眼科學(xué)教學(xué)課件：青光眼

Glaucoma

青光眼

DefinitionAgroupofdiseasessharecertainfeaturesincludingcuppingandatrophyoftheopticnervehead（凹陷性視神經(jīng)萎縮）relatedtothelevelofintraocularpressure(IOP)。VisualFieldDamage

青光眼視野損害

IOP（眼壓）Difinition：thepressurecausedbyintraocularcontenttoeyeballwall.Normal：11-21mmHg，differenceofbotheye<5mmHg，differenceofthesameeyein24hours<8mmHgGlaucoma：>21mmHg，opticnervedamageHypertension高眼壓癥：IOP>21mmHg，noopticnervedamageNormalTensionGlaucoma正常眼壓青光眼：normalIOP，opticnervedamage

AqueousHumor(房水）CycleAqueoushumorsecretedbytheciliaryepitheliumentersposteriorchamber.ThroughthepupilenterstheanteriorchamberLeavestheeyethroughthetrabecularmeshwork-Schlemm’scanal,iriscryptsandchoroid-scleralpathway

Rateofaqueoushumorproduction

Resistancetotheoutflowofaqueoushumorattheangleoftheanteriorchamber

Levelofepi-scleralvenouspressureInfluncefactorsofIOPMechanismofglaucomatousopticneuropathyMechanicalpressureIschemiaIOPgoupIschemiafreeradicalAxoplasmicflowblockPoortissueperfusionExcitedtoxicityreactionGONPMechanismofglaucomatousopticneuropathy

ClinicalExaminationIOPAnteriorChamberAngle

VisualField

OpticDisk

VisualAcuityIOP壓陷眼壓計(jì)：Schiotz壓平眼壓計(jì)Goldmann非接觸式眼壓計(jì)眼壓曲線青光眼激發(fā)試驗(yàn)：飲水試驗(yàn)、伏臥試驗(yàn)、暗室試驗(yàn)、散瞳試驗(yàn)AnteriorChamberAngle房角鏡FundusexaminationOpticdiskcheckNormally

C/D﹤0.4differencebetweenbotheyes﹤0.2glaucomatousopticneuropathyEarlystageprogressstageNormalvisualfieldGlaucomatVisualfielddefect青光眼分類ClassificationPrimaryPrimaryAngle-ClosureGlaucomaacuteChronicPrimaryOpenAngleGlaucomaSecondaryCongenitalAcuteangle-closureglaucoma

急性閉角型青光眼

Cause：AnatomyAgingInducingfactorsAnatomycornea（小角膜）lens（大晶體）anteriorchamberangle

（淺前房）

eyeaxis（短眼軸）acuteangle-closureglaucomacharacteristic：pupillaryblock（瞳孔阻滯），aqueoushumoroutflowblocked。50

years，female，hyperopia，familialtraitInducingfactorsreading，exaust，exiting，stayindarkroomforlongtime，drukingtoomuchwater，anticholinergicagentClinicalstages Preclinicalphase臨床前期

發(fā)作眼之對側(cè)眼有家族史，病因急閉的解剖特點(diǎn)Presymptomphase先兆期Episodesphase發(fā)作期：Breakphase間歇期：房角開放Chronicphase慢性期：房角受損逐步加重，眼壓逐步升高Absolutephase絕對期：無光感Acutebreakoutclinicalfeature

急性發(fā)作臨床表現(xiàn)

Eyebilges,headache,nauseaandvomitingBlurringCornealedema角膜水腫IOPexceed50mmHgBrownKerato-precipitates,KPMydriasis瞳孔散大Segmentirisatropy階段虹膜萎縮Glaucomaticsubcapsularflecks晶體青光眼斑Flatanteriorchamber前房淺Breakphase：angleopen,IOPreturntonormalChronicphase：glaucomapetitmal(青光眼小發(fā)作）,goniosynechiaextend（房角粘連擴(kuò)大），trabecularimpaired（小梁功能受損）,IOPgoup（眼壓上升）,glaucomatousopticneuropathy（青光眼是神經(jīng)損害）,visualfielddefect（視野缺損）Absolutephase：NLP,intaocularhypertensionDifferentialdiagnosis

鑒別診斷Acuteconjunctivitis急性結(jié)膜炎Acuteiridocyclitis急性虹膜睫狀體炎：白色KP、瞳孔小Gastrointestinaldisease胃腸道疾病Craniocerebraldisease顱腦疾病Treatment

Contractpupil(縮瞳)Ocularhypotensiveagentlocal

systemicOperationIOPcontrolBloodshoteyesdisappearChronicACG

慢性閉角型青光眼

DevelopSlowlyIOPgoupgraduallyIgnoreeasilyCharacteristics

Diagnosis

診斷

IOPgoupmoderately(眼壓中等升高)Gonioscope:AnglenarrowirisperipheralanteriorsynechiaFundus:glaucomatousopticneuropathyVisualfield:defectTreatmentDrainagesurgeryPrimaryOpenAngleGlaucoma(POAG)

原發(fā)性開角型青光眼Etiology：

unclear，hereditaryfactorCharacteristics:

angleopen,intaocularhypertensionLesionlocation

tabecularmeshwork,schlemm’scanalClinicalfeatureSymptom:noIOP:goesupgradullyAnteriorchamber:normalordeepangle:openOpticnerve:cuppingandatropyVisaulfield:defectVisualacuity:goodforlongtimePOAGdiagnosisIntrocularhypertensionAngleopenglaucomatousopticneuropathyVisualfielddefectAuxiliarydiagnosisTrabecularfunctionCoefficientofaqueousoutlow房水流暢系數(shù)

Tonography

眼壓描記

VisualfunctionColorsense色覺Contrastsensitiviy對比敏感度Visualelectrophysiology視覺電生理ElseFamilyhistoryStimulatetestWaterdeprivationtest飲水實(shí)驗(yàn)Normaltensionglaucoma(NTG)

正常眼壓青光眼IOPNormalOpticdiskHaemorrhageIncisuraAtropyVisualfieldDefectNeartofixationTreatmentmedicationLaserSurgeryTargetIOPRefractoryglaucoma

難治性青光眼的治療NoresponsetodrugSurgicaleffectisuncertainDrainagesurgeryfailureJuvenileglaucomaAphakicglaucomaNeovascularglaucomaAnti-glaucomasurgery

抗青光眼手術(shù)PuppillaryblockPeripheraliridectomyLaserperipheraliridotomyobstruciontrabecularGoniotomyTrabeculotomyArgonlasertrabeculoplastyReducingaqueoushumorCyclocryotherapyCyclodiathermycyclophotocoagulationDrainageTrabeculectomyNon-penetatingtrabeclarsurgeryDrainagedeviceLaserperipheraliridotomyAnti-glaucomaagents

抗青光眼藥物IncreasingdrainageSympatheticdrug擬交感藥dipivefinParasympatheticdrug擬副交感藥pilocarpineProstaglandinsderivative前列腺素衍生物latanoprostReducingaqueousCarbonicanhydraseinhibitor碳酸酐酶抑制劑diamox?receptorblocker??受體阻滯劑timololdehydratGlycerin甘油

Mannitol甘露醇

Ocularhypertension

高眼壓癥IOPexceed21mmHgNoglaucomadamageAngleopenTreatment:FollowupIOPexceed30mmHg,treatasPOAGSecondaryglaucoma

繼發(fā)青光眼Glaucomatocycliticcrsis青睫綜合癥Corticosteroid-inducedglaucoma糖皮質(zhì)激素性青光眼Neovascularglaucoma新生血管性青光眼

Lensinducedglaucoma晶體源性青光眼Traumainducedglaucoma眼外傷致青光眼Iridocyclitisinducedglaucoma虹睫炎繼發(fā)性青光眼SurgeryPigmentaryglaucomaIridocornealendothelialsydrome

Congen