ࡱ> [ lbjbjZΐΐ0>L L $P+DoVR[[@vvv1P3P3P3P3P3P3PFTVV3Pvvvvv3PR222v1P2v1P226NO0DF,FOP&R0VRO>WN2>W8O>WO vv2vvvvv3P3P2vvvVRvvvv>WvvvvvvvvvL 1 }: 2A 4-1#2"I-" (Low Risk Group Red Eye) B" 2"A"L@%4($4L !1H 5 RED EYE 2A@G-22#A%0-22#A*5HDIH-"CB#2+%2" 4 2AD!HC HB# AH@G 2'05H!52#"2"1'-+%-@%7-5H!2+%H-@%5I"2 @G 2'05HH-6'2!44-2 9IH'"2A63@GI-DI#12##'-"H2%0@-5" @7H-+2*2@+8-2A5HAI#4 2#"2"1'-+%-@%7- @4DI2%DH-D5I 1. Active vascular dilatation @G2#"2"1'-+%-@%7-C 2'05H!52#-1@*@46I @G Defense mechanism - #H22"H-*4H5H0!5-1#2"H-'2 2#"2"1'-+%-@%7- A5I!5 2 4 1.1 Conjunctival Injection Conjunctival injection 1I@422#"2"1'- posterior conjunctival vessels #4@' conjunctival fornices 2A 45IDIC 2'05H!52#-1@*- conjunctiva A%0 eye lid -2@G localized +#7- generalized GDI 1.2 Ciliary Injection (Ciliary Flush) Ciliary injection @422#"2"1'- anterior ciliary vessels 5H!2@%5I" extraocular muscles A%I'AA11'%C sclera #4@' limbus @I2DH-1 long posterior ciliary vessels 5H!2@%5I" uveal tissues C#55H!52#-1@*- Cornea, Iris, Ciliary body A%0 Choroid @*I@%7-#4@'5I0"2"1'#- limbus 3C+I@+G2A#- cornea 2. Passive vascular congestion @G2#"2"1'-+%-@%7- @7H-2!5 obstruction - venous return @ H C#5- Carotid-Cavernous Fistula 3C+I@%7-D+%--2 Episcleral venous vessels D!HDI @4 congestion -@%7-C vessels 3C+I+%-@%7-"2"1'6I C2414-2AH9IH'"5H!52A--@G 2 %8H! 1. High Risk Group 9IH'"5H!52A%8H!5I !5'2!@*5H"H-2#*9 @*5"*2"2 +#7-'2*9 I2DI#1 2#'44 1"D!H9I- +#7-DI#12##1)2D!H12# +#7-D!H9I- A"L1H'F D'#C+I'2!*C A%0*HH-C+I1)8A"L@G9I9A%9IH'"%8H!5I 2. Low Risk Group 9IH'"5H!52A%8H!5I !5'2!@*5H"H-2#*9 @*5"*2"2 +#7-'2I-" A"L1H'DH209A%#1)29IH'"%8H!5I@-DI '2!AH2-%8H!1I*- 9DI22#2H-D5I RED EYEHIGH RISKLOW RISKSymptomPainDiscomfortVisual AcuityDecreaseNormalInjectionCiliaryConjunctivalCorneaIrregular, CloudySmooth, ClearPupilDilate or Constrict Non-reactiveReactiveIntraocular PressureIncrease or DecreaseNormalRed ReflexDecrease or AbsentNormal B"*#8A%I' 0'H22AC%8H! High Risk @422#-1@*- ocular structure 1IAH Cornea @I2DC Intraocular cavity @ H Corneal ulcer, Acute uveitis, Acute glaucoma @GI *H'2AC%8H!- Low Risk 1I @422#-1@*- ocular surface 7- lid A%0 conjunctiva @ H 1. Lids and Lacrimal apparatus disorders 1.1 Blepharitis 1.2 Hordeolum 1.3 Chalazion 1.4 Dacryocystitis 2. Conjunctival disorders 2.1 Degeneration 2.1.1 Pinguecula 2.1.2 Pterygium 2.2 Trauma - Subconjunctival Hemorrhage 2.3 Infection 2.3.1 Bacterial conjunctivitis 2.3.2 Viral conjunctivitis 2.3.3 Chlamydial conjunctivitis 2.4 Allergy 2.4.1 Phlyctenular conjunctivitis 2.4.2 Hay Fever conjunctivitis 2.4.3 Acute allergic conjunctivitis 2.4.4 Vernal conjunctivitis Lids and Lacrimal apparatus disorders Blepharitis @G2#-1@*- lid margin @G 2'0@#7I-#1 DIH-" "1D!H#2*2@+85HAH- @ 7H-'H2 Staphylococcal infection A%0 Seborrhea !5*H'*31 5H3C+I@4 Blepharitis 2##1)22#-1@*-@%7-2 45I!1DI%D!H@G5HH2-C @7H-2"1D!H!5'45#1)25HAH- @7H-2 lid margin A%0 ocular surface !5'2!*1!1L1-"9H 2#-1@*-@%7-263C+I@42#@%5H"A%- ocular surface A%0 cornea I'" 2#2"-2!51 +2@5H"'1 Tear Film I'" 2#-1@*- Lid margin AH--DI@G 2 4 1. Anterior Blepharitis 2. Posterior Blepharitis -22#-1I*- 4%I2"1!2 -1@G%!22'2!44-I32 -22#@+%H25IDIAH Burning sensation, Foreign Body sensation, Photophobia A%0 Lid Crusting. Anterior Blepharitis AHDI@G 2 4 1. Staphylococcal anterior blepharitis 2. Seborrheic anterior blepharitis Staphylococcal anterior blepharitis @42 chronic infection 5H base -2 3C+I@4 Tiny infrafollicular abscess #4@' lid margin @G%3C+I@4 dermal A%0 epidermal ulceration A%0 tissue destruction 2#-1@*-@%7-2 45I !1C9IH'"5H!5#0'14 Eczema A%0C9I+ 4!2'H29I 2" A%0C young patient !2'H2 Seborrheic blepharitis Symptoms and Signs -22#A%0-22#A*5H DIAH anterior lid margin 0!5 Hyperemia, Telangiectasia, A%0 Scaling 6H!5%1)0AGA%0@#20 A%0@20-"9H#- F 2-2 I2 Remove scale -- 03C+I!5@%7---2A%@%G F DI Complications C#5 Severe long-standing case -2 Trichiasis, Madarosis A%0 Poliosis DI anterior lid margin -2!5 scar +#7- notching @46I I2 Infection A#HD6 Glands of Zeis A%0 Glands of Moll G03C+I@4 Acute external hordeolum A%0I2A#HD6 Meibomian glands G3C+I@4 Internal hordeolum DI@ H@5"'1 2#2"-23C+I@4 Recurrent acute bacterial conjunctivitis. Secondary changes @42 Hypersensitivity H- Staphylococcal exotoxins 1. Mild papillary conjunctivitis 2. Toxic punctate epitheliopathy B"@ 20#4@' Inferior third - cornea 3. Marginal keratitis 4. Phlyctenulosis 5. Tear Film instability Treatment *4H*31 C2##1)29IH'"5H!52#-1@*- lid margin 45I DIAH '2!#0*L- 9IH'"@- @7H-29IH'"I-C+I'2!#H'!!7-4142!3A03-A"L-"H29I-A%0*!H3@*!- *4H@+%H25I DIAH 1. Lid hygiene 2##1)2'2!*0-2- lid margin @G*4H3@GC2##1)22#-1@*-@%7-2 45I 2#3'2!*0-2@%7-23DI B"2# Remove crust A%0 Toxic product --B" Scrub lid margin '1%0 2 #1I B"C ID!I1*3%5 8 Baby shampoo 2. Antibiotics ointment +%123'2!*0-2 lid margin A%I'C+I2I'" antibiotics ointment @ H Bacitracin +#7- Erythromycin ointment I2@GDDI'# Identify organism A%I'C I"22! sensitivity 1I F 3. Topical Steroid Topical steroid -H- F @ H Fluoromethalone '1%0 4 #1I 0 H'"%2#-1@*- conjunctiva DI 4. Artificial Tear C#55H#' Tear Film instability '#C+II32@5"!C2##1)29IH'"C%8H!5I I'" 03C+I-22#-9IH'"56I Seborrheic anterior blepharitis 2#-1@*-@%7-2 45I@42'2!44- Glands of Zeis A%0 Glands of Moll !1@4#H'!1 Seborrheic dermatitis B" Seborrhea #4@'+1(5#)0, 4I' A%0+%1+9 Seborrheic blepharitis -2@4A"+#7-#H'!1 Staphylococcal blepharitis GDI -22#- Seborrheic blepharitis 0%I2"1-22#- Staphylococcal blepharitis AH0 Severe I-"'H2 Treatment 2##1)23DIB"2#3'2!*0-2 lid margin I'" Bicarbonate Soda 6H@G de-greasing agent #H'!1C+I Artificial Tear C#55H!5 Tear Film instability Posterior blepharitis 2#-1@*- lid margin 45I@42 dysfunction - Meibomian glands -2@4#H'!1 Seborrheic blepharitis DI -22#!5DI1IAHI-"D+2!2 0!52# dilate - Meibomian glands @!7H-#4@' glands 0!5 lipid --!2#4@' margin C#5 advance case -2!5 Thickening - lid DI Treatment 2##1)2 posterior blepharitis 1I 3@GI-C+I systemic antibiotics @7H-D inhibit production - Bacterial lipase A%0 Free fatty acid -2C I antibiotics 4C 4+6H 15I 1. Tetracycline (250 mg) '1%0*-#1I@G@'%2 1 @7- AH+I2!C I Tetracycline C 1I## L +#7-3%1@%5I"@GI'"!A!H A%0@G-2"8H3'H2 12 5 2. Doxycycline 100 mg '1%0#1I @G-52@%7-+6H A Tetracycline DI !5 side effect I-" 3. Erythromycin C IC#55HD!H*2!2#C I Tetracycline +#7- Doxycycline DI External Hordeolum (Stye, Sty) External Hordeolum @G small abscess 5H@42 Acute supparative Staphylococcal infection - Glands of Zeis A%0 Glands of Moll Symptoms and Signs 9IH'"0!5-22#'2, 2'!, @%7-2A-"H2#'@#G' H-!20%2"@G Abscess 2#2"-2@G+%2"A+HC2@5"'1 +#7-@G#I-!1*-2GDI -2 Abscess A%I' 9IH'"2#2"-2!5 Preseptal Cellulitis #H'!I'"GDI Treatment 1. External Hordeolum -2+2"@-DIB"D!HI-#1)2 +#7-A--!2@-C%I lid margin 2. 2#C I Hot compresses +#7- Warm compresses #1I%0 15 25 '1%0 4 #1I 03C+I +2"@#G'6I @7H-2 Warm compresses 03C+I@4 Local vasodilatation 3@-2 Natural defense @ H PMN, Macrophage !2#3A+H5H!5 Infection 3C+I Infection 56I 3. Topical antibiotics 8 1 1H'B! 0 H'"C+I Infection +2"@#G'6I AH"25HC II-#-%8! @ 7I-5H3C+I@4 Hordeolum 7- Staphylococcus aureus @ H Sulfacetamide eye drop +#7- Chloramphenicol eye drop 4. Systemic antibiotics -23@GI-C IC#55H'H2!5 Preseptal Cellulitis #H'!I'" AHB"4A%I' D!H!5'2!3@GI-C I 5. 2#3H21 Incision and Curettage 03C#55H Hordeolum D!H56I+#7-@4@G Abscess A%I' Internal Hordeolum (Meibomian abscess) @G small abscess 5H@42 Acute supparative Staphylococcal infection - Meibomian glands Symptoms and Signs 9IH'"!5-22#A%0-22#A*%I2" External Hordeolum 7- '2, 2'!, @%7-2A, @G AH Lesion 0-"9HC Tarsal plate 8+-0 5ID2I2C-@%7-2 -25H@%7-2+#7-@%7-2%H2GDI 2#1IDI+%2"A+HC2@5"'1 +#7-1I*-2GDI Treatment 2##1)2 Internal Hordeolum 3DI@ H@5"'1 External Hordeolum 7-@#4H!I'" Warm compresses, Topical antibiotics, Systemic antibiotics C#55H!5 Preseptal Cellulitis A%0 Incision and curettage C#55H@G Abscess A%I' C#55H!5 Recurrent Hordeolum 1I 4 External A%0 Internal Hordeolum '#42#29'H29IH'"!5 Predisposing Factors I'"+#7-D!H @ H Personal hygiene, Environmental pollution, Immune status +#7- Systemic diseases @ H D.M I2D!H Factors @+%H25I AH"1!5 Recurrence -"9HH-" F '#C+I Oral Tetracycline 250 mg '1%0 4 #1I 1-2 *12+L+#7-2'H21I @7H-C+I Tetracycline D*0*!C Meibomian glands. Chalazion (Meibomian cyst) @G chronic sterile inflammation - Meibomian glands B"!52#-81- Meibomian glands orifices A%0!5 stagnation - sebaceous secretion Symptoms and Signs 9IH'"!1!2I'"@#7H-!5@!G5H@%7-2 %39@GI-AG AHD!H@G, D!H' -22#-1@*- Lid !5I-"!2+#7-D!H!5@%" Treatment 2#3 Warm compresses -23C+II-@%G%DII2 AHD!H*2!2#3C+II-+2"D@%" I2I-D!H+2"-242#23 Intralesional injection I'" steroid +#7-3 Incision and curettage C#55H!5 Recurrence H-" F B"@ 20C9IH'"5H!5-2"8!2C+I**1"'H2-2@G Meibomian gland malignant tumors +#7- Malignant changes DI '#*H 4I@7I-#'+2 Malignant cells I'" Dacryocystitis @G2#-1@*B"!52#4@ 7I-- lacrimal sac !1@G%!222# obstruction - nasolacrimal duct 6HD@4--5HB#!9 2#-81- nasolacrimal duct DI*-%8H!-2"8 7- @GA#%- 6HH-I32"1D!H12@G!5H1C9IC+ H5H-2"8!2'H2 40 5 6H!1@42!5 Trachoma !2H- *H'-2"8-25I!1@42 Trauma 2#-1@*B"2#4@ 7I-- lacrimal sac !5 2 4 7- 4@ 5"%1A%0 4@#7I-#1 Acute Dacryocystitis @G2#-1@*4@ 7I-- lacrimal sac 2 Staphylococcus aureus 9IH'"0!5-22#'2!2, 2'!, @%7-2A, I32D+%, 5I2!2 !5+---22 #'20 localized swelling A%0 tender #4@' lacirmal sac @!7H-0!5+---!2 2#2" Form @G Abscess A%0A--!25H4'+1@4@G Fistula DI Treatment 2##1)2 Acute Dacryocystitis C#0"0 Acute period !1C+I4 antibiotics 5H#-%8! Staphylococcus 'H22#-1@*0+2" +%121II-AI1 +22# obstruction - nasolacrimal duct B"2#3H21 Chronic Dacryocystitis 9IH'"C%8H!5I0D!H!5-22#'2 +#7-2'! AH0!2I'"@#7H-I32D+%D!H+2", 5I2!2, #4@'+1'20!5 mucous +#7-+---!2 2#2"-2!5 recurrent unilateral conjunctivitis Treatment 1. #0"05H!5+- '#C+I Topical antibiotics #H'!12#' sac 2. AID nasolacrimal duct obstruction B"2#3H21 AID2#-81-H-I32 Conjunctival disorders Degeneration Pinguecula @G Degeneration - Bulbar conjunctiva B"!5 degeneration - collagen fiber A%0 thinning - conjunctival epithelium. Symptoms Signs 9IH'"0!2A"L@#7H-!58H!*5@+%7- F #4@' Interpalpebral fissue I2 F 23 I2 nasal +#7- temporal +#7-1I 2 I2#I-!1GDI 2#1I-2!5 Inflammation @46I3C+I2A#4@'8H!I2F 23 9IH'"0!5-22#@7-2, A*2, I32D+% @7H-2 Pinguecula H-"C9IH'"5H-2(1"-"9H#4@' Topical zone 5H!5A*A1, 8H%!!2 63C+I@ 7H-1'H2 chronic exposure H-*4H@+%H25I !5*H' H'"C@4 pinguecula Treatment @7H-2 Pinguecula B"1'-!1@-D!H3C+I@4-1#2"H-'2A%0*2"2 6D!H3@GI-C+I2##1)2 "@'I#55H!52#-I@*- Pinguecula 3C+I!5-22##02"@7-2, A*2, 2A I32D+% -242#2C I"2+"-2#0@  Vasoconstricting agents +#7- Astringents D!H'#C I Steroid @#20-23C+I@4 complication @ H glaucoma DI Pterygium @G Degeneration - Bulbar conjunctiva @ H@5"'1 Pinguecula DIH-"CD" B"@ 205H32%2A @ H '@)## +#7- 2'#0! Symptoms and Signs Pterygium !5%1)0@GI-@7I- Fibrovascular tissue #9*2!@+%5H"!-2 Bulbar conjunctiva #4@' Interpalpebral fissue invade @I2D cornea I2 nasal +#7- temporal +#7-1I 2 I2 #I-!1 -2'H2!5 Pigment #4@'+1'- Pterygium DI Epidemiology A%0 Pathology - Pterygium 0@+!7-1- Pinguecula 7-C#0@(@#I-5HI- Expose H-A*A5H!5 Ultraviolet light !2 8H, %! A%0'2!A+IA%IG!5*H'3C+I@4 Pterygium B"1H'DA%I' Pterygium 0D!H!5-22#-0D#-2@#7H-'2!*'"2!@H21I AHI2!52#-1@*- Pterygium @*I@%7-#4@'5H!52#-1@*0"2"1'6I3C+I2A A%0@7-2, A*2, I32D+%DI @!7H-@'%2H2D Pterygium *2!2#B6IDI A%0-2D cornea 3C+I@4 astigmatism +#7-D1#9 pupil 3C+I*2"2!1'%DI Treatment C#55HD!H!5-22#-0D# D!HI-C I"2 @5"AH-9IH'"'H2D!H!5-1#2"-0D# -2B6IDI @!7H-6@'%2-1'#I-3H21%--- C#55H!52#-1@*@46IA%I'3C+I2A, #02"@7-2, A*2, I32D+% -2C I Vasoconstricting agents +#7- Astringents H'"%-22#1%H2'DI D!H'#C I Topical steroid @#20-23C+I@4 glaucoma DI C#55H!5 Progression +#7-#'2#!-@+G +#7-2##-244 -2I-42#23H21%--- B"4042#23 Surgical Excision GH-@!7H-!5 Indications 15I 1. Visual impairment 2. Ocular motility limitation 3. Recurrence 4. Cosmetic reason Trauma Subconjunctival Hemorrhage @G 2'05H!5@%7-1H-"9HCI conjunctiva 3C+I2A* 9IH'"0C!2 @#202A0"2"C+ H6I-"H2#'@#G' *2@+8-2@422#D-A#F, 2!A#F, !7-"5I2, -814@+8 '2!1B%+4*9 B#@%7- +#7-@42 Acute hemorrhagic conjunctivitis GDI Treatment B"1'-!1@- subconjunctival hemorrhage D!H!5-1#2"C F @%7-!1+"8DI@- A%I'099 6!%1+! C 1-2 *12+L B"D!HI-#1)2-0D# AHC#55HDI#1-814@+8 I-#0'1'H2D!H!5 injury -"H2-7H#H'!I'" @#202#5 subconjunctival hemorrhage -2@42'182@%G5H!5 High Velocity '4HH20%8 conjunctiva 3C+I@%7-1HCI conjunctiva A%I''181ID1-"9HC'2DI @ H Intraocular Foreign Body Inflammation Clinical Evaluation of Conjunctival Inflammation C2#'44 1"A"B#- Conjunctival inflammation I-42#2 clinical features 4 -"H2I'"1 7- 1. Type of discharge 2. Type of conjunctival reaction 3. Presence of true membrane or Pseudomembrane 4. Presence or absence of lymphadenopathy Discharge Discharge #0-I'" exudate 6H9 Filter --!22 dilated blood vessels, 4'- conjunctiva 0 Epithelial debris, mucus, A%0 tear #H'!I'" Type of Discharge 1. Watery discharge #0-I'" serous exudate A%0I32@G-15HDIC viral A%0 toxic inflammation 2. Mucoid discharge DIC Vernal conjunctivitis 3. Purulent discharge @4C severe acute bacterial conjunctivitis 4. Mucopurulent discharge @4C mild bacterial conjunctivitis Inflammatory Conjuncitval Response @7H-2 Conjunctiva @G Ocular structure 5H-"9H-*8-'2 6 Expose H-@ 7I-B#DIH2"*8 @#20 01I@7H-'2!%- 1" #H22"6@#5"! Natural defense mechanism D'I @7H-H-*9I1@ 7I-B#5H-23-1#2"H-2DI Natural defense mechanism 1%H2' DIAH 1. Tear Film I3203+I25H 0%I2*4H*#--22 -21II32"1!5 Enzymes A%0 Immunoglobulins D'I3%2"@ 7I-B#I'" 2. Inflammatory cells @!7H-!5 Infection @46I0!5 Inflammatory cells --!2 C#0"0A# Inflammatory cells 0@G' PMN A%I'2!I'" Lymphocytes *H'C Chronic case 0 Plasma cells, Fibroblasts A%0 Macrophages C2 Clinic A%I' Reaction @+%H25I manifest --!2C 2 %1)0 1. Follicle !5%1)0@G@!G@%G F 2 0.5-5 mm @G Focal lymphoid hyperplasia - Conjunctiva #%23+I25H@G germinal center !5 characteristic 7- 0@+G@*I@%7--"-"9H#-F -@!G@%G *H'#%2@!G0D!H'H2!5@*I@%7--0D# C 2'04-2 Follicle #4@' Inferior conjunctival fornix DI 2. Papilla !5%1)0@G#9@+%5H"!@#5"1@G mosaic pattern B"AH%0-10!5 septum "641 underlying tarsus 3C+I papilla !52#0!2 1 mm C#55H!52#'!- tissues !2 septum -22DI 3C+I!52##'!1'1- papilla C%I@5" !52C+ H6I@#5"'H2 giant papilla '2!#4A%I' papilla @42 vascular response !52# leak - Fluid A%0 Inflammatory cells --2@*I@%7- 3C+I tissue '!6I @#20 01I#%2- papilla 0!5@*I@%7-'4H-"9H 6HH22 Follicle Infections Bacterial Conjunctivitis Acute Bacterial Conjunctivitis (Simple Bacterial Conjunctivitis) @G2#-1@*- conjunctiva 2 bacterial micro-organism @G most common self-limiting condition @ 7I- bacteria 5H3C+I@4 condition 5I 5HDIH-"!5 3 1' 7- Staphylococcus epidermid(*\bd " > @ ^ `  8 < ( * V X h n v z  6 v ,2fxŶŶŶŶŶŶŶŶťŶŶŶŶŶŶŶťŶŶŶŶŶ#h'5>*CJ OJQJ\^JaJ h'5CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ #h'5CJ(OJQJ\^JaJ( h'5CJ(OJQJ\^JaJ(h' h':*\d : x H \Pi]i 8i]i$a$$ 8a$$ a$$a$X$4@Rjx~NR.T v| ":>PR~ѿѿѿ⺶h' h'#h'5>*CJ OJQJ\^JaJ h'5CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ HR:*< $ 8$Ifa$$ 8a$ 8i]i2B<>RTVln$LT,LR\b|)| !6!:!Z!r!!!!!!!!""("߿߿߿߿߿߿߿߻h' h'5CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ #h'5>*CJ OJQJ\^JaJ J<>NXnuuu 8$Ifkd$$IflFF\rX   0    4 lanpuuu 8$Ifkd$$IflFF\rX   0    4 lauuu 8$Ifkd>$$IflFF\rX   0    4 la <uuu 8$Ifkd$$IflFF\rX   0    4 la<>Jtuuuu 8$Ifkd|$$IflFF\rX   0    4 lauuu 8$Ifkd$$IflFF\rX   0    4 laBPuuu 8$Ifkd$$IflFF\rX   0    4 laPRT^yssqqqqqqqqq  8kdY$$IflFF\rX   0    4 la *Fn2jj !8!J#$%P%%&'f'''$a$ 8(">"l""##H#L#^#v#|####,$L$R$b$j$n$$$$$$$%%%%%%&&.&&&&' ''''((6(<(H(V(X(j((((())8)>)l)))))* *.*N*\*******+&+`+f+|++++#h'5>*CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ R''''(***V,X,t,l/n//0F00181n1p1142233 3"3$ 8a$$a$+++++++ ,,,H,J,L,N,T,X,r,v,,,,,, --:-D-P-X-l-|--------.L.j....../n//////0000p1111122222242H2L222 333(3.3 h'5CJ OJQJ\^JaJ #h'5>*CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ L"3$3&3F334v55p6 7l77>8h88>9999<<<==>J@$ 8a$$ 8a$$a$i]i$a$.3D3P3x3334(4.4d4f4r444445 5&50545Z5x5~55556"6N6V6z666667\7d7f7h7n7t7777777778888:8`8f8j8p88888<9H9P9T999992:R:X:x:߿߿߿ h'5CJ OJQJ\^JaJ h'CJ OJQJ^JaJ h'CJ OJQJ^JaJ #h'5>*CJ OJQJ\^JaJ Kx:::::; ;;;,;`;;;;;;<4<n<x<<<<<<<<==2=B=h=|====>>,>D>`>z>>>>>>>2?4?B?R?X?~???????? 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"2#0@ 5I0#-%8! Bacteria DI1I 3 4 1%H2'A%I' *3+#1 antibiotics ointment !14"!C+IH-- @#20"20-"9HDI2'H2 eye drop D!H4"!C+I%2'1 @#2003C+I2!1'DI Hyperacute Bacterial Conjuncitivitis (Adult gonococcal conjunctivitis) @G2#-1@*- conjunctiva 2@ 7I- Neisseria gonorrhea +#7- Neisseria meningitidis 4A#DIH-"'H2A%0-2DIC@GA#%-5HA!H@G gonorhea I'" C#59IC+ H!1@42 autoinoculation B"@ 7I-5H genitourinary system D45H21'@- Symptoms and Signs -22#@#4H!A#%I2"1 acute bacterial conjunctivitis !2 AH progress DI@#G'!2 9IH'"0'2, 2'!, @%7-2A, 5I2!2, !5 Purulent discharge, Conjunctival hyperemia A%0 Chemosis, !1!5 Preauricular lymphadenopathy CI25H@G#H'!I'" @G bacteria 1'@5"'5H3C+I@4 Preauricular lymphadenopathy I2D!HDI#12##1)2C+I1H'5 +#7-9I--20%8%2!@I2 cornea @ 7I-'5I*2!2# invade intact corneal epithelium DI @4@G corneal ulcer A%0 perforation DI *3+#1 Neisseria meningitidis 1I -2A#H@I2*9H#0A*@%7-3C+I@4 Meningococcemia A%0 Meningitis DI 9IH'"8#2"3@GI-3 conjunctival scraping "I-! Gram stain +#7- Giemsa stain @7H-+2@ 7I- -25I"1I-3 culture A%0 sensitivity test I'" @#20@ 7I--207I-"2DI Treatment 9IH'"5HDI#12#'44 1"'H2@G Hyperacute Bacterial Conjunctivitis I-DI#12##11'D'I#1)2CB#"22% @7H-2@GB#5H-1#2"A%03C+I*9 @*5"'2DI B""25HC I!515I Topical antibiotics -2@%7-C I-"H2C-"H2+6H 15I 1. Penicillin- G Sodium (100,000 unit/ml) B"C I Parenteral PGS *!1 Sterile distilled water C+IDI'2!@I!I 100,000 unit/ml +"-28 1 1H'B! 2. Bacitracin ointment 500 unit/gm I2"28 2 1H'B! @G@'%2 2 '1 +%121I C+I'1%0 5 #1I'H20+2" 3. Cefazoline 10 mg/ml +"-28 1 1H'B! Systemic antibiotics -2C+I-"H2C-"H2+6H 15I 1. Cefoxitin 1 gm intravenous +#7- Cefotaxime 500 mg intravenous '1%0 4 #1I I2@G @ 20 conjunctiva C+I'1@5"'- AHI2!5 corneal involvement I-C+I 3-5 '1 60- 2. Ceftriaxone 1 gm intravenous #1I@5"'- 3. Spectinomycin 2 gm intramuscular C#55H@ 7I-@G Penicillin-resistant Neonatal gonococcal conjunctivitis @G Hyperacute bacterial conjunctivitis 5H@4C@GA#%- B"4!22 H-%--A!H B"!5 incubation period 5H@#G'!2#0!2 24-48 1H'B! +%1%-@G0@#4H!!5-22#2A 0 +12'!!224 %7!2D!HDI @%7-2A, 5I2!2 !5+-D+%--!222!2@#-0AI! conjunctival hyperemia A%0 chemosis 2#2"-2!5 corneal ulcer DI Treatment Topical antibiotics - C I Penicillin G sodium 100,000 unit/ml 8 1 1H'B! @ H@5"'19IC+ H Systemic antibiotics C I single dose - cefotaxime 100 mg/kg 5@I2%I2! Viral Conjunctivitis @G Conjunctival Inflammation 5H@42@ 7I- viruses 6H!5-"9H 2 %8H! 5H3C+I@4 conjunctivitis 1. Adenovirus Virus %8H!5I3C+I@4 syndrome DI 2 4 7- Acute Pharyngoconjunctival Fever A%0 Epidermic Keratoconjunctivitis 2. Picornavirus 3C+I@4 Acute hemorrhagic conjunctivitis Acute Pharyngoconjunctival Fever (PCF) @G Viral conjunctivitis 5H@42@ 7I- Virus ' Adenovirus type 3 A%0 type 7 !1@41@G Symptoms and Signs common clinical pictures #0-I'" Pharyngitis, Conjunctivitis A%0 Fever @#20 01I 9IH'"0!5-22#@G- !5DI A%02A, @7-2, I32D+% #'20'H2!5 Follicular response - conjunctiva, conjunctival hyperemia, watery discharge, #'-0!5 inflammation - pharyngeal mucooa A%0!5DI#H'!I'" -2 Preauricular lymphadenopathy A%0 keratitis 6HDI 30% - case Treatment B"4A%I' Acute Pharyngoconjunctival Fever +2"DI@-C 2 *12+L @7H-2"1D!H!5"2*3+#1#1)2 viral conjunctivitis 2##1)26@G@5" symptomatic treatment @ H C+I Astringent C#55H!5-22#@7-2 AHI2!5 secondary bacterial infection -23@GI-C+I Topical antibiotic eye drop 8 1 1H'B! *3+#1 Topical steroid 1I '#+%5@%5H" "@'IC#55H!5 severe inflammation @H21I -23C+IDI*2"6I AH+I2!C IC#55HD!H*2!2# Exclude Herpes Simplex Infection Acute Epidermic Keratoconjunctivitis (EKC) @G Viral conjunctivitis 5H@42 virus ' Adenovirus type 8 A%0 19 @7H-2 virus '5I4H-DIH2"!2 6!1@G 2 2 @*!- AH-20@GD!H#I-!1GDI 25H@G5H+%10!5-22#I-"'H22A# @#20#H22"!5 Immunity D'IH-A%I' 2##02-B#@GA direct contact Symptoms and Signs 9IH'"0!2I'"-22#2A, 2'!, I32D+%, @7-2 '2@%GI-" I2!5 secondary bacterial infection -2!55I2DI #'20+12'!, conjunctival hyperemia, profuse watery discharge, follicular response 2#2"-2 subconjunctival hemorrhage @GA petechia -2*4H#'1%H2'A%I' -2 Preauricular lymphadenopathy *H' corneal involvement 1I  keratitis DI 80% Treatment C181"1D!H!5'4531 Adenovirus 5H Effective B"1H'DB#0+2"DI@-C 2 *12+L 2##1)26@G@5" supportive treatment @H21I @ H 2#C+I Astringent eye drop C#55H!5 secondary bacterial infection -242#2C+I Topical antibiotic eye drop @7H-#1)2 Bacterial infection *H' Topical steroid 1I '#+%5@%5H" "@'IC#55H!5 Inflammation !2 9IH'"!5-22#!2 +#7-!5 corneal involvement 3C+I@4 keratitis 3C+IDI!5-22#!2A%02!1'% -22##1)29IH'"A%I' '#A039IH'"I'"'H2B#5I4H-1DIH2"!2D!H'#DC*25H5H!5!2 @ H CB#@#5", B#2-8*2+##! @GI Acute Hemorrhagic Conjunctivitis (AHC) @G Viral conjunctivitis 5H@42@ 7I- Enterovirus 70 6H@G virus 1'+6HC%8H!- Picornavirus 4H-DI2 direct contact +#7-C I-#H'!1 !1C+!9H Low socioeconomic status 5H-2(1"-"9HI'"1@G+!9H0A%0!54*1"D!H -%I2!7- 3C+I4H-1DIH2" Symptoms and Signs 9IH'"0!5-22#'2, 2'!, 2A, @7-2, I32D+% *9IA*D!HDI #'20@%7-2'! conjunctival hyperemia, subconjunctival hemorrhage 6H-A#0@G8@%G F H-!20 diffuse C+ H6I 9H2%1''H2-A# #0!2 60% -9IH'"0'H2!5 Preauricular lymphadenopathy A%0 25% -9IH'"0!5-22##1H@7I-#1H1'#H'!I'" A%0'@!7H-"2!1' -25I9IH'"'5II2D--3%12" +#7- 5"2@I2%I2! -23C+I@4 Paralysis DI 2 Acute myelitis Treatment 181"1D!H!5'45#1)25HAH- *H'C+ H@G supportive treatment 2!-22#@ H@5"'1 viral infection 1'-7H F @ H Astringent, Antibiotics C#55H!5 secondary bacterial infection @GI '#+%5@%5H" steroid @#20-2@4 complication DI Chlamydial Conjunctivitis Adult Inclusion Conjunctivitis @G Acute conjunctivitis 5H@42@ 7I- Chlamydia trachomatis !1@GC young adult H'5H!5 sexual active year -22#220#2 +%12 sexual exposure #0!2+6H*12+:L A%0-2!5 non-specific urethritis #H'!I'" Symptoms and Signs 9IH'"!1!2I'"@#7H- unilateral chronic mucopurulent discharge #'20 Follicle #4@' Fornices C severe case 0!25H upper tarsal conjunctiva I2B#@G!26I0 Follicle #4@' limbus A%0 bulbar conjunctiva A%0!52#'!- conjunctiva A%0 plica #H'!1 Preauricular lymphadenopathy -2 Epithelial keratitis I'" Treatment Topical antibiotics C I Tetracycline ointment I2"2'1%0 4 #1I @G@'%2 6 *12+L Systemic antibiotics C I-"H2C-"H2+6HH-D5I 1. Doxycycline @G long-acting tetracycline !5%C2#1)21I2A%0 genital infection C I"2#0!2 300 mg H-*12+L@G@'%2 3 *12+L +#7- 100 mg H-'1 8'1@G @'%2 1-2 *12+L "21'5I99 6!DI5'H2 Tetracycline A%0'#2+%1-2+2#@7H- I-1 stomach upsets. 2. Tetracycline 250 mg '1%0 4 #1I @G@'%2 6 *12+L @7H-22#9 6!0I-"% I22#I-!-2+2# @#20 01I'#C+I"25IH--2+2# D!H'#C+I"21'5IC@G-2"8H3 'H2 12 5 +#7-1I## L +#7-3%1 lactation @#2003C+I"2D45H13C+I1@G @+%7-44 3. Erythromycin 250 mg '1%0 4 #1I @G@'%2 6 *12+L Neonatal Chlamydial Conjunctivitis Chlamydial infection @G most common cause - neonatal conjunctivitis Symtoms and Signs @G0!2I'"@#7H- Acute mucopurulent conjunctivitis +%12%-#0!2 5-14 '1 conjunctival response 0@GA papillary response @7H-2@G-H-"1D!H*2!2# Form follicle DI 'H20!5-2"8 3 @7- 2#'44 1"A%02##1)25H9I-@G*4H3@G @#202#1I Chlamydial infection 3C+I@4 superior corneal pannus, conjunctival scarring A%0 corneal opacity DI Treatment B#5I*2!2##1)2DIB" Topical tetracycline '1%0 4 #1I A%0C+I4 Erythromycin 25 mg/kg '1%0 2 #1I @G@'%2 2 *12+L Trachoma @GB#25HDIH-"A%0@G*2@+8-2- @G-11+6H-B% @42@ 7I- Chlamydia trachomatis B#5I!1C 8! 5H-"9H1-"H2A--1 !52#H2"@-22(D!H5 !5 poor sanitation 2##02"-B#@GA Direct contact +#7-H221'2 @ H A!%'1 A!%+'5H '2!#8A#-B#6I13'@ 7I-5HDI#1A%0-2"8-9IH'" I2-2"8!20!5'2!#8A#A%0B#A# I-!2'H2-2"8I-" Symptoms and Signs +%12DI#1@ 7I- Chlamydia trachomatis !2 0C I@'%2#0!2 7 '1 C2#11' 9IH'"0@#4H!!5-22#%I2" Bacterial conjunctivitis 7- pain, lacrimation, photophobia #'20@%7-2'! conjunctival chemosis A%0 hyperemia, follicular A%0 papillary response -25I-2 Preauricular lymphadenopathy Trachoma AH--DI@G 4 stages 2!2#@%5H"A%- conjunctiva 15I Stage 1 (Incipient stage)  Immature follicle #4@' upper palpebral conjunctiva Stage 2 (Established stage) AH--DI@G 2 stage "H-" F Stage 2 a  Mature follicle !2'H2 papilla Stage 2 b Papillary hypertrophy !2'H21 Follicle Stage 3 (Cicatricial Stage) #0"05I@#4H!!5 conjunctival scarring @+G@G@*I2 F CI Epithelium @#5"'H2 Arlt s line #H'!1 Follicle A%0 Papilla Stage 4 (Healed or Inactive Stage) #0"05I0 Extensive conjunctival scar *H' Follicle 0+2"D+! *3+#1 stage 2 1I -20 Follicle A%0 Papilla A%I' "1-2 Epithelial keratitis, Pannus A%0 Superior limbal follicle 6H!5%1)0@ 20 7- @+G@G@!G8H@%GI-"%I2" gel  limbus B"!5 Pannus #- F @!7H-B#@I2*9H#0"0 cicatricial stage, limbal follicle 0+2"D 4I#-"@GD'I@G'%! 2! limbus @#5"'H2 Herbert s pits Complications Trachoma 03C+I@4 scar 6I5H ocular surface A%I'H-C+I@41 +22!!27- Dry eye Trichiasis, Entropion, Ptosis, Nasolacrimal duct obstruction A%0 chronic dacryocystitis, corneal ulcer A%0 corneal scar Treatment 2##1)2 Trachoma 3DIB"C+I4 Tetracycline +#7- Erythromycin 250 mg '1%0 4 #1I @G@'%2 4 *12+L +#7--2C I Topical Tetracycline ointment I2"2 '1%0 4 #1I @G@'%2 6 *12+L 9IH'"0!5-22#56I AHI20C+IDI%5@G!5H0C I@'%2#0!2 3 @7- Allergy Phlyctenulosis (Phlyctenular Conjunctivitis) @G2#-1@*- conjunctiva 5H@42 allergic reaction H- microbial antigen 2 4 @ H Staphylococcus, Tuberculosis 3A+H- infection B" micro-organism @+%H25ID!H3@GI--"9H5H2 0-"9H5H*H'C-#H22"GDI A%I'%H-" antigen C+I@I2*9H systemic H-C+I@4 non-specific delayed hypersensitivity reaction 6I5H2 B"!5 lymphocytic infiltration #'!1'1@4@G8H!6I C+I@+G Symptoms and Signs C05H!52#-1@*-"9H 9IH'"0!5-22#@G2@%GI-" 2A, I32D+%, *9IA*D!HDI 2#2"-2!5 Blepharospasm #'2#0"0A#08H!*5 !9 #4@' conjunctiva C%I1 limbus +#7-#4@' limbus H-!20@%7H-D6 cornea @4@G corneal phlyctenulosis DI, conjunctival blood vessels #- phlyctenule 0 dilate, +%12 superficial surface +%8-- lesion 0H-" F +2"DDI@- *H' lesion  cornea -24I#-"- scar DI Treatment 2##1)2 Phlyctenulosis 3DIB"C I Topical steroid eye drop '1%0 4 #1I #0!2 1 *12+L 9IH'"056I!2 -21I'##1)2A+%H- Infection I'" @ H Staphylococcal blepharitis +#7- Pulmonary Tuberculosis @GI Hay Fever Conjunctivitis @G conjunctivitis 5H@42 allergic reaction H- antigens 5H%-"-"9HC-22( @ H %0--@)# -D!I, %0--@ 7I-#2, *1'L, 8HC-22( 9IH'"!1!5#0'14 Allergic rhinitis +#7- Asthma #H'!I'" %D2#@4 allergic reaction @GA Type I hypersensitivity B"!5 Systemic Ig E @G Mediator D@201 mast cells A%I' !52#%H-" histamine A%0 leukotriens --!2 3C+I@4-22#6I-"H2#'@#G'A%0+2"@#G'@ H1 @!7H- allergen 931--D #1IDI allergen !2C+!HG0!5-22#-5 9IH'"6!5-22#@G F +2" F D!HAH- Symptoms and Signs -22#*31 - Hay Fever Conjunctivitis 7- 12!2, 2A-"H2#'@#G', I32D+% -22#@+%H25I0@G-"9H 1H'#2'@!7H- allergen 931+!-22#0+2"D #'20@%7-2'!, conjunctival chemosis A%0 diffuse papillary response, mucoid discharge I23 conjunctival scraping 0 Eosinophil @G*H'!2 Treatment 2##1)2 Hay Fever Conjunctivitis 3DI 15I 1. Cold compresses 0 H'"%-22#12DI 2. Topical vasoconstricting agents @ H Epinephrine #H'!1 Antihistamine 3. Topical mast cells stabilizer @ H 2% Sodium cromoglycate drop +#7- 0.1% Lodoxamide drop 4. Topical Steroid drop AHI-#0'1 side effect Acute allergic conjunctivitis acute allergic conjunctivitis @G urticarial reaction 5H@42 allergen 3'!2@I2DC conjunctival sac !1C@G+%12@%H1*1'L@%5I" +#7-'4H@%HC*2!+ I2 2#2"@428HD#CI2 Symptoms and Signs 9IH'"0A*--B"!5-22#151C B"!5@%7-2'!!2 conjunctival chemosis !2 A%00+2"DI@-C@'%2D!H5H 1H'B! Treatment @7H-2@G condition 5H+2"DI@- 6D!H!5 specific treatment -22# Reassurance @H21I Vernal Conjunctivitis @G allergic reaction - conjunctiva -5 4+6H @G Recurrent bilateral, external, ocular inflammation !1C@GA%0 young adult H- puberty A%0C9I 2"!2'H29I+ 4 B#5I@4B" Ig E mediated mechanism Symptoms and Sings -22#*31 - Vernal conjunctivitis 7- 12!2 #H'!1 lacrimation, photophobia, foreign body sensation A%0 burning sensation 2#2"-2!5 Blepharospasm -25IG!5 mucus discharge A%0-2!5 ptosis DI -22#0A#@%5H"2!$92% C#0@(+2'!10@G$9CD!I%4 A%00+2"C$9+2' 6H allergen %% *H'C#0@(#I--"H2#0@(D" -22#0D!HAH- -22#-2@G%-5GDI *8AH'H2DI allergen !2H-"AHD+ C#0"0A#- vernal conjunctivitis 0 conjunctival hyperemia A%0 chemosis H-!20 papillary hypertrophy 5H upper tarsal conjunctiva 2#1I-2 papillary response # limbus @#5" limbal vernal conjunctivitis @!7H-@G2 F @I2 papillary hypertrophy #4@' tarsal conjunctiva 0#'!1'1C+ H6I @G giant papilla !5%1)0@G cobblestone 6H-2D#9233C+I@4A%6I5H23DI @#5"'H2 Shield ulcer A%5I0I2-23 correspond 13A+H- papilla I23 conjunctival scraping 0 Eosinophils A%0 Mast cells Treatment Specific treatment - vernal conjunctivitis 7- 2#+%5@%5H" allergen 6HC2414A%I'3DI"2 @7H-2 allergen !1 contaminate -"9H1H'D 9IH'"@-GD!H#2'H2AI-0D# 2##1)263DI 1H-D5I 1. Symptomatic treatment 2. Cold compresses %-22#-9IH'" 3. Vasoconstricting agents @ H Epinephrine #H'!1 Antihistamine 4. Topical Steroid drop 0 H'"%-22#DI5!2 AH2#C I"21'5II-#0'1@G4@() @7H-2B#5I@GB#@#7I-#1 I-C I steroid 4H-12 -2@4 steroid side effects DI @ H steroid induced glaucoma @#20 01II2+%5@%5H" steroid DI '#+%5@%5H" 5. 2% Sodium cromoglycate '1%0 4 #1I 0 H'" stabilize mast cells D!HC+I%H-" histamine --!2 *2!2#%2#C I steroid %DI 6. 0.1% Lodoxamide @G"21'C+!H5HDI%5'H2 sodium cromoglycate 7. 5% Acetylcysteine '1%0 4 #1I @7H-#1)2 plaque formation @7H-2"21'5I!5 mucolytic proporties -"9H REFERENCES 1. Daniel A.Albert, Frederick A.Jokobiec : Principle and Practice of Ophthalmology Clinical Practice Volume 1. W.B.Saunder 1994. 2. William T., Edward A.Jaeger : Duane s Clinical Ophthalmology Volume 4. J.B. Lippincott 1993. 3. Jack J.Kanski : Clinical Ophthalmology A Systemic Approach 3rd Ed. Butterworth-Heinemann. 1994. 4. Gholam A.Peyman, Donald R.Sanders, Morton F.Goldberg : Principle and Practice of Ophthalmology Volume 1. 1980. 5. Vaughan D., Asbury T : General Ophthalmology Lange Medical Publisher 1980.     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