眼结膜疾病PPT.ppt

医学课件园 Conjunctival diseases 北京大学人民医院眼科 陈晶华 The anatomy of conjunctiva Palpebral 睑结膜 Bulbar 球结膜 Fornical 穹隆结膜 Histology 组织学 不角化的鳞状上皮 上皮层 杯状细胞—黏液 粘膜 腺样层—浆液krause Wolfring 固有层 （血管、淋巴）纤维层－滤泡 Conjunctivitis Cause: Microorganism： 病毒、细菌、衣原体 Others:化学、物理、过敏 Pathology of conjunctivitis Congestion and edema Secretion:病毒、细菌、过敏 Subconjunctival hemorrhage Papillary hypertrophy Follicula Membrane Lymph node Scar 角膜血管翳 Hyperacute bacteril conjunctivitis Cause: 淋球菌：生殖器－眼或生殖器－手－眼 脑膜炎球菌：血源 Manifestation: 双眼，症状重，进展快 畏光流泪、眼睑红肿 结膜充血、水肿、炎性假膜、脓漏眼 淋巴结、角膜穿孔 其他部位化脓炎症 Hyperacute bacteril conjunctivitis Diagnosis: 分泌物涂片或结膜刮片 Treatment:局部＋全身 Irrigation：N.S或1：10000高锰酸钾 Drop:5000~10000u/mL青霉素、15%磺胺醋酰钠、0.1%利福平、红霉素眼膏 青霉素（壮观霉素、喹喏酮）、头孢曲松钠；抗衣原体 防止传染：1%硝酸银 Acute subacute conjunctivitis(Acute catarrhal conjunctivitis) Cause: 肺炎链球菌、Koch-Weeks杆菌、流感嗜血杆菌、金葡 Manifestation: “红眼病”，春秋，散发或流行 急、双眼、全身症状 流泪、异物、灼痛，粘液或脓性分泌物 假膜：肺炎链球菌、Koch-Weeks杆菌 角膜浸润：流感嗜血杆菌 In acute conjunctivitis the epithelium is edematous and infiltrated by polymorphonuclear leukocytes. (Inset) Bilateral acute conjunctivitis with purulent exudate Conjunctival scrapings from purulent conjunctivitis stained with Grams stain. (A) Bacteria (cocci) are present in a polymorphonuclear leukocyte and (B) in a large (epithelial?) cell Acute subacute conjunctivitis(Acute catarrhal conjunctivitis) Diagnosis: 分泌物涂片或结膜刮片 Treatment: self limit G+: 氯霉素、利福平、磺胺醋酰钠、红霉素 G-: 庆大霉素、环丙沙星、氧氟沙星 Prevention 预防： Papillary hypertrophy in chronic conjunctivitis Papillary hypertrophy in chronic conjunctivitis. (A) Papillary hypertrophy in a patient with vernal catarrh. Note the dark center and light base of each papilla. (B) Papillary configuration of the epithelium. (C) High magnification shows a papillary frond covered by the epithelium. Note the vascular core and chronic round inflammatory cells, mainly lymphocytes and plasma cell