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1、Conjunctival diseaseOphthalmology department of the second affiliated hospital, Chongqing medical university简嘉简嘉 1.General introduction1.1 Summary palpebral conjunctivaconjuctiva bulbar conjunctiva fornix conjunctiva conjunctivitis :the most common conjunctival disease1.2 Etiological factorMicroorga
2、nisms infectionPhysical or chemical damageAllergic factors Malnutrition, etc1.3 Classificationn Etiological： infectional、immune、chemical、secondary、 system、no reasonnspeed ： hyperacute、acute（3w）nappearance： Papillar hypertrophy 、Follicle、Membranes or pseudomembranes 、 scar、Granulomas1.4 Clinical mani
3、festationvSymptom(症状)“Foreign body” sensation, 异物感Scratching or burning sensation, 烧灼感 Itching, 痒If cornea be involved ineye ache , 眼痛Tearing , 流泪Photophobia, 畏光Blur 视物模糊vSigns (体征)Hyperemia 充血Three type：conjunctival congestionciliary congestionmixed congestionconjunctival congestion（结膜充血）ciliary co
4、ngestion（睫状充血）originconjunctival posterior arterysanterior cilliary arterypositionzone of the fornixCorneal limbusappearanceReticulate,more vascular branch, bright redradiate、less vascular branch, dark redmobilityMovable with conjunctivaNon-movable with conjunctiva Reponse to ADExtinct fastExtinct m
5、ildlyChemosis 水肿 secretion 分泌物n根据分泌物性质判断病因Bacterial：呈无定形的浆液、粘液或脓性Allergical ：呈粘稠丝状viral：呈水样或浆液性gonococcal：大量脓性分泌物 n分泌物涂片 、培养可明确病因n接触传染subconjunctival hemorrhage 结膜下出血Papillar hypertrophy 乳头增生Nonspecific Follicle 滤泡Focal lymphoid hyperplasia, rounded avascular white or gray structure（5）乳头增生、滤泡形成乳头增生
6、Papillar hypertrophy 滤泡形成 Follicle 分布睑结膜或角结膜缘上睑结膜，或下穹窿结膜，或角结膜缘外观扁平状或圆顶状，多为天鹅绒样外观，大于1mm为巨大乳头多为0.5-2mm，白色或灰白色圆形隆起的外观成因增生肥大的上皮皱叠或隆凸而成，为非特异性体征淋巴细胞反应引起特点中心有扩张的毛细血管到达顶端，成轮辐状散开中央无血管，小血管从其边缘绕行常见病上睑：春季结膜炎，或结膜对异物刺激的反应下睑：过敏性结膜炎病毒衣原体寄生虫等结膜炎；或为生理性改变（儿童青少年）Membranes 膜or pseudomembranes假膜：nformed by fibrious exuda
7、tion and cohere with palpebral conjunctiva, the former binding with conjunctiva strongly and can be stripped difficultly , but the latter loosely and easily. pseudomembranesMembranes Conjunctival scar: 结膜瘢痕nonset only when conjunctival matrix was damaged. Granulomas 肉芽肿Preauricular lymphadenopathy 耳
8、前淋巴结肿大nusually appear in viral conjunctivitis，Pseudoptosis infiltration of Mullers muscle 假性上睑下垂1.5 Checking and diagnosisvClinical examinationvCytological examinationBacterial conjunctivitis : polymorphonuclear leukocytes, Viral conjunctivitis: mononuclear and lymphocyte,Chlamydial（衣原体性） conjunctiv
9、itis: neutrophil and lymphocyte,Allergical and vernal conjunctivitis: Eosinophilia and basophilvEtiological examination the microscopic examination of conjunctival secretion smear and scrapings（分泌物涂片、结膜刮片）, when necessary, fractional cultivation and antibiotic sensitivity tests are desirable1.6 Trea
10、tment v Depending on microbiologic agent. Topical therapy is capital and assists with systemic therapy vTopical therapyEye drops: The capital route of administration。It should be used frequently in acute time and decreased frequency when state improving 。 Eye ointment : a persistent therapeutic acti
11、on, but it can make patient feel fogged vision medication at bedtime Conjunctival sac flushing :when conjunctival secretion is copious, flushing is necessary with non-stimulate rinse, such as 3% boric acid solution、 1-2 times everyday. Wrapping is inhibitted in acute conjunctivitisv systemic drugsIt
12、 is not necessary in common conjunctivitis, but in gonococcal （淋菌性）and chlamydial（衣原体） conjunctivitis its necessary1.7 Prognosis and preventionvMost conjunctivitis can be cured and has no sequelae, in some severe or chronic cases, symblepharon （睑球粘连）or dry eye can occur.vMedical members shoud wash h
13、ands after checking patients, the washing utensil of patients should be separated and steriled, in addition, healthful administration of public place should be strengthened 2.Bacterial conjunctivitisv inflammation and purulent exudation hyperacute-purulent(24h) acute mucopurulent or subacute(several
14、 hours to days) chronic(several days to weeks)分 类发病快慢病情常见病原菌 超急性（24小时内）重度奈瑟淋球菌奈瑟脑膜炎球菌急性或亚急性（几小时至几天）中至重度流感嗜血杆菌肺炎链球菌Koch-Week杆菌慢性（数天至数周）轻至中度金黄色葡萄球菌Morax-Axenfeld双杆菌变形杆菌大肠杆菌假单胞杆菌Hyperacutev Pathogenisis : Neisseria gonorrhoeae淋球菌 or meningococcus 脑膜炎球菌v Characteristic: strong infectivity, Destructivene
15、ss; profuse purulent exudatev incubation peroid several hours，2-3days, develop rapidlyvClinical symptoms and signs symptoms: pain, photophobia, tearing signs: neyelids edema ,n conjunctival hyperemian chemosis conjunctiva can protrude out of lid fissure when chemosis stronglySecretion: from serous o
16、r hematodes to purulent, and flow from lid fissure continually。After 10days or several weeks, purulent exudate decrease gradually。 Severe corneal damage, perforation or loss of eye Preauricular lymphadenopathy 耳前淋巴结肿大Septicemia 败血症 or meningitis 脑膜炎。Acute or subacute conjunctivitisvPathogenic bacteriav streptococcus pneumoniae, Koch-weeks bacillus, hemophilies influenzae, staphylococci,etc。流感嗜血杆菌,Koch-Week杆菌,肺炎链球菌vcharacteristicoften occurs in epidemic form and is called “pinkeye”; acute onset;
