医学课件巩膜病专业医学知识宣讲.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,巩 膜 病 概 述,组成：由胶原纤维和弹力纤维交织组成,功能：维持眼球形状,病理改变：肉芽肿性增殖反应、变性、坏死。,巩膜炎容易发生在表层血管较多,（尤其是前睫状血管穿过巩膜）的部位。,修复能力差：因为血管和神经少，代谢不活跃，药物疗效较差。,特点：病程长、反复发作、疼痛、畏光、流泪。,常见巩膜病：表层巩膜炎(episcleritis)、巩膜炎(scleritis)、巩膜葡萄肿(staphyloma)。,Episcleritis,Sectoral redness,engorged episcleral vessels,mild pain,Normal vision,Typically idiopathic,sometimes collagen-vascular disease related,Rx topical steroids,REFER if recurrent,Episcleral redness with localized tenderness,usually sectoral,may be nodular,blanches with topical epinephrine 2.5%,benign and self-limited,Etiology:idiopathic,collagen vascular disease-RA,SLE,gout,表层巩膜炎,(episcleritis),是复发性、暂时性、自限性巩膜表层组织的非特异性炎症。,特征：无刺激症状的眼红。,常发生于角膜缘至肌肉附着点、睑裂部常见。,发病率：女:男=3:1。,好发于年轻人。,类型：结节性表层巩膜炎(nodular episcleritis)、周期性表层巩膜炎(periodic episcleritis)。,治疗：本病具有自限性，12周内自愈，一般无需特殊治疗。,结节性表层巩膜炎,(nodular episcleritis),特征：局限性结节样隆起。,结节直径约23mm，单发或数个，暗红色。,结节及周围结膜充血和水肿。,疼痛和压痛，轻度刺激症状。,发病持续约两周，易复发。,起病隐匿，症状严重，病程长。,周期性表层巩膜炎,(periodic episcleritis),又称单纯性表层巩膜炎（simple episcleritis),周期性发作，间隔可为13个月，每次发病通常持续1数天。,巩膜表层和球结膜呈弥漫性充血和水肿。,病程持续36年或更长。,妇女月经期发作多见,一般不影响视力。,巩 膜 炎,（scleritis),为巩膜基质层的炎症，病情和预后较表层巩膜炎严重。,2060岁、女性、双眼多见,病因：1.全身感染性疾病：结核、麻风、带状疱疹或,感染病灶引起的过敏反应有关。,2.自身免疫性疾病：风湿性关节炎、Wegener肉,芽肿、系统性红斑狼疮、多发性结节性动脉,炎等。,3.代谢性疾病：痛风,4.其他：外伤或结膜、角膜、葡萄膜、眶内炎症,感染扩散,结节性,分类：1.前部巩膜炎(anterior scleritis弥漫性,坏死性,2.后部巩膜炎(posterior scleritis),Clinical features:,Granulomatous inflammation of the sclera.,May present in association with systemic diseases i.e.rheumatoid arthritis,SLE,polyarteritis nodosa,or Wegeners granulomatosis.,Symptoms:ocular pain with or without decreased vision.,May be self-limiting or progress to necotizing process that may be potentially blinding.,May be classified into non-necrotizing or necrotizing anterior scleritis and non-necrotizing or necrotizing posterior scleritis.,Non-necrotizing inflammation may be differentiated into nodular and diffuse scleritis.,Complications:scleral thinning(especially in the chronic recurrent scleritis),scleromalacia,scleral perforation,sclerosing keratitis,peripheral corneal melting,uveitis,cataract,macula edema,retinal detachment and choroidal granuloma.,Work up:,Systemic rheumatology evaluation.,Always rule out infection in cases of necrotizing scleritis.,Treatment:systemic NSAIDs,systemic or topical corticosteroids,cyclophosphamide,cyclosporin or other immunosuppressive therapies.,前部巩膜炎,(anterior scleritis),病变位于赤道部之前。,双眼先后发病，可持续数周、数月、数年。,眼部疼痛剧烈，有刺激症状。,弥漫性或局限的紫红色充血、隆起，有压痛，结节不能推动。,球结膜高度水肿。,并发症：葡萄膜炎、角膜炎、白内障，继发性青光眼。,类型：,结节性前部巩膜炎、弥漫性前部巩膜炎、坏死性前部巩膜炎。,前部巩膜炎,(anterior scleritis),结节性前部巩膜炎(nodular anterior scleritis)：巩膜呈紫红色结节样隆起，不能推动，质硬，压痛,大约4450的病人合并有系统性疾病。,弥漫性前部巩膜炎(diffuse anterior scleritis)：最常见，症状最轻，巩膜呈弥漫性充血，球结膜水肿，预后相对较好。,坏死性前部巩膜炎(necrotizing anterior scleritis)：破坏性较大，损害视力，双眼发病，可伴有严重的自身免疫性疾病。局部巩膜斑块的边缘炎性反应较中间重，眼痛明显。另有一种坏死性巩膜炎主要表现为进行性巩膜变薄、软化、坏死和穿孔,又称穿孔性巩膜软化症（scleromalacia perforans)。,diffuse,后部巩膜炎,(posterior scleritis),发生于赤道后方巩膜的一种肉芽肿性炎性。,多单眼发病，眼前段一般无明显改变。,程度不同的眼痛和压痛，眼险及球结膜水肿，眼球轻度突出，眼球运动受限及复视。,若合并葡萄膜炎、玻璃体炎症、视神经炎、渗出性视网膜脱离时视力明显减退。,B超、CT扫描或MRI能显示后部巩膜增厚。,巩膜炎的并发症,葡萄膜炎,角膜炎,角膜基质炎,眼内压增高,眼底异常,巩膜炎的治疗,针对病因治疗,抗炎治疗：局部滴用及全身应用皮质类固醇,免疫抑制剂、免疫调节剂、细胞毒制剂。,阿托品,对坏死、穿孔的巩膜部位可试行异体巩膜移植术，术后局部或全身应用免疫抑制剂。出现并发症时按相应的疾病处理原则进行。,先天性巩膜异常,蓝色巩膜（blue sclera),生后3年巩膜仍为蓝色时，视为病理状态。,巩膜色素斑（pigmentary patches of sclera),临床无特殊意义。,巩膜葡萄肿,（scleral staphyloma),由于巩膜变薄，在眼内压作用下变薄的巩膜以及深层的葡萄膜向外扩张膨出，显露出葡萄膜颜色而呈蓝黑色，称为巩膜葡萄膜肿。,前巩膜葡萄膜肿：膨出位于睫状体区。常见于炎症、外伤合并继发性青光眼。,赤道部巩膜葡萄膜肿：多为绝对期青光眼并发症。,后巩膜葡萄膜肿：位于眼底后极部及视盘周围，多见于高度近视眼。,