眼科学：10 葡萄膜炎

Classification of uveitis 葡萄膜炎分类：
– Etiology病因:
• infectious and non–infectious
– Duration 病程:
• acute and chronic
– Pathological manifestation病理形态:
• granulomatous and nongranulomatous
Differential diagnosis鉴别诊断
• Acute Angle Closure Glaucoma 急性闭角性青光眼:
– Shallow anterior chamber 浅前房 – Pupil dialysis 瞳孔散大 – Elevated IOP 眼压高 – Use myotic eyedrop治疗时用缩瞳剂
Glaucoma 青光眼
--Due to drainage defect
Complications 并发症:
• Cataract 并发性白内障
– Posterior capsular or cortical cataract
• Hypotony and phthisis 低眼压及眼 球萎缩
Diagnosis 诊断:
Scholossman Syndrome) – Herpetic disease
• Chronic anterior uveitis
– Juvenile rheumatoid arthritis
– Fuchs heterochromic iridocyclits
Clinical Manifestations
• Laboratory Testing 实验室检查
Differential diagnosis鉴别诊断
• Acute conjunctivitis 急性结膜炎
– No decrease of vision – Bulbar and palpebral conjunctival congestion – Conjunctivห้องสมุดไป่ตู้l discharge
KP
Tyndall Phenomenon (Tyn)
– aqueous flare 房水闪辉
房水细胞
– Hypopyon 前房积脓
临床表现(体征）
• Pupilary change – miosis – Synechia – Seclusion （闭 锁） – occlusion of pupil (膜闭） – iris bombe
– Anatomic regions 解剖部位:
• Anterior • Intermediate • Posterior • pan
Anterior Uveitis
前葡萄膜炎
Common name for iritis虹膜炎and iridocyclitis虹膜睫状体炎
• Acute anterior uveitis
• Circumcorneal redness
KP
• Keratic precipitates， KP （角膜后沉着物 ) – Dust KP 粉尘状 – Middle sized KP 中等大
– Mutton fat KP
羊脂状
Located inferior in Arlt’s triangle
Uveitis
Uveal Tract: iris, ciliary body and choroid
Uveal Tract
• Blood vessels • Pigment
Diseases of the Uveal Tract
• Inflammation (uveitis) • Tumors
– HLA-B27 associated • Ankylosing spondylitis • Reiter’s syndrome • Ulcerative colitis and Crohn disease • Psoriatic arthritis
– Behçet syndrome – Glaucomatocyclitic crisis (Posner-
Uveitis
Uveitis
• Etiology and Pathogenesis 病因及发病机理 – Infectious 感染性:
• fungal, treponimal, bacterial, viral – exogenous 外源性：手术，外伤 – endogenous内源性
– Non-infectious 非感染性 • Auto-immune reactions自身免疫因素 • Oxidative stress damage 氧化损伤-细胞膜 脂，蛋白及核酸 • Immune-genetic mechanisms 免疫遗传机 制
• Clinical manifestation临床表现 • -3 main symptoms症状
-3 main +2 minor signs体征:
– Ciliary congestion 睫状充血
– KP
– Tyndall
– Miosis 瞳孔缩小 – Iris posterior synechiae 虹膜后粘连
Differential diagnosis
• Intraocular tumor 眼内肿瘤:----masqurade syndrome 伪装综合症
临床表现
• Symptoms 症状
– pain疼痛 – photophobia畏光 – Blurred vision 视力减退
Signs体征
• Ciliary congestion 睫状充血 • KP • Tyndall phenomenon
充血
• 睫状充血或混合性充血
– ciliary injection or mixed injection
临床表现(体征）- occlusion of pupil
临床表现(体征）- iris bombe
Signs- iris nodules
– Koeppe nodules (at iris margin) – Busacca nodules (at iris stroma)
前段玻璃体混浊
Complications 并发症: