青光眼---(中英文版)课件

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,GLAUCOMA,Chapter 11,第十一章 青光眼,1GLAUCOMAChapter 11第十一章 青光,2,第,节 概述,Definition:Glaucoma is a group of characteristic in,optic atrophy,and,visual field defects,as the common characteristic disease.,Pathologic intraocular pressure heighten,is one of the main risk factors.,青光眼定义：是一类以,特征性视神经萎缩,和,视野缺损,为共同特征的疾病,.,病理性眼压增高,是其主要的危险因素,.,2第节 概述 Definition:Glauco,3,I,ntraocular pressure,(IOP),:the pressure,of the,eye content,to,the eye,wall,眼压,:,眼球内容物作用于眼球内壁的压力,Normal IOP:,1,0,2l mmHg,Double IOP difference,5,mmHg,IOP curve day and night50y female,pain red eye vision loss,with headache nausea vomiting,病因：具有遗传倾向，解剖结构异常，,常有诱因。,临床特征：年龄50岁，女性多见。,主诉为眼胀痛眼红，视力下降，,伴头痛、恶心、呕吐。,13Primary angle-closure glauco,14,Clinical stages,急性闭角型青光眼临床分期,Preclinical stage:No symptom,Shallow anterior chamber,One eye get disease,the other eye with no symptom.,1,.,临床前期：没有自觉症状，具有浅前房，房角窄，虹膜膨隆。,一眼发作，另眼没发作。,Precursor stage:Transient Ease fast,2,.,先兆期：一过性，多次小发作，自行缓解。,14Clinical stages急性闭角型青光眼临床分期,15,Acute stage:,Symptom:eye:pain,photophobia,tears,severe vision loss.,with headaches,nausea and vomiting.,Sign:Eyelid edema,Conjunctival congestion,Corneal epithelium edema,Anterior chamber extremely shallow,The pupil dilated and light reflection disappeared,Anterior chamber angle closed.,Intraocular pressure increased 50 mmHg.,3,.,急性发作期：,症状：眼部：眼痛、眼胀、畏光、流泪、严重视力下降。,全身：头痛、恶心、呕吐。,体征：眼睑水肿、结膜混合充血、角膜上皮水肿、角膜后色素沉着、前房极浅、虹膜严重缺血、房水浑浊、絮状渗出、瞳孔中等大、竖椭圆、光反射消失、局限后粘连、房角关闭、眼底不清、视网膜动脉搏动,眼压明显升高,50mmHg,。,15Acute stage:,16,闭角青光眼前房和前房角,16闭角青光眼前房和前房角,17,急性闭角型青光眼发作,17急性闭角型青光眼发作,18,Acute onset sequela:,Visual acuity get better,KP,Iris:atrophy,pigmentation defects and limited sticky,The pupil cant return to normal,Cloudy-glaucoma spot on the anterior lens capsule,Anterior chamber Angle extensive stick,急性发作后遗症：,视力好转,角膜后色素沉着,虹膜阶段性萎缩、色素脱失、局限后粘,瞳孔不能恢复正常,晶体前囊下片状白色混浊,-,青光眼斑,房角广泛粘连,18Acute onset sequela:,19,Remission stage:symptoms to ease and anterior chamber angle open,Chronic stage:anterior chamber angle extensive stick,Final stage:the continuous high intraocular pressure,poor eyesight or no light feeling.,4 间歇期：小发作后自行缓解，房角开放，不用药或少量缩瞳药。,5 慢性期：房角广泛粘连半周，眼压中度升高，视盘病理凹陷，视 野缺损。,6,绝对期：持续高眼压，视力极差或无光感,。,19Remission stage:symptoms t,诊断,青光眼激发试验：,1.,暗室试验,2.,俯卧试验,3.,暗室,+,俯卧试验,20,诊断青光眼激发试验：20,21,Differential diagnosis,鉴别诊断,Eye disease:Conjunctivitis,Anterior uveitis,Systemic disease:gastrointestinal disease,brain disease,hypertension,etc,眼病：结膜炎、前部葡萄膜炎。,全身病：胃肠道疾病、颅脑疾患、高血压病等。,21Differential diagnosis,22,Treatment of primary angle-closure,glaucoma,原发性闭角型青光眼的治疗,Drugs:,increased aqueous eduction:,myotic,inhibit aqueous,generated,high permeability agent,adjuvant treatment:calm or sleeping,purge,hormone reduce inflammation response.,Laser:,Operation,:,药物,:1.,增加房水排出：缩瞳剂,2,.,抑制房水生成：,醋氮酰胺、塞吗酰安,3,.,高渗剂：,20%甘露醇1一1.5,gkg、,50%,甘油2一3,ml/kg,4.,辅助治疗：镇静、安眠、,通便、激素减轻炎反应。,激光：,手术：,22Treatment of primary angle-c,23,Chronic angle-closure glaucoma,（二）、慢性闭角型青光眼,Clinical symptom:,Age is earlier,Progressive,Have no acute history,Intraocular pressure increased gradually.,临床症状：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，房角粘连和眼压增高逐渐进展。,眼压,0.6,Visual field defects,临床：无自觉症状，晚期发现。,眼压升高，房角开放。,视乳头损伤,C/D0.6,或双眼差0,.2(,火焰状出血),视野缺损(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,),28Clinical:No self-conscious,29,Diagnosis:,High IOP,Optic disk damage,Visual field defects,2 of the 3 signs+anterior chamber angle opening,Others:electric physiology exam,family history,etc.,Treatment:,Drug therapy:,Laser therapy:,Operation:,诊断：眼压高、视乳头损害、视野缺损,其中两项+房角宽,其他：电生理、家族史等。,治疗：药物治疗：前列腺素衍生物,激光治疗：,手术治疗：滤过性手术,29Diagnosis:High IOP,30,Ocular hypertension,第三节 高眼压症,Definition:Intraocular pressure is higher than normal,without the optic disk and vision field damage.Anterior chamber angle keep opening.,Regularly return visit:To minimize risk factors.,概念,:,眼压高于正常上限,无视盘和视野损害,房角开放。,定期随访,:,使危险因素降到最小。,30 Ocular hypertension第三节 高眼压,31,Secondary glaucoma,第四节继发性青光眼,Glaucomatocyclitic,syndrome,Corticosteroids glaucoma:,Traumatic glaucoma,Cataract expansion glaucoma,Anterior uveal inflammatory glaucoma,Neovascular glaucoma,Ciliary ring obstructive glaucoma,一、青光眼睫状体炎综合征,:,中年男性多见。,二、糖皮质激素性青光眼,:,小梁细胞功能受损,三、眼外伤：溶血、晶体脱位、房角后退,四、白内障：膨胀期 过熟期,五、虹膜睫状体炎,六、新生血管性青光眼,七、睫状环阻塞青光眼,(,恶性青光眼,),31Secondary glaucoma 第四节继发性青光,32,Congenital glaucoma,第五节 先天性青光眼,Infantile glaucoma,:,Photophobia,Tears,Corneal increases and cloudy,anterior chamber deepened.,IOP Increased and,physiological concave expand,一、婴幼儿型青光眼,:,常染色体隐性遗传，房角结构发育不良。,畏光，流泪。角膜增大，混浊，前房加深。,眼压增高，视乳头凹陷增大。,Juvenile glaucoma,:,6yage30y,二、青少年型青光眼,:6,岁年龄30岁。同开角型青光眼。,三、先天性青光眼伴有其他先天异常,32Congenital glaucoma 第五节 先,33,思考题,定义：青光眼,病理性眼压,高眼压症,正常眼压性青光眼,什么是眼内压？正常值的范围是多少？,房水循环途径是什么？,急性闭角型青光眼的临床分期,急性闭角型青光眼的临床表现,急性闭角型青光眼的治疗,急性闭角型青光眼与急性结膜炎和急性虹膜睫状体炎的鉴别诊断,33思考题定义：青光眼,