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Slide 1
Ophthalmology Shen Jiaquan Dept. of Ophthalmology Shandong
Provincial Hospital
Slide 2
Introduction to Ophthalmology Deal with optic organ including:
eyeball adenexa visual pathway visual center onset treatment
preventiopnof eye diseases
Slide 3
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
Slide 4
Eyewall: A. External layer: fibrosa Ant. Cornea: 1 epithelium 2
Bowmans or ant elastic 3 stroma 4 Descement membrane 5 endothelium
Post. Sclera:
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B. Middle layer: uvea ant. iris, pupil 2.5~4mm mid. ciliary
body, post. choroid, C. Inner layer: retina
Slide 6
Contents of the eye : aqueous humor anterior chamber lens
posterior chamber vitreous body
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Adenexa A. Eyelid skin subcutineous muscular fibrous
conjuntiva
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B. Conjunctiva palpebral conj. bulbar conj. fornical conj.
Treatment: local hot compress antibiotics incision &
drainage vertical for internal parallel for external
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Chalazion Etiology: lipogranulomatous inflammation caused by
blockage of excretory ducts of tarsal glands
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Blepharitis 3 types A. Squamous B. Ulcerative C. Angular
Treatment: wash with 3% boric acid antibiotics 0.5% ZnSO4 VitB
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Entropion A. congenital B. spastic C. cicatricial
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Ectropion A. cicatricial B. senile C. paralytic
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Trichiasis Lagophthalmos Epicanthus Blepharoptosis ptosis of
upper eyelid, palpebral fissure narrowed A. congenital B.
aquired
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1. mechanic 2. myogenic 3. Neurogenic
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Chapter 3. Diseases of lacrimal apparatus Secretory
Excretory
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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
Slide 24
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.
B. Endogenous: often with systemic disoders; dermatitis;
allergic; C. Local spreading Clinical manifestation Symptoms:
secreations, discharges, foreign body sensation, burning, tearing
or itching;
Baterial conjunctivitis A. Hyperacute conjunctivitis Etilogy :
mostly by gonococus or meningitis cocus; Clinical findings: rapid
progression; symptoms and signs severe; purulent ( pus leakage);
pseudomembrane;
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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.
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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.
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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;
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palpabral or fornical hyperemia; subconjunctival hemorrahage;
3~5 days peak, then subside, recover in about 2 weeks
Complications: catarrhal marginal corneal infiltration or
ulcer.
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Treatment: Eyedrops : 0.25 % chloramycin 0.4 % gentamycin 15 %
S.C 0.3% tobramycin, etc. Ointment: erythromycin, etc.
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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
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;
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:
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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.
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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;
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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.
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Treatment: 1. early stage: observe 2.surgery
Slide 45
Chapter 5. Diseases of cornea General discription window
refractive media pump avascular immune exemptiom
Slide 46
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.
Bacterial keratitis Etiology: staphylococus, streptococus, etc.
after injury of cornea, FB removal; dry eye, trichiasis, CL
wearing, diabetis, severe burn, coma, etc.
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Clinical findings: symptoms: acute onset after injury in 24~48
hrs pain, vision reduction, photophobia, tearing, spasm of eyelid,
pus;
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signs: edema of eyelid and conjunctiva, ciliary or mixed
congestion, epithelial ulcer, infiltration, later deeper ulcer,
hypopyon, panophthalmitis,
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Treatment: hign concentration antibiotics eyedrops, ointment in
the evening, hot compress Vit B, C if perforation, cornea
transplatation
Slide 53
Fungal keratitis Etiology: infected with fungus: such as
fusarium, candida, aspergillus, penicillium,etc. mostly in harvest
season, eye injuried by plant,wheat,etc.
Slide 54
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
Slide 55
Diagnosis: history of plant injury; characteristic of corneal
focus; scraching for Gram & Giemsa stain; culture + drug
sensitivity test;