,abiteofelasticity.Treatment:Toinciseinconjunctivalsurfaceanddischargecontentandtoextractitscapsule.瞼板腺囊腫(chalazion)瞼緣炎(blepharitis)是指瞼緣表面、睫毛毛囊及其腺組織的亞急性或慢性炎癥鱗屑性瞼緣炎(squamousblepharitis)潰瘍性瞼緣炎(ulcerativeblepharitis)眥部瞼緣炎(angular

blepharitis)瞼緣炎(blepharitis)病毒性瞼皮炎單純皰疹病毒性瞼皮炎（herpessimplexpalpebraldermatitis）帶狀皰疹病毒性瞼皮炎（herpeszosterpalpebraldermatitis）眼瞼位置、功能和先天異常

眼瞼的正常位置眼瞼緊貼眼球瞼緣保持弧度，睫毛向前眼瞼能緊密閉合上瞼能上舉上、下淚點(diǎn)貼淚阜Theeyelidscloselycontactwiththesufaceoftheglobe.Eyelashesofbotheyelidsareupwardanddownwardseparatelyintidyarrangement.Thesuperioreyelidcanelevate.Thesuperiorandinferiorpunctasituatedatanteriorlipofpalpebralmarginsininnercanthus眼瞼位置、功能和先天異常

倒睫(trichiasis)與亂睫(aberrantlashes)瞼內(nèi)翻(entropion)瞼外翻(ectropion)眼瞼閉合不全(hypophasis)上瞼下垂(ptosis)先天異常(congenitalabnormal)Entropion病因：瘢痕、先天、老年痙攣性臨床表現(xiàn)：刺激癥狀、相應(yīng)角、結(jié)膜損傷診斷治療：手術(shù)

Etiology:cicatricialcontractionoftheconjunctivaortarsusbecauseoftrachomaandburn;seniledegenerationofpalpebraltissue.Clinicalfindings:photophobia,tearing,stabbingpain,palpebralspasm.Inseverecase,corneaandconjunctivalepitheliumbeexfoliated,evenconealstromabeopacity.Treatment:mostneedsurgery.Ectropion病因：瘢痕、老年性、麻痹性、機(jī)械性表現(xiàn)：溢淚、角結(jié)膜損傷，嚴(yán)重時(shí)伴閉合不全診斷治療：手術(shù)瞼外翻Etiology:scarformationonthepalpebralskin;paralysisoffacialnerveorsenilelaxationoforbicularisoculimuscleClinicalfindings:tearing,dry,severecasescausecorneaepitheliumdamage,andlagophthalmosTreatment:mostneedsurgeryPtosis病因：先天性和獲得性臨床表現(xiàn)：上瞼遮蓋角膜>3mm,代償頭位診斷:排除重癥肌無(wú)力治療:手術(shù)Etiology:congenitalandacquiredClinicalfindings:Theupperlidcan’tbeelevatedandcoverupperpartofcornea>3mm;faceupword.Treatment:directedtoitsvariouscauses;congenitalptosisneedssurgery眼瞼腫瘤(Palpebraltumor)良性腫瘤(benign:血管瘤、色素痣、黃色瘤）惡性腫瘤(malignant:基底細(xì)胞癌、鱗狀細(xì)胞癌、皮脂腺癌）

眼瞼分裂痣黃色瘤基底細(xì)胞癌淚器病(DiseaseoftheLacrimalapparatus)流淚(lacrimation)溢淚(epiphora)淚液排出系統(tǒng)疾病

淚道阻塞和狹窄(stenosisoflacrimalpassage)新生兒淚囊炎(neonataldacryocystitis)慢性淚囊炎急性淚囊炎

急性淚囊炎(Acutedacryocystitis)Acutedacryocystitistakeplaceonthebasisofchronicdacryocystitis;areainthelacrimalsacappears:red,swollen,hot,pain.Whenpus-punctumappears,draingeisneededtodo.Wheninfectioniscontrolled,todooperationasthatofchronicdacryocystitis慢性淚囊炎

(chronicdacryocystitis)病因：鼻淚管狹窄或堵塞伴發(fā)細(xì)菌感染臨床表現(xiàn)：溢淚、溢濃

眼部感染病灶治療：手術(shù)

Etiology:trachoma,chronicrhinitis,nasalpolyp,hypertrophyofnasalconchaeClinicalfinding:epiphor,whencompressionalargeamountofmueopurulentsecretionrefluxfromthepunctaorlacrimalia.Clinicalmeaning:Chronicdacryocystitisasanocularfocusmakesconjunctivalsacinpollutedcondition,oncetheglobeisinjuriedoroperatedon,infectionbecomeseasy,severecomplicationwilltakeplace.淚液分泌系統(tǒng)疾病

淚腺炎(dacryoadenitis)淚腺腫瘤無(wú)淚癥淚液分泌過(guò)多

Diseaseofsecretorysystem1)Dacryoadenitis:lesscommon2)Tumoroflacrimalgland眼表疾病

(ocularsurfacedisorder)概述

眼表：參與維持眼球表面健康的防護(hù)體系中的所有外眼附屬器淚膜（tearfilm)結(jié)構(gòu)和功能眼表疾病(OSD):泛指損害角結(jié)膜眼表正常結(jié)構(gòu)與功能的疾病

Ocularsurface:AlltheexterapparatuswhichattendtomaintainahealthyprotectivesystemoftheglobeTear:includinglipidlayer,aqueouslayer,mucuslayer.Function:tomakethecorneaasmoothopticalsurfacebyabolishingminutesurfaceirregularitiesofitsepithelium;towetthesurfaceofthecornealandconjunctivalepithelium,preventingdamagetotheconjunctivalepithelialcell;toinhibitthegrowthofmicroorganismsontheconjunctivalandcorneabymechanicalflushingandtheantimicrobialactionofthetearfluid.Ocularsurfacedisorder(OSD):Generallyrefertothediseasesofimpairingnomalstructureandfunctionofcornealandconjunctivalsurface.眼表疾病治療原則

提供上皮細(xì)胞生長(zhǎng)所需的、相對(duì)健康的基質(zhì)和基底膜，以及有活力的上皮干細(xì)胞來(lái)源應(yīng)用藥物減輕炎癥反應(yīng)和抑制排斥反應(yīng)改善干眼癥狀

角結(jié)膜干燥癥（干眼癥）

(dryeyesyndrome)

定義：任何原因引起的淚液質(zhì)和量異?；騽?dòng)力學(xué)異常、導(dǎo)致淚膜穩(wěn)定性下降，并伴有眼部不適，引起眼表病變?yōu)樘卣鞯亩喾N病癥的總稱(chēng)。Clinicalfinding:scratchyorsandysensation,itchingorburningandphotosensitivity;rednessandpain,cornealandconjunctivalepitheliumdamage.Schirmertest:meartearsecretionTearfilmbreak-uptime:tomearthemucincontent.Twokinds:deficientproduction--aqueoesteardeficiency,ATD;overevaporation--meibomainglanddysfunction,MGDTreatment:ATD—artificialtear;;MGD—ophthalmicvehiclesofhighmolecularweight干眼癥分類(lèi)淚液生成不足(deficientproduction)(aqueoesteardeficiency,ATD)蒸發(fā)過(guò)強(qiáng)(overevaporation)(meibomainglanddysfunction,MGD)干眼癥臨床表現(xiàn)與診斷：癥狀、淚液分泌不足和淚膜不穩(wěn)定、眼表上皮的損害、淚液滲透壓增加、淚液分泌試驗(yàn)、淚膜破裂時(shí)間、淚液蕨類(lèi)試驗(yàn)干眼癥治療ADT：消除誘因、替代療法、減少淚液排出、促進(jìn)淚液分泌MGD：物理清潔、抗生素、局部藥物VDT（visualdisplaytermminal）結(jié)膜病(DiseaseoftheConjunctiva)

細(xì)菌性結(jié)膜炎

(bacterialconjunctivitis)

超急性細(xì)菌性結(jié)膜炎（淋球菌、腦膜炎球菌）:可累及角膜急性或亞急性細(xì)菌性結(jié)膜炎（肺炎雙球菌等）慢性結(jié)膜炎細(xì)菌性結(jié)膜炎的診斷、治療和預(yù)防

bacterialconjunctivitisHyperacutebacterialconjunctivitis:Etiology:Neisseriagonorrhoeae.Inadult,autoinfectionbyurethritis;innewbornbythebirthcanal.Clinicfinding:seroussecretion,purulent,thesymptomdevelopsquickly,corneaulcerformandevenperforation.Treatment:washingthoroughly,penicillinisdropedintotheeyebacterialconjunctivitisAcutebacterialconjunctivitisEtiology:diplococuspneumoniae,Koch-Weeksbacillusstaphylococcusandsoon.Clinicfinding:mostlybotheyesaffected,symptoms:tearing,sandysensation,burning,eyelidswellen,butnofolliclorpapillaryhyperplasia.Treatment:asthesameasaboveintroduced.Chronicconjunctivitis

Etiology:bacterialinfection,trichiasis,blepharitis,physicalandchemicalstimulation.Clinicfinding:itching,sandysensation,burning,secretionisn’tmuchmucous.Treatment:removethecause,treataccordingdifferentcause衣原性結(jié)膜炎（沙眼）

(trochoma)病因：沙眼衣原體臨床表現(xiàn)：急性期、慢性期、晚期診斷與分期治療

Trachomaisachronic,bilateralcicatrizingkeratoconjunctivitiscausedbychlamyditrachomatis.Clinicfinding:acuteperiod:tearing,photophobia,sandingsensation;sign:hyperemia,papillaryhyperplsia,follicles,cornealepithelitis.chronicperiod:hyperemiadecrease,papillaryhyperplsia,folliclesformation,graduallyscarformatnasalsulcusofupperpalpebralconjunctiva.Classification:stage1:Profressivestage,papillaeandfolliclesarecoexisted,theconjunctivaltissueofupperfornixisblurred,thereiscornealpannus.stage2:Regressivestage,fromthediscoveryofscartoalmostchangedintoscar,thereisonlyalittleactivelesion.stage3:Completecicatricialstage,cativelesiondisappearedcompletelyinsteadofscar,noinfectiviy.Complications:Entropionandtrichiasis,Symblepharon,Blepharoptosis,Parechymatousxerosisofconjunctiva,Chronicdacryocystitis,CornealulcerTreatment:antibioticsdropsfortropicaltreatment,forcomplicationsneedsurgery.病毒性結(jié)膜炎

(viralconjunctivitis)腺病毒性角結(jié)膜炎（EKC）病因：腺病毒8、19、29、37型臨床表現(xiàn)：結(jié)膜、角膜、全身表現(xiàn)；可散發(fā)可流行治療：冷敷、抗病毒藥物、抗菌素、激素流行性出血性結(jié)膜炎

Etiology:adenovirus8,19and37Clinicalfinding:palpe