-眼表疾病課件

1、眼表疾病ocular surface diseasesDefinitionAnatomy：mucous membrane lining the eyelidsHistology：cornea, conjunctiva and tear filmOcular surfaceEpitheliumCorneal epithelium: the stem cells reside at the corneoscleral limbusConjunctival epithelium: the conjunctival fornix or the junction between the posterio

2、r eyelid and the eyeball CONJUNCTIVA CORNEA LIMBUS STEMCELLS TRANSIENT AMPLIFYINGCELLS POSTMITOTICCELLS TERMINALLYDIFFERENTIATEDCELLS Limbal stem cells Source of corneal epitheliumIncreased potential for proliferation, high capacity of self-renewal with a long cell cycle time and asymmetric cell div

3、isionClassification proliferated cells differentiated cells SC TAC PMC TDCReproductive activity infinite finite Fissionability low high Differentiation potency + + + +Characteristics of limbal stem cellsLocation: the basement of corneal limbusEpithelium repair when limbus defected Corneal epithelial

4、 cells concentric movement Conjunctiva to corneal-like epithelium “Conjunctivalization of the cornea with vascularizationLimbal Stem Cell Deficiency Pathogenesis: lumbus epithelium defectedPathology: corneal epithelium occupied and replaced by conjunctival epitheliumManifest: conjunctivalization, va

5、scularization, chronic inflammation, persistent uncle, basilar membrane failure, fibrocyte invasionTriple-symptom complex： Conjunciva epithelial cells concentric movement, corneal vascularization, healing delayAmnion application in ocular surface reconstrucion羊膜的作用機(jī)制抑制炎癥反應(yīng)促進(jìn)上皮化抗新生血管形成抗纖維化緩解疼痛羊膜角膜緣干細(xì)

6、胞體外培養(yǎng)的龕環(huán)境將角膜緣處的上皮或口腔黏膜上皮放到冷凍干燥保存的羊膜上進(jìn)行培養(yǎng)、擴(kuò)增，并移植到眼表衰竭（角膜緣缺陷）的患眼上冷凍干燥保存羊膜Stem cells of corneal limbus cultivation and transplantation a 正常人角膜 b 正常人口腔黏膜 c 培養(yǎng)的角膜上皮 d 培養(yǎng)的口腔黏膜上皮（與前者具有相似的復(fù)層上皮結(jié)構(gòu)）口腔黏膜上皮羊膜Rama P et al：Transplantation 72：1478，2001abcdStem cells of corneal limbus cultivation and transplantation

7、A. 對(duì)照組B. 實(shí)驗(yàn)組2W4W眼類天皰瘡 術(shù)前（a、b）眼表重建 術(shù)后（c、d）abcdShimazaki J et al：Ophthalmology 109：1285，2002Stem cells of corneal limbus cultivation and transplantation眼類天皰瘡術(shù)前（視力：0.01） 術(shù)后14個(gè)月（視力：0.6）Hayashida Y et al：Invest Ophthalmol Vis Sci 46：1632，2005Stem cells of corneal limbus cultivation and transplantationKer

8、atoconjunctivitis sicca (KCS) Tear film functionImprove optical properties of corneaClean and dilute foreign bodies and toxinMoisten and lubricate ocular surface to protect epitheliumIntermediary agent where corneal epithelium breatheDefense specificity and non-specificity inflammatoryThe structure

9、of the tear-filmLipid layer produced bymeibomian glandsAqueous layer by accessory lacrimal glandsMucin layerby goblet cellsNeuronal feedback loopLacrimal glandSecretomotor impulseAfford ocular surface tearNervous of ocularSurface excitationPathology of tear filmAqueous tear deficiency Mucus deficien

10、cyLipid disorderDefinitionDry eye is a disorder of the tear film due to tear deciency or excessive evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort. -1995 NEI Report on Dry EyeDry eye is a multifactorial disease of the tears a

11、nd ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. - 2007 Report of the Dry Eye WorkShop病理學(xué)機(jī)制-假說 The ea

12、rth is suffering from “dry eye”virgin forest desert and gobiThe influence of organic evolution and human modern civilizationMarine life Amphibia Terrestrial animal Human beingHuman “civilization” break the balance of the evolutionShanxiZhejiangBeijingLanzhouThe eye “working environment” and visual f

13、unction burdenWorking face the screenVisual function burden increased The eyes is hard to defense due to lifestyles change About 50% female who is 35-50 years old in U.S.A. suffering from the dry eye symptomsNeurotrophy disorder SchirmerII and decrease, osmotic pressure of tear increase, and all wil

14、l recover in 69 months.Physiological functions degeneration with yearsDry eye syndromeEtiological classification： Aqueous tear deficiency（ATD） Mucin tear deficiency Lipid tear deficiency Tear dynamics disorder Mixed typeDry eye syndromeVisual display termminal (VDT)Building disease syndrome (SBS)Off

15、ice of the eye syndrome (OES) work result in winking decreased environment cause over evaporationEnvironmental factorsTear function examinationSchirmer test：5mm35mm filter paper, measure the length of the moist part in 5min. Normal value:1030mm。BUT：Normal value:1545s, 312mOms/LDetermination of tear

16、lysozyme：Tear clearance rate：Impression cytology and biopsy：TreatmentEliminate the cause of diseaseReplacement therapy: self serum, artificial tears without preservativesSave tearsPromote tears productionSurgery：Autologous transplantation of free submandibularTreatment protocolsClinical patternLow s

17、ecretionsupply and save tears, reduce evaporation, improve tears productionanti-inflammation and inhibit the immune responseOver evaporationaim at MGD, anti-inflammation, reduce evaporation, clean eyelidslipid replacement therapy Treatment protocolsPathogenetic conditionmild only artificial tears (0

18、.1% Sodium Hyaluronate Eye Drops)moderate main thick artificial tears without antiseptics (0.3% Sodium Hyaluronate Eye Drops) puncta embolismsevere 0.05%CsA and puncta embolism tarsorrhaphy and Submandibular gland transferCorneal disease Keratitis Etiological factorInfectious： Bacteria Staphylococcu

19、s epidermidis, Pseudomonas Aeruginosa, Staphylococcus aureus Fungus Fusarium spp. aspergillus Viruses HSV AmebaEndogenous：Local spread：Keratitis Symptom： ophthalmalgia photophobia, lacrimation pink eye impaired vision secretion increaseKeratitisBasic signs： ciliary congestion corneal edema, opacity,

20、 infiltration ulceration fluorescein staining positiveKeratitisTherapeutic principle：Etiological treatmentThe rational use of steroid，reduce corneal scarring，prevent complicationPerforation, corneal leucoma or corneal macula, then corneal transplantation Bacterial keratitispathogenic bacteria: Staph

21、ylococcus Pneumococcus Pseudomonas Aeruginosa Streptococcus Gonococcus Pseudomonas Bacterial keratitisInducement： corneal trauma corneal foreign body corneal contact lens Bacterial keratitisClinical manifestationAcute onset, severe symtoms, fast progress Impaired visionPurulent secretionEyelids and

22、bulbar conjunctiva edema Bacterial keratitisTreatment:Scraping and G stainingbacteria and fungus cultivation and drug sensitive testG- : Gentamycin, TobramycinG+ : Ofloxacin, CiprofloxacinAdjust medication according to drug sensitive test Bacterial keratitisTreatment：Acute phase: antibiotics eye dro

23、ps per 15-30min, drug combination per 15min in turnCycloplegics conventionally: 1 AtropinePseudomonas aeruginosa corneal ulcer: drug discontinuance with cautionBed isolation to inpatients Fungal keratitisInducementVegetality trauma Glucocorticoid eye drops in long-term useAntibiotics eye drops in lo

24、ng-term useContaminative corneal contact lensLack of specific antifungal angents, so high blindness rateFungal keratitisClinical manifestationSlow onset, sight irritation at the beginningThen ophthalmalgia, photophobia and lacrimation with blurred visionA corneal ulcer with satellite lesions in the

25、surrounding corneaThick hypopyonCorneal scraping: hyphae or spores Bacterial keratitisFungal keratitis Bacterial keratitis Bacterial keratitisFungal keratitisFungal keratitisFungal keratitisFungus in general尖孢鐮刀菌芽生菌黃曲霉Chysosporium sp.Fungus microscopic characteristics茄病鐮刀菌芽生菌彎孢霉黃曲霉HRTFungal keratiti

26、sFungal keratitisTreatment：Antifungal agents： 0.25% amphotericin B eye drops 0.5% fluconazole eye drops Natamycin eye dropsGlucocorticoid disabledAtropine Corneal transplantationCorneal transplantation indicationCCorneal transplantation indicationCorneal transplantation indicationAmeba keratitis Amo

27、ebic keratitis Ameba keratitisAmeba keratitisAmeba keratitisAmeba keratitis離體組織學(xué)檢查 (光學(xué)顯微鏡)活體檢查 (NIDEK)Ameba keratitis (HRT 3)Ameba keratitisLaboratory examinationCorneal lesion smear testBacteriology cultivationCorneal pathology examinationConfocal microscopeHerpes simplex keratitisHerpes simplex vi

28、rus infectionOften by HSV-I HSV-II by chancePrimary infectionLatent infectionRecurrent infectionHerpes simplex keratitisTreatmentAntiviral drugsCorticosteroid drops Symptomatic treatmentLeucoma: corneal transplantationviral keratitisNecrotic interstitial keratitisviral keratitisAutoimmune interstiti

29、al keratitisviral keratitisviral keratitisviral keratitis Neuroparalytic keratitisNeuroparalytic keratitisTreatmentArtificial tears, antibiotics drops and ointment, soft contact lensesBlepharorrhaphyConsultation of neurology department Degeneration and dystrophyDegeneration: Secondary lesion on the basis of primary pathological change.Dystr