Conjunctivaldisease1.Generalintroduction1.1Summary

palpebralconjunctivaconjuctiva

bulbarconjunctiva

fornixconjunctiva

conjunctivitis:themostcommonconjunctivaldisease1.2EtiologicalfactorMicroorganismsinfectionPhysicalorchemicaldamageAllergicfactorsMalnutrition,etc1.3Classification

Etiological：infectional、immune、chemical、secondary、system、noreasonspeed：

hyperacute、acute（<3W）、subacute、chronic（>3w）appearance：

Papillarhypertrophy、Follicle、Membranesorpseudomembranes、scar、Granulomas1.4ClinicalmanifestationSymptom(癥狀)“Foreignbody”sensation,異物感Scratchingorburningsensation,燒灼感

Itching,癢Ifcorneabeinvolvedineyeache,眼痛Tearing,流淚Photophobia,

畏光Blur視物模糊Signs(體征)Hyperemia

充血Threetype：conjunctivalcongestionciliarycongestionmixedcongestionconjunctivalcongestion（結(jié)膜充血）ciliarycongestion（睫狀充血）originconjunctivalposterior

arterysanteriorcilliaryarterypositionzoneofthefornixCorneallimbusappearanceReticulate,morevascularbranch,brightredradiate、lessvascularbranch,darkredmobilityMovablewithconjunctivaNon-movablewithconjunctivaReponsetoADExtinctfastExtinctmildlyChemosis

水腫

secretion分泌物根據(jù)分泌物性質(zhì)判斷病因Bacterial：呈無(wú)定形的漿液、粘液或膿性Allergical：呈粘稠絲狀viral：呈水樣或漿液性gonococcal：大量膿性分泌物

分泌物涂片、培養(yǎng)可明確病因接觸傳染subconjunctivalhemorrhage結(jié)膜下出血Papillarhypertrophy乳頭增生NonspecificFollicle濾泡Focallymphoidhyperplasia,roundedavascularwhiteorgraystructure（5）乳頭增生、濾泡形成乳頭增生Papillarhypertrophy濾泡形成Follicle分布瞼結(jié)膜或角結(jié)膜緣上瞼結(jié)膜，或下穹窿結(jié)膜，或角結(jié)膜緣外觀扁平狀或圓頂狀，多為天鵝絨樣外觀，大于1mm為巨大乳頭多為0.5-2mm，白色或灰白色圓形隆起的外觀成因增生肥大的上皮皺疊或隆凸而成，為非特異性體征淋巴細(xì)胞反應(yīng)引起特點(diǎn)中心有擴(kuò)張的毛細(xì)血管到達(dá)頂端，成輪輻狀散開(kāi)中央無(wú)血管，小血管從其邊緣繞行常見(jiàn)病上瞼：春季結(jié)膜炎，或結(jié)膜對(duì)異物刺激的反應(yīng)下瞼：過(guò)敏性結(jié)膜炎病毒衣原體寄生蟲(chóng)等結(jié)膜炎；或?yàn)樯硇愿淖儯▋和嗌倌辏㎝embranes膜orpseudomembranes假膜：formedbyfibriousexudationandcoherewithpalpebralconjunctiva,theformerbindingwithconjunctivastronglyandcanbestrippeddifficultly,butthelatterlooselyandeasily.pseudomembranesMembranesConjunctivalscar:結(jié)膜瘢痕onsetonlywhenconjunctivalmatrixwasdamaged.

Granulomas肉芽腫Preauricularlymphadenopathy

耳前淋巴結(jié)腫大usuallyappearinviralconjunctivitis，PseudoptosisinfiltrationofMuller’smuscle

假性上瞼下垂1.5CheckinganddiagnosisClinicalexaminationCytologicalexaminationBacterialconjunctivitis:polymorphonuclearleukocytes,Viralconjunctivitis:mononuclearandlymphocyte,Chlamydial（衣原體性）conjunctivitis:neutrophilandlymphocyte,Allergicalandvernalconjunctivitis:EosinophiliaandbasophilEtiologicalexamination

themicroscopic

examinationofconjunctivalsecretionsmearandscrapings（分泌物涂片、結(jié)膜刮片）,whennecessary,fractionalcultivationandantibioticsensitivitytestsaredesirable1.6Treatment

Dependingonmicrobiologicagent.Topicaltherapyiscapitalandassistswithsystemictherapy

TopicaltherapyEyedrops:Thecapitalrouteofadministration。Itshouldbeusedfrequentlyinacutetimeanddecreasedfrequencywhenstateimproving。

Eyeointment:apersistenttherapeuticaction,butitcanmakepatientfeelfoggedvision–medicationatbedtimeConjunctivalsacflushing:whenconjunctivalsecretioniscopious,flushingisnecessarywithnon-stimulaterinse,suchas3%boricacidsolution、1-2timeseveryday.WrappingisinhibittedinacuteconjunctivitissystemicdrugsItisnotnecessaryincommonconjunctivitis,butingonococcal（淋菌性）andchlamydial（衣原體）conjunctivitisit’snecessary1.7PrognosisandpreventionMostconjunctivitiscanbecuredandhasnosequelae,insomesevereorchroniccases,symblepharon（瞼球粘連）ordryeyecanoccur.Medicalmembersshoudwashhandsaftercheckingpatients,thewashingutensilofpatientsshouldbeseparatedandsteriled,inaddition,healthfuladministrationofpublicplaceshouldbestrengthened

2.Bacterialconjunctivitis

inflammationandpurulentexudation

hyperacute---purulent(<24h)acutemucopurulentorsubacute(severalhourstodays)chronic(severaldaystoweeks)分類(lèi)發(fā)病快慢病情常見(jiàn)病原菌超急性（24小時(shí)內(nèi)）重度奈瑟淋球菌奈瑟腦膜炎球菌急性或亞急性（幾小時(shí)至幾天）中至重度流感嗜血桿菌肺炎鏈球菌Koch-Week桿菌慢性（數(shù)天至數(shù)周）輕至中度金黃色葡萄球菌Morax-Axenfeld雙桿菌變形桿菌大腸桿菌假單胞桿菌Hyperacute

Pathogenisis:Neisseriagonorrhoeae淋球菌ormeningococcus腦膜炎球菌

Characteristic:stronginfectivity,Destructiveness;

profusepurulentexudateincubationperoidseveralhours，2-3days,developrapidlyClinicalsymptomsandsigns

symptoms:pain,photophobia,tearingsigns:eyelidsedema,conjunctivalhyperemia

chemosis

conjunctivacanprotrudeoutoflidfissurewhenchemosisstronglySecretion:fromserousorhematodestopurulent,andflowfromlidfissurecontinually。After10daysorseveralweeks,purulentexudatedecreasegradually。

Severecornealdamage,perforationorlossofeye

Preauricularlymphadenopathy耳前淋巴結(jié)腫大Septicemia敗血癥ormeningitis腦膜炎。AcuteorsubacuteconjunctivitisPathogenicbacteria

streptococcuspneumoniae,Koch-weeksbacillus,hemophiliesinfluenzae,staphylococci,etc。流感嗜血桿菌,Koch-Week桿菌,肺炎鏈球菌characteristicoftenoccursinepidemicformandiscalled“pinkeye”;acuteonset;botheyesinvasionorseparatedby1-3days;symptoms:tearing,foreignbodysensation,burningsensationSigns:

Secretion

iscopious,sothelidsareoftenfirmlystucktogetheronwakingHyperemia:especiallyinfornixandbulbarconjunctivaPseudomembraneormembraneChronicHyperemiamildlyandlittlemucoussecretionSymptoms:Itching,foreignbodysensation,eyestrain（眼疲勞）.Signs:hyperemia,littlepapillaryhypertrophyandfollicle

SystemictherapyisasimportantastopicaltherapyTopicaltherapy:conjunctivalsacflushingfrequentlywithsalineor1：10000liquorpotassicpermanganate（高錳酸鉀）or3%boricacidwhenconjunctivalsecretionisprofuse.Eyedropsandeye-ointment：properantibioticapplicationcanshortencourseofdisease,eyedropsapplicationfrequentlyTreatmentmentSystemictherapy:systemicantibioticapplicationisemphasizedinNeisseriabacteriaPreventionHygiene衛(wèi)生Patientsinacutephaseseparated隔離Cleanse消毒Protecthealthfuleye,etc.保護(hù)健眼3.Chlamydialconjunctivitis

衣原體性結(jié)膜炎TrachomaAchronicinfectivekeratoconjunctivitisEpidemicbeforethe1950sinourcountry,anditisthefirstcauseofblindnessDropobviouslyafterthe1970sandonlyappearinremoteareanow.Etiologicalfactorchamydia

(antigenictypeA、B、C、orBa）Inclusionconjunctivitis包涵體性結(jié)膜炎1.chamydia（D－K型）。2.Adult：潛伏期1－2周，癥狀可輕可重，但結(jié)膜體征明顯：以乳頭增生和濾泡形成為主其結(jié)膜肥厚和濾泡可持續(xù)存在3－6個(gè)月?？捎薪Y(jié)膜瘢痕，但無(wú)角膜瘢痕?？砂槠渌课灰略w感染；Infant：潛伏期為生后5－14天，有胎膜早破者生后1天即可出現(xiàn)，多為雙眼，大量膿性分泌物，持續(xù)2－3月后可出現(xiàn)白色光澤濾泡，重者可有偽膜形成及芥末斑痕化，并可有角膜瘢痕及新生血管出現(xiàn)，可伴全身其他部位衣原體感染。3.Dignosis：根據(jù)臨床表現(xiàn)容易診斷。實(shí)驗(yàn)室檢查：在結(jié)膜上皮的胞漿內(nèi)檢出嗜堿性包涵體，有助于鑒別診斷。4.

Treatment：強(qiáng)調(diào)局部治療與全身治療結(jié)合。5.Prenosis加強(qiáng)衛(wèi)生宣教；提高產(chǎn)前護(hù)理質(zhì)量，加強(qiáng)生殖道衣原體感染的控制和治療；藥物預(yù)防：如1％硝酸銀、0.5%紅霉素、2.5%聚烯吡酮碘等。4.ViralconjunctivitisAdenovirusconjunctivitis

AcutefollicularconjunctivitisStronginfectiveAppearin2types

EpidemickeratoconjunctivitisPharyngoconjunctivalfeverEpidemickeratoconjunctivitisCausedbyadenovirustypes8,19,29and37(subgroupDofthehumanadenoviruses)Clinicalmanifestation

Incubationperoid:5-7days,usuallybilateral,thewholecoursecontinue3-4weeksSyptoms:foreignbodysensation,pain,photophobia,tearingSigns:eyelidsedema,obvioushyperemia,chemosis,muchfolliclesandsubconjunctivalhemorrhageoftenappearingwithin48h,Pseudomembraneormembrane,Preauricularlymphadenopathyischaracteristic,Corneal:epithelialkeratitis,roundsubepithelialopacities.流行性角結(jié)膜炎Treatment

thereisnospecifictherapyatpresent,topicaladministrationismainmethod,suchasantiviraleyedropsColdcompresses（冷敷）andangiotonica（血管收縮）willrelievesomesymptoms.EpidemichemorrhagicconjunctivitisCausedbyenterovirustype70,self-limitedStronginfective,epidemicwidelyin1971inourcountryClinicalmanifestion

symptoms:pain,photophobia,tearing,red,foreignbodysensationSigns:hyperemia,chemosis,copiousfollicles,subconjunctivalhemorrhage(onsetfromtheupperconjunctiva),preauricularlymphadenopathyTreatment:sametoepidemickeratoconjunctivitis5.ImmunologicconjunctivitisVernalconjunctivitis

it’sabilateralallergicdiseasethatusuallybeginsintheprepubertalyears（青春期）andlastsfor5-10y,moreoftenerinboysthaningirls.seasonal,repeated

Clinicalmanifestion

symptom:extremeitchingSigns:devidinginto3typesaccordingtodiseasedregionasfollowing:Tarsalconjunctivaltype