裂隙燈使用操作

裂隙燈的操作使用視明眼鏡公司視光培訓(xùn)2015-05裂隙燈簡介裂隙燈：全稱“裂隙燈顯微鏡”是眼科使用最頻繁的一種光學(xué)設(shè)備。通過裂隙燈顯微鏡可以清楚地觀察眼瞼、結(jié)膜、鞏膜、角膜、前房、虹膜、瞳孔、晶狀體及玻璃體前1/3，可確定病變的位置、性質(zhì)、大小及其深度。若配以附件，其檢查范圍將更加廣泛。因而裂隙燈不僅是眼科醫(yī)生檢查的重要設(shè)備，也成為配鏡驗(yàn)光人員的必備和必須掌握的儀器。裂隙燈顯微鏡的原理裂隙燈：顧名思義就是燈光透過一個(gè)裂隙對眼睛進(jìn)行照明。由于是一條窄縫光源，因此被稱之為“光刀”。將這種“光刀”照射于眼睛形成一個(gè)光學(xué)切面，即可觀察眼睛各部位的健康狀況。其原理是利用了英國物理學(xué)家丁達(dá)爾的“丁達(dá)爾現(xiàn)象”。裂隙燈顯微鏡的原理裂隙燈顯微鏡又稱活體顯微鏡，簡稱裂隙燈唯一能觀察活體切片的儀器是眼科一種重要的檢查工具強(qiáng)烈而集中的光源和雙目顯微鏡的放大相配合，不僅能使表淺的病變觀察得十分清楚，并且可以利用裂隙光帶通過眼球各部的透明組織，形成一系列光學(xué)切面，使深部組織的病變也能清楚地顯示出來HydronQibeiOptometryEliteInstitute

結(jié)構(gòu)和原理

裂隙燈顯微鏡功能部件輔助部件投照系統(tǒng)觀察系統(tǒng)托架調(diào)焦手柄控制板52/3/20248:35PM裂隙燈顯微鏡6HydronQibeiOptometryEliteInstitute測試前準(zhǔn)備

測試者充分洗手

適當(dāng)降低室內(nèi)光線亮度

將裂隙光線投照于調(diào)焦棒分別調(diào)節(jié)雙眼目鏡的焦距手輪，使焦平面清晰

調(diào)整目鏡間距，使測試者得以雙眼同時(shí)觀察目標(biāo)

122/3/20248:35PMHydronQibeiOptometryEliteInstitute調(diào)試裂隙燈顯微鏡目鏡132/3/20248:35PMHydronQibeiOptometryEliteInstitute

使被測試者取舒適坐姿（可適當(dāng)升降座椅或操作臺(tái)）面部向前，將額部和頦部緊附額托和頦托

142/3/20248:35PMHydronQibeiOptometryEliteInstitute

調(diào)整頦托手輪使被檢查者的外眥部與托架縱桿眼位刻度線相平152/3/20248:35PMHydronQibeiOptometryEliteInstitute3.

基礎(chǔ)調(diào)試

旋動(dòng)裂隙寬度手輪，將裂隙寬度調(diào)整至窄裂隙

162/3/20248:35PMHydronQibeiOptometryEliteInstitute

調(diào)整燈臂，使基礎(chǔ)投射角度保持大致30°左右172/3/20248:35PMHydronQibeiOptometryEliteInstitute

旋動(dòng)亮度手輪，使基礎(chǔ)投照亮度保持中低度182/3/20248:35PMHydronQibeiOptometryEliteInstitute

旋動(dòng)倍率手輪，設(shè)置基礎(chǔ)倍率為10×

192/3/20248:35PMHydronQibeiOptometryEliteInstitute

調(diào)整濾鏡掣，設(shè)置基礎(chǔ)濾鏡為散熱光柵

旋動(dòng)裂隙長度手輪，將裂隙長度設(shè)置為最長、傾斜度垂直202/3/20248:35PMHydronQibeiOptometryEliteInstitute4.投照和觀察技術(shù)

彌散投照法直接投照法間接投照法背面投照法鏡面反射投照法全內(nèi)反射投照法濾光式投照法常用投照和觀察技術(shù)212/3/20248:35PMHydronQibeiOptometryEliteInstitute

彌散投照法（diffuseillumination）

觀察方法光源加覆磨砂濾光鏡裂隙寬度調(diào)整為寬大放大倍率6×~10×投照亮度為高度濾鏡調(diào)整為無光柵彌散透照法的觀察視野較大

222/3/20248:35PMHydronQibeiOptometryEliteInstitute彌散投照法觀察方法232/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容外眼各部：眼瞼、瞼緣、睫毛、球結(jié)膜、瞼結(jié)膜、淚小點(diǎn)、淚液角膜、角鞏膜緣部、前房、虹膜、瞳孔和部分晶狀體角膜接觸鏡配適的動(dòng)態(tài)評估：鏡片的覆蓋度、中心定位、移動(dòng)度、下垂度、松緊度242/3/20248:35PMHydronQibeiOptometryEliteInstitute軟鏡的配適252/3/20248:35PMHydronQibeiOptometryEliteInstitute硬鏡的配適262/3/20248:35PMHydronQibeiOptometryEliteInstitute

直接投射法（directillumination）

觀察方法投射軸與觀察軸夾角30°~50°裂隙寬度0.2mm-1.5mm或錐形光束放大倍率6×~25×投照亮度從中度逐漸調(diào)至高度濾鏡調(diào)整為無光柵顯微鏡焦平面處在光源照亮的部位

272/3/20248:35PMHydronQibeiOptometryEliteInstitute直接投照法觀察方法30°~50°282/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容窄裂隙：稱為光切片觀察角膜弧度（如圓錐角膜），角膜厚度（如角膜水腫）角膜創(chuàng)傷的深度和異物的位置寬裂隙：觀察上皮層（如疤痕）、基質(zhì)層、內(nèi)皮層的病變鏡片表面的異物和沉淀物；鏡片的移動(dòng)度和松緊度錐形光束：觀察房水閃輝現(xiàn)象

292/3/20248:35PMHydronQibeiOptometryEliteInstitute圓錐角膜302/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜厚度312/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜疤痕322/3/20248:35PMHydronQibeiOptometryEliteInstitute鏡片沉淀物332/3/20248:35PMHydronQibeiOptometryEliteInstitute

間接投照法（indirectillumination）

觀察方法投射軸與觀察軸夾角45°~60°裂隙寬度1.0mm~2.0mm放大倍率16×~40×投照亮度從中度調(diào)至高度，濾鏡調(diào)整為散熱光柵顯微鏡焦平面位于光源照亮的旁側(cè)，借助角膜背面分散折射的光線照亮裂隙光旁側(cè)的觀察目標(biāo)

342/3/20248:35PMHydronQibeiOptometryEliteInstitute間接投照法觀察方法45°~60°352/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容

觀察淚液的脂質(zhì)成分氧代謝障礙誘發(fā)的角膜上皮微囊、微泡

362/3/20248:35PMHydronQibeiOptometryEliteInstitute上皮微泡372/3/20248:35PMHydronQibeiOptometryEliteInstitute

背面投照法（retroillumination）

觀察方法投射軸與觀察軸夾角30°~50°裂隙寬度1.5mm~3.0mm放大倍率16×~25×投照亮度低度逐漸調(diào)至中度382/3/20248:35PMHydronQibeiOptometryEliteInstitute背面投照法又稱后映法光源投射于顯微鏡焦平面后方的虹膜上利用虹膜組織發(fā)出的彌散反光從背面照亮角膜進(jìn)行觀察

分為直接法和間接法直接法的觀察目標(biāo)以照亮的虹膜為背景間接法觀察目標(biāo)以照亮的虹膜旁側(cè)的暗區(qū)為背景392/3/20248:35PMHydronQibeiOptometryEliteInstitute背面投照法觀察方法直接法間接法30°~50°30°~50°402/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容

直接法：觀察角膜新生血管和角膜異物間接法：利用從背面照亮的角膜發(fā)出的彌散光為背景觀察角膜浸潤、角膜基質(zhì)層的水腫皺紋和鏡片表面的沉淀物412/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜新生血管422/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜疤痕432/3/20248:35PMHydronQibeiOptometryEliteInstitute脂質(zhì)沉淀物442/3/20248:35PMHydronQibeiOptometryEliteInstitute

鏡面反射投照法（mirrorreflectionillumination）

方法

調(diào)整顯微鏡與燈臂的位置使眼軸與投射軸的夾角和眼軸與觀察軸的夾角相等投射軸與觀察軸夾角60°裂隙寬度1.5mm~2.0mm放大倍率16×~40×投照亮度中度至高度452/3/20248:35PMHydronQibeiOptometryEliteInstitute鏡面反射投照法又稱平行光切法移動(dòng)裂隙光，使之與投射光在角膜表面上的反光點(diǎn)相重合可觀察到角膜后彈力層如同鏡面一樣的的反射光使顯微鏡的焦平面落在反射光上即可透過透明的后彈力層觀察到角膜內(nèi)皮細(xì)胞層

462/3/20248:35PMHydronQibeiOptometryEliteInstitute鏡面反射投照法觀察方法60°472/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容角膜內(nèi)皮細(xì)胞的病理性改變和淚液層的質(zhì)量

角膜內(nèi)皮細(xì)胞層482/3/20248:35PMHydronQibeiOptometryEliteInstitute

全內(nèi)反射投照法（totalinternalillumination）

觀察方法

投射軸與觀察軸夾角45°~60°裂隙寬度1.0mm~2.0mm放大倍率10×~16×投照亮度從中度調(diào)至高度濾鏡調(diào)整為無光柵492/3/20248:35PMHydronQibeiOptometryEliteInstitute全內(nèi)反射投照法又稱角膜緣分光法使光裂隙集中投照角膜邊緣光線在角膜上皮層和內(nèi)皮層之間反復(fù)折射投照成功的標(biāo)準(zhǔn)時(shí)角鞏膜緣形成彌散光環(huán)顯微鏡焦平面則觀察角膜中央至另一側(cè)

502/3/20248:35PMHydronQibeiOptometryEliteInstitute全內(nèi)反射投照法觀察方法512/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容

角膜基質(zhì)層的水腫皺紋瘢痕、上皮損傷異物和浸潤等鏡片的不透明沉淀物

522/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜上皮浸潤532/3/20248:35PMHydronQibeiOptometryEliteInstitute

濾光式投照法（filteredillumination）

觀察方法裂隙寬度調(diào)整為寬大放大倍率6×~10×投照亮度為高度采用鈷蘭光源、磨砂濾光鏡、黃色濾光鏡、1%熒光素鈉542/3/20248:35PMHydronQibeiOptometryEliteInstitute

觀察內(nèi)容

角膜和結(jié)膜損傷染色的形態(tài)和深度透氣硬鏡的配適評估等

552/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜上皮損傷562/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜塑形鏡靜態(tài)配適572/3/20248:35PMHydronQibeiOptometryEliteInstitute配鏡前眼部檢查PerCheckingforContactlenses582/3/20248:35PMHydronQibeiOptometryEliteInstitute1.觀察方法

囑被檢查者直視前方用彌散光投照法依次觀察：眼瞼、瞼緣、睫毛、角膜、前房、虹膜、瞳孔、晶狀體

囑被檢眼水平轉(zhuǎn)動(dòng)在眼球左轉(zhuǎn)和右轉(zhuǎn)時(shí)充分觀察側(cè)方的球結(jié)膜、鞏膜和淚阜592/3/20248:35PMHydronQibeiOptometryEliteInstitute

囑被檢眼向上看用拇指在緊靠下瞼緣處撐開下眼瞼觀察下方的瞼結(jié)膜、球結(jié)膜、鞏膜和下淚點(diǎn)并沿瞼緣顳側(cè)向鼻側(cè)推按淚囊，觀察淚小點(diǎn)有無溢出液

囑被檢查眼向下看用拇指和食指捏住上眼瞼，輕輕提起并翻開上眼瞼觀察上方球結(jié)膜、瞼結(jié)膜、鞏膜和上淚點(diǎn)

602/3/20248:35PMHydronQibeiOptometryEliteInstitute外眼檢查612/3/20248:35PMHydronQibeiOptometryEliteInstitute翻開上眼瞼的過程

622/3/20248:35PMHydronQibeiOptometryEliteInstitute以上檢查先右眼后左眼，依次進(jìn)行根據(jù)病史提示或遇到陽性體征時(shí)可進(jìn)行其他投照技術(shù)的檢查同時(shí)提高放大倍率進(jìn)行觀察632/3/20248:35PMHydronQibeiOptometryEliteInstitute2.

觀察內(nèi)容1）

眼外觀

雙眼突出或一眼突出

突眼性甲狀腺腫（exophthalmicgoiter）

眼眶腫瘤（orbitaltumors）不宜配戴角膜接觸鏡642/3/20248:35PMHydronQibeiOptometryEliteInstitute突眼性甲狀腺腫

652/3/20248:35PMHydronQibeiOptometryEliteInstitute眼眶腫瘤

662/3/20248:35PMHydronQibeiOptometryEliteInstitute

視線指向

采用角膜映光試驗(yàn)評估被檢雙眼

顯性斜視（manifeststrabismus）

眼球震顫（nystagmus）須考慮戴角膜接觸鏡能否獲得滿意的矯正視力672/3/20248:35PMHydronQibeiOptometryEliteInstitute外顯斜視

682/3/20248:35PMHydronQibeiOptometryEliteInstitute

雙瞼靜態(tài)對稱瞬目對稱

眼瞼下垂可妨礙戴鏡和摘鏡

眼瞼閉合不全易招至軟鏡脫水

瞬目遲緩（少于10次/min）易引起眼干和軟鏡脫水

上述情況均不宜配戴角膜接觸鏡

先天性小瞼裂應(yīng)注意戴鏡發(fā)生困難

692/3/20248:35PMHydronQibeiOptometryEliteInstitute眼瞼下垂

702/3/20248:35PMHydronQibeiOptometryEliteInstitute先天性小瞼裂

712/3/20248:35PMHydronQibeiOptometryEliteInstitute2）眼瞼

眼瞼皮炎表現(xiàn)為眼瞼皮膚水腫，潮紅、干燥、瘙痕

眼瞼腫瘤表現(xiàn)為眼瞼部腫塊、結(jié)節(jié)

麥粒腫（stye）表現(xiàn)為瞼緣紅腫、膿性包塊722/3/20248:35PMHydronQibeiOptometryEliteInstitute眼瞼神經(jīng)性皮炎

732/3/20248:35PMHydronQibeiOptometryEliteInstitute眼瞼單純性皰疹

742/3/20248:35PMHydronQibeiOptometryEliteInstitute麥粒腫

752/3/20248:35PMHydronQibeiOptometryEliteInstitute

瞼緣炎（blepharitis）表現(xiàn)為瞼緣有超量皮脂溢出，并有皮屑、結(jié)痂、瘙癢

睫毛倒生（trichiasis）表現(xiàn)為睫毛亂生或瞼緣內(nèi)翻，睫毛刺激角膜

眼瞼外翻表現(xiàn)為眼瞼松馳，淚液外溢上述各癥均不應(yīng)配戴角膜接觸鏡

762/3/20248:35PMHydronQibeiOptometryEliteInstitute瞼緣炎

772/3/20248:35PMHydronQibeiOptometryEliteInstitute倒睫

782/3/20248:35PMHydronQibeiOptometryEliteInstitute眼瞼外翻792/3/20248:35PMHydronQibeiOptometryEliteInstitute3）淚器

采用彌散式投照法觀察

淚小點(diǎn)異位表現(xiàn)為被檢眼瞬目時(shí)淚小點(diǎn)的位置不能納入淚湖之內(nèi)因而不能正常收納眼液

慢性淚囊炎（dacryocystitis）表現(xiàn)為壓迫淚囊部有粘液性或膿性分泌物返溢不宜配戴角膜接觸鏡802/3/20248:35PMHydronQibeiOptometryEliteInstitute慢性淚囊炎

812/3/20248:35PMHydronQibeiOptometryEliteInstitute淚小點(diǎn)異位

淚小點(diǎn)異物

822/3/20248:35PMHydronQibeiOptometryEliteInstitute4）淚液

干眼癥正常情況下少量淚液聚存于下瞼緣用直接投照法窄裂隙光切片觀察瞼緣積淚呈三角形形似半個(gè)彎月，稱為半月形淚線若半月形淚線＜0.25mm者診為干眼癥宜慎戴角膜接觸鏡832/3/20248:35PMHydronQibeiOptometryEliteInstitute半月形淚線842/3/20248:35PMHydronQibeiOptometryEliteInstitute干眼癥852/3/20248:35PMHydronQibeiOptometryEliteInstitute

脂質(zhì)淚用間接法投照角膜面有大量細(xì)小半透明顆粒在淚液中移動(dòng)為脂質(zhì)型淚液的表現(xiàn)易導(dǎo)致鏡片上脂質(zhì)沉淀物聚沉，使鏡片干燥宜慎戴角膜接觸鏡862/3/20248:35PMHydronQibeiOptometryEliteInstitute脂質(zhì)型淚液872/3/20248:35PMHydronQibeiOptometryEliteInstitute5）球結(jié)膜

正常球結(jié)膜應(yīng)為無色透明可見到層下的腺樣層呈淡灰色球結(jié)膜發(fā)生炎性病變時(shí)可出現(xiàn)透明度下降、水腫、上皮增厚、血管充盈等體征882/3/20248:35PMHydronQibeiOptometryEliteInstitute正常球結(jié)膜892/3/20248:35PMHydronQibeiOptometryEliteInstitute

結(jié)膜充血（conjunctivalcongestion）可分為

周邊部充血，為結(jié)膜炎的表現(xiàn)

睫狀充血，為角膜損傷、炎癥或色素膜炎癥的表現(xiàn)

周邊部充血與睫狀充血二者同時(shí)存在時(shí)，稱為混合性充血

若充血局限于某一部位，則稱為局限性充血

902/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜充血分型912/3/20248:35PMHydronQibeiOptometryEliteInstitute發(fā)生結(jié)膜充血宜停戴角膜接觸鏡進(jìn)行必要的治療，直至充血完全消退后恢復(fù)戴鏡查明招致結(jié)膜充血的原因，避免復(fù)發(fā)

922/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜周邊充血球結(jié)膜睫狀充血932/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜混合充血942/3/20248:35PMHydronQibeiOptometryEliteInstitute急性結(jié)膜炎952/3/20248:35PMHydronQibeiOptometryEliteInstitute

瞼裂斑（pinguecula）球結(jié)膜瞼裂區(qū)黃白色三角形或橢圓形粗糙隆起斑塊者通常對配戴角膜接觸鏡并無影響962/3/20248:35PMHydronQibeiOptometryEliteInstitute瞼裂斑972/3/20248:35PMHydronQibeiOptometryEliteInstitute

翼狀胬肉（pterygium）眥角部有肥厚的結(jié)膜及結(jié)膜下組織呈條帶狀向角膜生長，多發(fā)于鼻側(cè)若條帶充血，角膜端隆起，有慢性角膜浸潤不宜配戴角膜接觸鏡

982/3/20248:35PMHydronQibeiOptometryEliteInstitute翼狀胬肉992/3/20248:35PMHydronQibeiOptometryEliteInstitute

泡性結(jié)膜炎（phlyctenularconjunctivitis）角膜緣見直徑1mm~2mm泡狀隆起灶周邊有明顯炎性充血待治愈后方可配戴角膜接觸鏡1002/3/20248:35PMHydronQibeiOptometryEliteInstitute泡性結(jié)膜炎1012/3/20248:35PMHydronQibeiOptometryEliteInstitute

球結(jié)膜下出血（subconjunctivalhemorrhage）球結(jié)膜下見斑片狀鮮紅色出血灶，沒有明顯癥狀宜待其自行吸收以后再配戴角膜接觸鏡

1022/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜下出血1032/3/20248:35PMHydronQibeiOptometryEliteInstitute

球結(jié)膜淋巴濾泡因結(jié)膜淋巴循環(huán)系統(tǒng)障礙在結(jié)膜面形成透明的小囊多可自行吸收，并反復(fù)出現(xiàn)對配戴角膜接觸鏡無影響1042/3/20248:35PMHydronQibeiOptometryEliteInstitute

球結(jié)膜色素沉著球結(jié)膜見黑褐色斑片狀沉著常為先天性或幼年即發(fā)現(xiàn)無癥狀、不發(fā)展增大對配戴角膜接觸鏡無影響1052/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜色素沉著1062/3/20248:35PMHydronQibeiOptometryEliteInstitute

球結(jié)膜異生見半透明球結(jié)膜覆蓋角膜緣伸入2~3mm異生的球結(jié)膜可見到新生血管熒光素染色陰性無疼痛和刺激癥狀對配戴角膜接觸鏡無影響1072/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜異生1082/3/20248:35PMHydronQibeiOptometryEliteInstitute

球結(jié)膜瘤見角膜緣部球結(jié)膜增生為球狀隆起瘤體表面可見到新生血管熒光素染色陰性由于瘤體障礙，不宜配戴角膜接觸鏡1092/3/20248:35PMHydronQibeiOptometryEliteInstitute球結(jié)膜瘤1102/3/20248:35PMHydronQibeiOptometryEliteInstitute6）

瞼結(jié)膜

正常的瞼結(jié)膜透明，呈淡紅色可清晰地看到其下血管和瞼板腺上瞼結(jié)膜近內(nèi)外眥部可見少數(shù)極小的濾泡和乳頭

1112/3/20248:35PMHydronQibeiOptometryEliteInstitute正常瞼結(jié)膜1122/3/20248:35PMHydronQibeiOptometryEliteInstitute

瞼結(jié)膜炎水腫、充血透明度下降，血管影消失乳頭增生、濾泡形成覆蓋粘液性分泌物宜停戴角膜接觸鏡

1132/3/20248:35PMHydronQibeiOptometryEliteInstitute瞼結(jié)膜炎1142/3/20248:35PMHydronQibeiOptometryEliteInstitute

巨乳頭性結(jié)膜炎（giantpapillaryconjunctivitis）戴角膜接觸鏡引起直徑1mm~3mm增生乳頭分布于瞼板區(qū)或整個(gè)上瞼結(jié)膜宜停戴角膜接觸鏡1152/3/20248:35PMHydronQibeiOptometryEliteInstitute巨乳頭性結(jié)膜炎1162/3/20248:35PMHydronQibeiOptometryEliteInstitute

沙眼（trachoma）

發(fā)病率較高，配戴角膜接觸鏡必須認(rèn)真甄別

若無明顯癥狀，且瞼結(jié)膜無明顯充血沙眼乳頭和濾泡局限于穹窿結(jié)膜可酌情配戴角膜接觸鏡，注意控制戴鏡時(shí)間嚴(yán)格護(hù)理鏡片，定期復(fù)查，同時(shí)積極治療沙眼

1172/3/20248:35PMHydronQibeiOptometryEliteInstitute

若有畏光、流淚、瘙癢、分泌物膠著等癥狀上瞼結(jié)膜充血，血管影混濁或瞼板腺輪廓消失沙眼乳頭和濾泡分布于大部上瞼結(jié)膜或上瞼結(jié)膜出現(xiàn)灰白色網(wǎng)狀瘢痕，發(fā)生內(nèi)翻倒睫

均不宜配戴角膜接觸鏡1182/3/20248:35PMHydronQibeiOptometryEliteInstitute沙眼乳頭1192/3/20248:35PMHydronQibeiOptometryEliteInstitute沙眼疤痕1202/3/20248:35PMHydronQibeiOptometryEliteInstitute巨乳頭性結(jié)膜炎與沙眼的比較1212/3/20248:35PMHydronQibeiOptometryEliteInstitute

瞼板腺囊腫（chalazion）眼瞼見結(jié)節(jié)狀隆起，硬質(zhì)結(jié)節(jié)瞼結(jié)膜見紫蘭色包塊，周邊稍充血宜手術(shù)治愈后再戴角膜接觸鏡

1222/3/20248:35PMHydronQibeiOptometryEliteInstitute瞼板腺囊腫1232/3/20248:35PMHydronQibeiOptometryEliteInstitute

結(jié)膜結(jié)石瞼結(jié)膜下見圓形或不規(guī)則形細(xì)小白色斑點(diǎn)若位于瞼結(jié)膜面淺表，可進(jìn)行手術(shù)去除深在者則對配戴角膜接觸鏡無礙1242/3/20248:35PMHydronQibeiOptometryEliteInstitute結(jié)膜結(jié)石1252/3/20248:35PMHydronQibeiOptometryEliteInstitute7）角膜

角膜的靜態(tài)觀察用裂隙燈顯微鏡直接投照法的窄裂隙觀察

角膜最前方的弧形線狀反光為淚膜的界面反光

其后的暗區(qū)為角膜上皮層

角膜上皮層后細(xì)窄的白色光帶為角膜前彈力層的界面反光

其后大部分灰白色區(qū)域?yàn)榻悄せ|(zhì)層

角膜基質(zhì)層后白色光帶為角膜后彈力層和房水的界面反光1262/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜的靜態(tài)觀察1272/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜的動(dòng)態(tài)觀察將裂隙燈顯微鏡的裂隙光帶沿著角膜面緩慢推移遇上皮缺如、基質(zhì)浸潤、異物、疤痕或新生血管等即可能表現(xiàn)為異常反光灶1282/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜的動(dòng)態(tài)觀察1292/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜上皮損傷可見灰白色的斑點(diǎn)狀、點(diǎn)片狀、蛛網(wǎng)狀、地圖狀上皮粗糙區(qū)宜治愈后2天再戴鏡1302/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜上皮損傷1312/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜上皮損傷1322/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜浸潤（cornealinfiltrate）距角膜緣2-3mm熒光素染色陰性角膜深層灰白色，團(tuán)絮狀，圓形，邊界模糊球結(jié)膜不同程度混合充血宜治愈后再戴鏡1332/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜浸潤1342/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜異物（cornea

foreignbody）角膜面見到斑點(diǎn)狀、不透明異物異物邊緣區(qū)角膜呈灰白浸潤應(yīng)及時(shí)手術(shù)去除宜角膜康復(fù)后戴角膜接觸鏡1352/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜異物1362/3/20248:35PMHydronQibeiOptometryEliteInstitute

新生血管（neovascularization）角膜基質(zhì)層見異常血管伸入越過角膜緣2mm以上常發(fā)生于角膜上緣立即停戴角膜接觸鏡1372/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜新生血管1382/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜白斑、云翳（cornealnebula）角膜組織見白色、灰白色疤痕復(fù)習(xí)被檢者過去史為陳舊性病灶熒光素染色陰性無論外傷史或患感染性角膜病變者均慎戴角膜接觸鏡角膜疤痕引起的不規(guī)則散光可考慮戴角膜接觸鏡利用淚液透鏡形成球面屈光體系，但須監(jiān)控安全

1392/3/20248:35PMHydronQibeiOptometryEliteInstitute角膜白斑、云翳1402/3/20248:35PMHydronQibeiOptometryEliteInstitute

圓錐角膜（Keratoconu）角膜中心部不同程度錐形隆起囑被檢眼向下注視下瞼緣彎曲提示Munson征陽性可配戴專門矯正圓錐角膜的角膜接觸鏡1412/3/20248:35PMHydronQibeiOptometryEliteInstitute圓錐角膜裂隙燈檢測Munson征陽性1422/3/20248:35PMHydronQibeiOptometryEliteInstitute

角膜不規(guī)則散光（Irregularastigmatism）角膜表面反光影不均勻使角膜失去統(tǒng)一的準(zhǔn)球面屈光界面注意對照觀察其驗(yàn)光后的矯正視力和戴角膜接觸鏡的視力

1432/3/20248:35PMHydronQibeiOptometryEliteInstitute圓錐角膜裂隙燈檢測1442/3/20248:35PMHydronQibeiOptometryEliteInstitute

營養(yǎng)不良性角膜變性（cornealdystrophy）被檢眼可見角膜瞳孔區(qū)有數(shù)量不等的乳白色的顆?；蛴扇榘咨?xì)線構(gòu)成的網(wǎng)狀混濁或由乳白色細(xì)線構(gòu)成的放射狀混濁，稱為Fabry病為家族遺傳性疾病，不宜配戴角膜接觸鏡

1452/3/20248:35PMHydronQibeiOptometryEliteInstitute顆粒狀角膜變性Fabry角膜變性1462/3/20248:35PMHydronQibeiOptometryEliteInstitute蠶食性角膜潰瘍（ulcurcornealrodens）角膜緣充血、灰白色角膜浸潤，多點(diǎn)發(fā)生熒光素染色陽性緩慢發(fā)展溶解角膜自發(fā)性疼痛病因不明，不宜配戴角膜接觸鏡

1472/3/20248:35PMHydronQibeiOptometryEliteInstitute蠶食性角膜潰瘍1482/3/20248:35PMHydronQibeiOptometryEliteInstitute8）前房和房水

前房深度采用直接投照法透照前房使焦平面會(huì)聚虹膜若見虹膜卷縮輪向前突出，提示前房較淺需測試眼壓，排除閉角性青光眼（glaucoma）確診青光眼不宜配戴角膜接觸鏡1492/3/20248:35PMHydronQibeiOptometryEliteInstitute虹膜卷