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1、1,GLAUCOMAChapter 11第十一章 青光眼,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.,3,Intraoc
2、ular 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: 102l mmHgDouble IOP difference5mmHgIOP curve day and night8mmHg正常眼压： 102lmmHg双眼压差5mmHg昼夜眼压曲线8mmHg。,4,Pathological IOP: IOP is beyond eyeball internal organization, especially the optic nerve bearing lim
3、it.Cause optic atrophy and visual field defects病理眼压:超越眼球内部组织，特别是视神经承受限度的眼压。引起视神经萎缩和视野缺损,5,Ocular hypertension: IOP is higher than normal IOP range, but no damage of the nerve and visual field.高眼压症:眼压高出正常眼压范围，但无视神经和视野损害。Normal tension glaucoma: In the normal range of IOP, the optic nerve and visual f
4、ield of the damage there.正常眼压性青光眼：眼压在正常范围,但出现视神经 和视野的损伤。,6,房水循环途径:Aqueous cycle way:,Ciliary process posterior chamber pupil睫状突(产生房水) 后房 瞳孔 Anterior chamber Angle Anterior chamber 前房角(排出房水) 前房,房水产生率 房水排出率,维持正常眼压,大多数青光眼眼压升高的原因为房水排出受阻,7,8,athophysiological process病理生理过程：,Aqueous producing rateTrabecul
5、ar meshwork resistanceSclera vein pressure三个因素：房水生成率 小梁网阻力 上巩膜静脉压aqueous outflow resistance Increased大多数青光眼眼压升高的原因是房水外流阻力增高,9,Classification分 类,Primary glaucoma: Angle-closure glaucoma: Acute angle-closure glaucoma Chronic angle-closure glaucoma Open-angle glaucoma: Primary open angle glaucoma norma
6、l tension glaucomaSecondary glaucoma:Congenital glaucoma: Infantile glaucoma Juvenile glaucoma Congenital glaucoma accompanied by other congenital anomaly glaucoma原发性：闭角型:急性闭角型青光眼 慢性闭角型青光眼 开角型：原发性开角型青光眼 正常眼压性青光眼继发性： (眼病、全身)先天性：婴幼儿型 青少年型 先天性青光眼伴有其他先天异常,10,前房角的检查及分类,前房角位于前房的最周边前房角的构成： 前壁角巩膜缘 房角隐窝睫状体前端
7、 后壁虹膜根部,11,12,第二节 原发性青光眼,原发性闭角型青光眼眼压升高 房角关闭 Primary angle-closure glaucoma原发性开角型青光眼眼压升高 房角开放 Primary Open-angle glaucoma,13,Primary angle-closure glaucoma一.原发性闭角型青光眼,Acute angle-closure glaucoma （一） 急性闭角型青光眼Etiology: genetic anatomy incentiveClinical features: age50y female pain red eye vision loss
8、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。,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: Transie
9、nt Ease fast2.先兆期：一过性，多次小发作，自行缓解。,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 disappea
10、red, 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。,16,闭角青光眼前房和前房角,17,急性闭角型青光眼发作,18,Acute onset sequela:Visual acuity
11、 get betterKPIris: atrophy, pigmentation defects and limited stickyThe pupil cant return to normalCloudy-glaucoma spot on the anterior lens capsuleAnterior 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,19,Remission stage : symptoms to ease and
12、anterior chamber angle openChronic stage: anterior chamber angle extensive stickFinal 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。,20,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,21,Diff
13、erential diagnosis鉴别诊断Eye disease: Conjunctivitis, Anterior uveitisSystemic 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。,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 gen
14、erated high permeability agentadjuvant 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1一1.5gkg、 50%甘油2一3ml/kg 4.辅助治疗：镇静、安眠、 通便、激素减轻炎反应。激光：手术：,23,Chronic angle-closure glaucoma（二）、慢性闭角型青光眼Clinical symptom: Age is
15、earlierProgressiveHave no acute historyIntraocular 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50mmHg,24,Signs: Optic atrophy and physiological concave expand Visual field gradually damage.体征： 视神经萎缩，生理凹扩大， 视野进行性损害。,25,26,27,Primary open angle g1aucoma二、原发性开角型青光眼,Fe
16、atures: When IOP increased the anterior chamber angle keep openingThe trabecular meshwork organization structure is abnormal特点：眼压升高，房角开放。 小梁网内组织结构异常,28,Clinical: No self-conscious symptom and be found late. Intraocular pressure increased with angle open Depending on the optic disk damage C/D0.6 Visu
17、al 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),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
18、: 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,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 mi
19、nimize 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。,31,Secondary glaucoma 第四节继发性青光眼,Glaucomatocyclitic syndromeCorticosteroids glaucoma:Traumatic glaucomaCataract expansion glaucomaAnterior uveal inflammatory glaucomaNeovascular glaucomaCiliary ring obstructive glaucoma一、青光眼睫状体炎综合征:中年男性多见
20、。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),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,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,
