睑缘炎相关性角结膜病变诊治的临床观察

目的研究睑缘炎相关性角结膜病变(BKC)的临床特征、诊治及预后。方法回顾分析2015年1月至2016年4月在十堰市太和医院眼科诊断为BKC并接受住院治疗的患者。结果共有17例BKC患者纳入研究。1例为儿童BKC患者,1例为青少年,15例为成年患者;轻度BKC1例,中度BKC5例,重度BKC11例;5例为后睑缘炎型BKC,12例为全睑缘炎型BKC。经过眼睑清洁、热敷、按摩,点用抗生素滴眼液联合或不联合糖皮质激素滴眼液,同时典必殊眼膏擦睑缘,必要时联合口服抗生素治疗。经过治疗,14例BKC得到临床治愈,其中2例曾因不尊医嘱停药导致BKC复发并再次得到临床治愈;3例BKC临床好转,目前仍在治疗及随访中。经过治疗大部分BKC患者视力得到了明显改善,但少数患者由于残留角膜云翳、角膜斑翳及角膜新生血管而严重影响视力。结论BKC仍未得到临床眼科医生的足够重视,BKC临床体征较为显著,及时发现并对症治疗,预后较好;误诊及漏诊将导致患者疾病迁延不愈、角膜云翳及角膜斑翳形成等,严重影响患者的视功能。     

睑缘炎相关角膜病变特点及其睑板腺功能的临床观察

目的 观察睑缘炎相关角膜病变的临床特点,探讨其与睑缘炎和睑板腺功能的关系。设计 回顾性病例系列。研究对象 2012年1~10月北京同仁眼科中心睑缘炎患者84例（168眼）。方法 裂隙灯下观察睑缘炎类型、睑板腺分泌物性状及脂质排出难易度、角膜病变临床表现及病变范围,并进行评分。分析角膜病变特点及病变范围与睑缘炎类型及睑板腺功能的关系。主要指标 睑缘炎类型、睑板腺分泌物性状、脂质排出难易度和角膜病变范围。结果 84例（168眼）睑缘炎患者平均病程（22.25±40.46）个月。其中前部睑缘炎1例（2眼）,后部睑缘炎42（84眼）例,混合型睑缘炎41例（82眼）。其中65例（104眼）出现角膜病变。角膜周边或中周部上皮下或浅基质浸润44例（73眼,70.2%）,角膜周边或中周部溃疡10例（15眼,18.3%）,角膜云翳或瘢翳5例（8眼,7.7%）,角膜点片状上皮混浊、糜烂3例（4眼,3.8%）。17眼（10.1%）角膜病变范围超过1/2角膜,10眼（6%）到达角膜中央,其中1例角膜中央融解、变薄。与后睑缘炎相比,混合型睑缘炎角膜浸润和溃疡更多见（P=0.003）;与无角膜病变者相比,有角膜病变者的睑板腺分泌难易程度和睑脂性状评分均较高（t=-4.606和13.418,P=0.033和0.000）。结论 睑缘炎相关角膜病变临床表现多样。混合型睑缘炎更容易发生角膜浸润和角膜溃疡。睑缘炎患者是否合并角膜病变与睑板腺功能密切相关。     

睑缘炎相关角结膜病变的诊断和治疗研究进展

睑缘炎相关角结膜病变(blepharokeratoconjunctivitis),简称为BKC,是指一类继发于睑缘炎的慢性角结膜炎性病变^\〖1\〗,在临床上是一类常见的疾病,同时也是一类容易被误诊、漏诊的疾病,导致延误治疗。病情迁延不愈或不合理的治疗可造成患者不可逆的视功能损害。近年来,随着人们对眼表疾病的认识不断加深,对BKC的重视度越来越高,临床上对其诊治进行了大量的探讨,但目前还未形成统一的诊治标准。针对现状,查阅相关文献,本文对BKC的诊断和治疗做一综述。     

《睑缘炎与睑板腺功能障碍》一书出版

由孙旭光教授主编的《睑缘炎与睑板腺功能障碍》一书,已由人民卫生出版社出版。本书分为基础篇和临床篇,共七章。对睑缘及睑板腺的基础知识、睑缘炎、蠕形瞒睑缘炎、睑缘炎相关角结膜病变、睑板腺功能障碍及睑板腺功能障碍相关干眼的诊治进行了详尽的论述。在临床篇每章的结尾,著者总结了该章诊治要点,还提供了典型病例作为参与,全书有相关疾病图片150余幅,希望对广大眼科工作者的临床及相关研究有所帮助。     

《睑缘炎与睑板腺功能障碍》一书出版

由孙旭光教授主编的《睑缘炎与睑板腺功能障碍》一书,已由人民卫生出版社出版。本书分为基础篇和临床篇,共七章。对睑缘及睑板腺的基础知识、睑缘炎、蠕形螨睑缘炎、睑缘炎相关角结膜病变、睑板腺功能障碍及睑板腺功能障碍相关干眼的诊治进行了详尽的论述。在临床篇每章的结尾,著者总结了该章诊治要点,还提供了典型病例作为参考,全书有相关疾病图片150余     

睑缘炎相关角结膜炎的治疗进展

睑缘炎相关角结膜炎(blepharokeratoconjunctivitis,BKC)是临床上常见的一类慢性眼表疾病,常累及结膜和角膜,对患者的视力造成严重威胁.由于其起病隐匿且临床表现及体征易与其他角结膜炎性疾病相混淆,从而容易造成误诊、漏诊,尤其对于儿童患者可导致弱视或更严重的视力损害.BKC的治疗首先需要控制睑缘...     

结膜松弛症眼表知觉敏感度观察

结膜松弛症 (ｃｏｎｊｕｎｃｔｉｖｏｃｈａｌａｓｉｓ)是指球结膜过度松弛堆积在眼球与下睑缘、内、外眦部之间 ,引起眼表泪液学异常的一组病变[1,2 ] 。在临床上常被视为老年人正常的生理现象 ,而被忽视。在国内还没有被广大的眼科医生所认识。我们1996年开始就对结膜松弛症进行了系统的观察诊治 ,为探讨结膜松弛症的发病机制 ,对 6例结膜松弛症患者进行眼表知觉敏感度检查比较 ,现报告如下。1　材料与方法1 1　结膜松弛症病例选择(1)裂隙灯检查球结膜过度松弛堆积在眼球与下睑缘、内、外眦部之间 ,形成皱褶 ,突出于眼表曲面 ,影响泪液的…     

电焊工角膜结膜改变的调查

我们于1992～1993年,对丽水市40多家乡镇企业及联办企业75名从事电焊工种的工人,进行眼部状况调查,报告如下:对象:调查组的75名电焊工种工人均为男性,年龄25～55岁,其中25～45岁65人:46～55岁10人.从事电焊工作2～17年,其中2～10年50人;11～17年25人.对照组60人,为行政后勤人员,均为男性,21～53岁.检查方法:两组均进行视力、结膜、角膜改变及角膜知觉检查.结膜、角膜的改变采用荧光素染色后裂隙灯显微镜下检查.角膜知觉用棉絮刺激法检查.采用灯箱式国际标准视力表进行视力检查.对视力低于1.0者用带状检影法检查屈光状况,并矫正视力.     

53例结膜松弛症临床分析

目的分析结膜松弛症的临床特点。方法回顾2003年3月-2006年10月间连续53例(106眼)结膜松弛症患者的临床资料,分析其临床表现、检查结果、年龄、性别、职业及相关外眼病变。结果结膜松弛症最常见表现为异物感(75.47%),干涩感(61.32%),视疲劳(53.7%),畏光(36.79%),流泪(27.36%)。基础泪液分泌试验(SchirmerⅠtest,ST)<10mm/5min(4.72%),泪膜破裂时间(brest-uptest,BUT)<10s(16.04%)。平均年龄66岁,男女比例为29∶24。从事职业以公务员为多见。相关外眼病变眼袋(69.81%),泪道堵塞(1.89%),下睑内翻倒睫(6.60%),睑缘炎(2.83%)。结论结膜松弛症常见与其他外眼病变相同的临床表现及相互的因果关系,ST、BUT等相关检查不可忽视。     

电焊工94例的角膜结膜改变

目的了解电焊工的角膜、结膜改变,找出与其相关因素,以达到预防的目的。方法对94例(188眼)电焊工种的工人进行眼部检查,并进行了对比分析。结果94例电焊工中158眼有不同程度的角膜、结膜损害。结论紫外线对眼组织的损害与辐射时间长短有密切关系。     

Segmentation and accuracy in copying and drawing: Experts and beginners

As part of an ongoing investigation into real-world copying and drawing, I recorded the eye-hand drawing strategies of 16 subjects with drawing experiences ranging from expert to novice while they copied a line drawing of a standing nude. The experts produced accurate copies whereas all the beginners produced marked inaccuracies of overall scaling, proportion and shape. Analysis of eye and hand movements showed that the experts alone segmented the original drawing into simple line sections that were copied one at a time using a direct eye-hand strategy not requiring intermediary encoding to visual memory. The results suggest that segmentation into simple lines defines the task-specific process of accurate copying, and that this process is restricted to experts, i.e. acquired through training and practice. Additional preliminary tests also suggest that a similar process may apply to drawing a model from life.     

Proximal and accommodative convergence and age

The authors have estimated the phoria for distant and near fixation in two groups of subjects (mean age 27.5 ± 4.4 and 59.2 ± 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower in presbyopic than in nonpresbyopic subjects. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.     

Anesthesia and preoperative and postoperative medications

Although certain methods such as retrobulbar blocks are used extensively, improvements in procedure can always be implemented. The use of ultrasound, low concentrations of anesthesia, careful monitoring, and, in the case of risk patients, anesthesia standby are all important considerations to ensure uneventful treatments. Topical anesthesia eliminates needle risk as well as risk of ptosis and bruising. Because it has been demonstrated that bacteria routinely enter the anterior chamber during uncomplicated cataract surgery, certain irrigation solutions are helpful, but still debatable. Postoperatively, diclofenac, flurbiprofen, and timolol have all been proven to be effective in reducing ocular inflammation, reducing incidence of CME, and controlling pressure increase, respectively.     

Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management

Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve–based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.     

Anesthesia and preoperative and postoperative medications

Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti-inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.     

Nodes and nodal points and lines in eyes and other optical systems

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system's nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities.     

Sensitivity to first- and second-order motion and form in children and adults

We compared the sensitivity of adults and children aged 3-10 years to first- and second-order motion and form. For first-order stimuli, at all ages sensitivity was better for motion than form, and motion thresholds were better at 6 Hz than at 1.5 Hz. For second-order stimuli, at all ages sensitivity was better for form than motion, and motion thresholds were better at 0.25 cyc/deg than at 1 cyc/deg. Thresholds became adult-like later for motion than for form and later for first-order than second-order stimuli. For first-order stimuli, the changes with age were larger and more protracted.     

Estrogen and progesterone receptors and human conjunctiva

Freshly frozen conjunctival tissue from premenopausal and postmenopausal women and male subjects were processed for estrogen and progesterone receptors by using monoclonal antibodies and a peroxidase-antiperoxidase technique. No immunocytochemical staining was localized in the nuclei of the cells treated with the monoclonal antibodies to human estrogen receptor or human progesterone receptor in any of the conjunctival specimens, in contrast to the strongly positive staining in breast adenocarcinoma controls. Immunocytochemical staining disclosed no evidence for estrogen or progesterone receptors on cells of the ocular surface.