青光眼中英文版课件

青光眼中英文版青光眼中英文版2I I I Intraocularntraocularntraocularntraocular pressurepressurepressurepressure(IOP)(IOP):thethethethe pressurepressurepressurepressure of of the the eyecontenteyecontenteyecontenteyecontent to to theeyetheeyetheeyetheeye wallwallwallwall眼压眼压:眼球内容物作用于眼球内壁的压力眼球内容物作用于眼球内壁的压力Normal IOP:Normal IOP:1 1 1 10 0 0 0 2l mmHg2l mmHg2l mmHg2l mmHgDouble IOP differenceDouble IOP difference5 5 5 5mmHgmmHgmmHgmmHgIOP curve day and nightIOP curve day and night50y female Clinical features:age50y female pain red eye vision loss pain red eye vision loss with headache nausea with headache nausea vomitingvomiting病因病因:具有遗传倾向具有遗传倾向,解剖结构异常解剖结构异常,常有诱因。常有诱因。临床特征临床特征:年龄年龄50505050岁岁,女性多见。女性多见。主诉为眼胀痛、眼红主诉为眼胀痛、眼红,视力下降视力下降,伴头痛、恶心、呕吐。伴头痛、恶心、呕吐。12Primary angle-closure glaua13Clinical stages急性闭角型青光眼临床分期急性闭角型青光眼临床分期Preclinical Preclinical stage:stage:No No symptom,symptom,Shallow Shallow anterior anterior chamber,chamber,One One eye eye get get disease,disease,the the other other eye eye with with no no symptom symptom、1 1 1 1、临床前期临床前期:没有自觉症状没有自觉症状,具有浅前房具有浅前房,房角窄房角窄,虹膜膨隆。虹膜膨隆。一眼发作一眼发作,另眼没发作。另眼没发作。Precursor stage:Transient Ease fastPrecursor stage:Transient Ease fast2 2 2 2、先兆期先兆期:一过性一过性,多次小发作多次小发作,自行缓解。自行缓解。13Clinical stages急性闭角型青光眼临床分期14Acute stage:Acute stage:Symptom:eye:pain,photophobia,tears,severe vision Symptom:eye:pain,photophobia,tears,severe vision lossloss、with headaches,nausea and vomiting with headaches,nausea and vomiting、Sign:Eyelid edema,Conjunctival congestion,Corneal Sign:Eyelid edema,Conjunctival congestion,Corneal epithelium edema,Anterior chamber extremely epithelium edema,Anterior chamber extremely shallow,The pupil dilated and light reflection shallow,The pupil dilated and light reflection disappeared,Anterior chamber angle closeddisappeared,Anterior chamber angle closed、Intraocular pressure increased 50 mmHgIntraocular pressure increased 50 mmHg、3 3 3 3、急性发作期急性发作期:症状症状:眼部眼部:眼痛、眼胀、畏光、流泪、严重视力下降。眼痛、眼胀、畏光、流泪、严重视力下降。全身全身:头痛、恶心、呕吐。头痛、恶心、呕吐。体体征征:眼眼睑睑水水肿肿、结结膜膜混混合合充充血血、角角膜膜上上皮皮水水肿肿、角角膜膜后后色色素素沉沉着着、前前房房极极浅浅、虹虹膜膜严严重重缺缺血血、房房水水浑浑浊浊、絮絮状状渗渗出出、瞳瞳孔孔中中等等大大、竖竖椭椭圆圆、光光反反射射消消失失、局局限限后后粘粘连连、房房角角关关闭闭、眼眼底底不不清清、视视网网膜膜动动脉脉搏搏动动,眼压明显升高眼压明显升高50mmHg50mmHg50mmHg50mmHg。14Acute stage:15闭角青光眼前房与前房角15闭角青光眼前房与前房角16急性闭角型青光眼发作16急性闭角型青光眼发作17Acute onset sequela:Visual acuity get betterVisual acuity get betterKPKPIris:atrophy,pigmentation defects and limited Iris:atrophy,pigmentation defects and limited stickystickyThe pupil cant return to normalThe pupil cant return to normalCloudy-glaua spot on the anterior lens capsuleCloudy-glaua spot on the anterior lens capsuleAnterior chamber Angle extensive stickAnterior chamber Angle extensive stick急性发作后遗症急性发作后遗症:视力好转视力好转角膜后色素沉着角膜后色素沉着虹膜时期性萎缩、色素脱失、局限后粘虹膜时期性萎缩、色素脱失、局限后粘瞳孔不能恢复正常瞳孔不能恢复正常晶体前囊下片状白色混浊晶体前囊下片状白色混浊-青光眼斑青光眼斑房角广泛粘连房角广泛粘连17Acute onset sequela:18Remission Remission stage stage:symptoms symptoms to to ease ease and and anterior chamber angle openanterior chamber angle openChronic Chronic stage:stage:anterior anterior chamber chamber angle angle extensive stickextensive stickFinal stage:the continuous high intraocular Final stage:the continuous high intraocular pressure,poor eyesight or no light feelingpressure,poor eyesight or no light feeling、4 4 4 4 间歇期间歇期:小发作后自行缓解小发作后自行缓解,房角开放房角开放,不用药或少量缩瞳药。不用药或少量缩瞳药。5 5 5 5 慢性期慢性期:房角广泛粘连房角广泛粘连 半周半周,眼压中度升高眼压中度升高,视盘病理凹陷视盘病理凹陷,视视 野缺损。野缺损。6666绝对期绝对期:持续高眼压持续高眼压,视力极差或无光感视力极差或无光感。18Remission stage:symptoms t诊断n n青光眼激发试验青光眼激发试验:1 1、暗室试验暗室试验2 2、俯卧试验俯卧试验3 3、暗室暗室+俯卧试验俯卧试验19诊断青光眼激发试验:1920Differential diagnosis鉴别诊断Eye Eye disease:disease:Conjunctivitis,Conjunctivitis,Anterior Anterior uveitisuveitisSystemic disease:gastrointestinal disease,Systemic disease:gastrointestinal disease,brain disease,brain disease,hypertension,etchypertension,etc眼病眼病:结膜炎、前部葡萄膜炎。结膜炎、前部葡萄膜炎。全身病全身病:胃肠道疾病、颅脑疾患、高血压病等。胃肠道疾病、颅脑疾患、高血压病等。20Differential diagnosis21Treatment of primary angle-closure glaua 原发性闭角型青光眼的治疗原发性闭角型青光眼的治疗Drugs:Drugs:increased aqueous eduction:increased aqueous eduction:myoticmyotic inhibit aqueous inhibit aqueous generated generated high permeability agenthigh permeability agentadjuvant treatment:calm or sleeping,adjuvant treatment:calm or sleeping,purge,hormone reduce inflammation responsepurge,hormone reduce inflammation response、Laser:Laser:OperationOperation:药物药物:1:1:1:1、增加房水排出增加房水排出:缩瞳剂缩瞳剂 2 2 2 2、抑制房水生成抑制房水生成:醋氮酰胺、塞不酰安醋氮酰胺、塞不酰安 3 3 3 3、高渗剂高渗剂:20%20%20%20%甘露醇甘露醇1 1 1 1一一1 1 1 1、5 5 5 5g g g gkgkgkgkg、50%50%50%50%甘油甘油2 2 2 2一一3 3 3 3ml/kgml/kgml/kgml/kg 4 4 4 4、辅助治疗辅助治疗:镇静、安眠、镇静、安眠、通便、激素减轻炎反应。通便、激素减轻炎反应。激光激光:手术手术:21Treatment of primary angle-c22 Chronic angle-closure glaua(二二)、慢性闭角型青光眼、慢性闭角型青光眼Clinical symptom:Clinical symptom:Age is earlierAge is earlierProgressiveProgressiveHave no acute historyHave no acute historyIntraocular pressure increased graduallyIntraocular pressure increased gradually、临床症状临床症状:年龄较急性为早、渐进性、可无明确发病史。年龄较急性为早、渐进性、可无明确发病史。一般无急性发作史一般无急性发作史,房角粘连与眼压增高逐渐进展。房角粘连与眼压增高逐渐进展。眼压眼压50mmHg50mmHg50mmHg0 Depending on the optic disk damage C/D0、6 6 Visual field defects Visual field defects 临床临床:无自觉症状无自觉症状,晚期发现。晚期发现。眼压升高眼压升高,房角开放。房角开放。视乳头损伤视乳头损伤C/D0C/D0C/D0C/D0、6 6 6 6或双眼差或双眼差0 0 0 0、2(2(2(2(火焰状出血火焰状出血)视野缺损视野缺损(旁中心暗点、鼻侧阶梯、弓形暗点、旁中心暗点、鼻侧阶梯、弓形暗点、环形暗点、向心性性缩小、管状、颞侧视岛环形暗点、向心性性缩小、管状、颞侧视岛)27Clinical:No self-conscious感谢您的聆听！感谢您的聆听！感谢您的聆听！