眼科學(xué)教學(xué)課件：Disorders of lacrimal apparatus Ocular surface disorder,OSD

DiseaseoftheEyelid

DisordersoflacrimalapparatusOcularsurfacedisorder,OSD

DiseaseoftheEyelid

GeneraldescriptionProtectivefunctionEyeclosingreflexprotectitfrominjuryRegularblinkingclearawaydustormicroorganismsskinsubcutaneouslayermuscularlayerfibrouslayerpalpebralconjuctivaMargineoftheeyelidAnatomyFivelayersthinnestskin,donotberemovedeasilyskinLooseconnectivetissueeasytobeswollensubcutaneouslayerOrbiculaisoculimuscle,innervatedbyVIIcranialnerve,itsfunctiontoclosetheeyemuscularlayerLevatormuscleinnervatedbyⅢcranialnerve,itsfunctiontoopentheeyemuscularlayer●

Tarsusandorbitalseptum●palpebralconjuctivaThesetwotissuesarecloselyattachedfibrouslayerpalpebralconjuctiva●

Marginoftheeyelid

itiscomposedofanteriorlayerandposteriorlayer.Thejunctionisgraylineandtherearedifferentpalpebralglands.DiseaseoftheEyelid

Palpebralinflammation：

hordeolum

、chalazion、blepharitis、dermatitisPositionalabnormality：Entropion

andtrichiasis、Lagophthalmus、Ptosis、EctropionCongenitalabnormalities：

Ptosis、Epicanthus、Distichiasis...Palpebraltumor

sty

(hordeolum)

commonpurulentinflammationofpalperalglandsinternalherdeolumexternalherdeolum(Moll’sorZeis’gland)Meibomiangland)Mostarecausedbyinfectionofstaphylococcusaureus一、Etiology：

positiveGramstainingPathologicalexamination:donnotneed

Purulentexudateconsistingofpolymorphonuclearleukocyteandcelluardebrisred,swelling,feverandpainpuricspotwithyellowish,ruptureditselfSwellingofthepreauricularlymphnodesComlication:palpebralcellulitis,septicemiaorthrombosisofthecavernoussinus二、ClinicalfindingsComplicationpalpebralcellulitis

thrombosisofthecavernoussinus

VenousbloodvesselshallowveinsinternalandexternaljugularveinsdeepveinsdrainintocavernoussinusWithoutvalves三、TreatmentLocaltreatment：hotcompressionPharmacotherapy:antibioticdrugSurgicaltherpy：incisionanddrainagethedirectionofincisionSystemictreatment：enough,broad-spectrum,sensitiveandeffectivesystemicantibioticinternalherdeolumexternalherdeolumDirectionofincisionMeibomianglandsgrainoftheskin霰粒腫(chalazion)瞼板腺囊腫(cystomaofmeibomiangland)一、Etiologygranulomainflammation二、Clinicalfindings

juvenileorinadultpalperbralsubcutaneousroundmassLongcourse

三、TreatmentSmallasymptomaticchalazion

LargeandsymptomaticchalazionSurgery：incisiondirection:verticalincisionextracttogetherwithitscapsule

foroldpatient,especiallyforthosewhohaverecurrenceafterexcision,pathologicalexaminationshouldbedonetoexcludethepossibilityofcarcinoma?。?！Video1Blepharitis

herpessimplexviralpalpebraldermatitisherpeszosterviralpalpebraldermatitis

contactdermatitisoflidsAllergypalpebraldermatitisPositionabnormalityoftheeyelidEntropionTrichiasisEctropionLagophthalmusPtosisWhatisthenormalposition?eyelidscloselycontact2.eyelashesdonotcontactwiththecornea

3.punctasituatedtomakesureoftearsflowinginsmoothly.itsmarginrollstowardstheglobe,eyelashesinevitablyfalltotheglobe,clinically,entropinandtrichiasisoftencoexist.

EntropionandTrichiasis

CongenitalentropionSpasticentropionCicatricialentropion一、classificationandetiologyCongenitalentropion1.Fat，infant2.Lowereyelid3.OccurfrequentlyamongAsians4.Usuallycombindwithflatnosebone5.Epicanthus6.Trichiasis7.Etology:thickeningoftheskinandorbicularisoculimusclenearthemarginoftheeyelidSpasticentropion1.Lowereyelid---only2.Thestructureofsupportingthelowereyelidbecomelaxwithage-----oldpeople3.Theorbicularisoculimuscleoverridethenormallysuperiormarginoftheeyelid4.Atrophyoftheorbitfattytissue

Cicatricialentropion1.Loweroruppereyelid2.Post-infectiousorpost-traumatictarsalcontracture(trachoma,burnorchemicalinjuries)3.Allergicandtoxicreactions(pemphigus,Stevens-Johnsonsyndrome,Lyell’ssyndrome)●ciliatoirritatethecornea:photophobia,tearing,stabbingpain,palpebralspasmandetc.●trichiasisrubscornealepithelium,diffusestainningoffluorescein.formulcerinducingextremepain●cornealsuperficiallayertoopacityandaccompaniedwithneovasculargrowth二、Clinicalfindingscornealepitheliumdiffusestainningoffluorescein（+）cornealulcercornealneovasculargrowthTrichiasis三、TreatmentCongenitalentropion：observe，at5～6year，suturesurgerySpasticentropion：accordingtothecauses。Senileentropionlocalinjectionofbotulinus,severeoneneedsurgicalcorrection.Cicatricialentropion：surgicalcorrection5-6yearsutureCongenitalentropionshortening

痙攣性瞼內(nèi)翻SpasticentropionCicatricialentropion

Difinition：apartofthecorneaandconjunctivaexposedtooutside

HyperthyroidismEctropionLagophthalmos

1.facialparalysis:oculimusclelosefunction

2.ectropionwithdifferentcauses,especiallycicatricialectropion

3.proportionalimbalancecausedbyorbitaltumor,hyperthyroidism,congenitalglaucoma,cornealstaphylomaandotherfactors4.Temporaryonemayoccurincomatoseorafterdeepanesthesia.

一、Etiology二、Clinicalfindings

1.Bell’sphenomenon.

2.mildlagophthalmos，thebulbarconjunctivaexposed---hyperemia,opacity,thickandmanifestsashyperkeratosis.

3.severecase,thecorneaisexposedoutsidetoo---corneadry,opaque,thenexfoliation,cornealulcer,andperforation.

1.Treatmenttoetiology2.preventthecornea(1)mild:sealthepalpebralfissurewithalotofointmentandartificialtearsolutions(2)eyeglassesora“watch-glass”bandage:Iftheconditionpermitting,contactlensmaybewearedforprotection(3)surgery----alateraltarsorrhaphy:forthosewhosecausecann’tbegotridoftemporary,tarsorrhaphyshouldbeconsidered.三、TreatmentPtosisParalysisofthelevatorpalpebralmuscle----droopingofuppereyelids----coverthecornea>2mm一、

ClassificationandEtiologyCongenitalptosis:Hereditary

1.Aplasiainthecoreoftheoculomotornerve(neurogenic)2.undevelopedlevatorpalpebralmuscle(myogenic)一、

classificationandEtiologyAcquiredptosis

1.paralyticptosis:oculomotorpalsy2.sympatheticptosis3.myotonicptosis4.traumaticptosis二、Clinicalfindings1.unilateral>bilateral2.narrowpelpebralfissure3.frowningfacesupwardmarkedwrinkles4.

formationofamblyopia5.primarydisorders

1.Congenital：severeunilateralblepharoptosisshoulebedoneasearlyaspossibletopreventtheformationofamblyopia.shorteningoflevatorpalpebralsuperioriselevatingeffectofthefrontalismuscle

2.Acquired：treatmentismainlydirectedtoitsvariouscauses.三、TreatmentMarcusGunn’syndromJaw-winkingphenomenonTherighteyedroopedobviously,buttheeyeopenswhenthemandibleisopenedordeviatedtotheleftside.SurgeryVideo2EctropionPalpebraltumor

Disordersof

LacrimalApparatus

Disordersof

LacrimalApparatus

LacrimalsecretorysystemreflectsecretorsbasicsecretorsLacrimalglandAccessorylacrimalglandLacrimaldrainagesystem淚點(diǎn)puncta鼻淚管nasolacrimalduct淚囊lacrimalsac淚小管canaliculiSymptomoflacrimaldiseaseTear

wateringeye

epiphora

lacrimation√

xDiseaseofthedrainagesystem(1)Stenosisorobstruction(2)Chronicdacryocystitis(3)Acutedacryocystitis(4)CanalicutilisStenosisorobstructionoflacrimalducts

1.

Abnormalpuncta

一、Etiologypositionshape

2.Stenosisorobsruction

CongenitalabnormalityInflammationInjuryTumor一、Etiology二、ClinicalfindingsEpiphoraInfantAdult三、Examination

Dyetest

IrrigationProbeImage三、ExaminationDyetestIrrigation

ProbeImage三、ExaminationDyetestIrrigationProbeImage三、ExaminationDyetestIrrigationProbeImage四、TreatmentInfantepiphoraAdultepiphora四、TreatmentInfantepiphoraAdultepiphoraDilatepuctaLaserandsoonLacrimalplastyStentintubationVideo3New----lacrimalendoscope

LightingchannelIrrigationchannelWorkingchannelMinimallyinvasive

treatmentoflacrimaldieseaseLacrimalmucosaPreoperativeimagePostoperativeimageMicrodrilldacryoplasty(MDP)

Laserdacryoplasty（LDP）

LacrimalbypasssurgeryChronicdacryocystitis一、Etiology

1.

obstuctioninthelowerendofnasolacrimalduct

2.tearsandbacteriastayinlacrimalsac

3.

chronicinflammation充血和水腫淤滯炎癥淚道暫時(shí)性阻塞二、ClinicalfindingsEpiphoraMucopurulentsecretionrefluxedafter

compression

Mucocele（cysticmass)ConjunctivaandskininflammationSeverethreat三、TreatmentDrugSurgicaltherapyEx-DCREn-DCRDacryocystectomy

Ex-DCR

En-DCRVideo4Acutedacryocystitis

1.onthebasisofchronicdacryocystisis

2.stronginvasivenessofbacteriaorprobing,compression3.infectiondiffusedintosurroundingtissueofthelacrimalsac一、Etiology二、Clinicalfindingsred,swelling,feverandpainSystemsymptomsMassRupturedanddrainagedFistulaformation三、TreatmentDrugSurgicaltherapy

Avoidlacrimalprobeorirrigation

1、early:heat,physicaltherapy.2、antibiotics.3、mature:incision+drainage.4、followedbychronicdacryocystitisprocessaftertheinflammationsubsided.

×Canalicutilis一、Etiology

1.

Chlamydiatrachomatis

2.

Actinomycetes

3.

Fungi

二、Clinicalfindingsred,swelling,MassMucopurulentsecretionrefluxedaftercompression三、TreatmentDrugSurgicaltherapyIrrigationwithantibiotic

solutionScrapingcutcanaliculi

ocularsurfacedisorder,OSDocularsurfacetearfilmGlobecellsLacrimalglandsMeibomianglandCompositionoftearMucinsproteinsStemcells

Lacrimalfunctionalunit

Keratoconjunctivitissicca

Dryeye一、Definitionanycauseabnormaltearqualityandquantityorhemodynamicabnormalitiesdecreasedtearfilmstabilitywitheye