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眼科实习心得常见眼疾鉴别与治疗经验分享眼科是医学领域中一门重要的专科，涉及到眼部疾病的诊断、治疗与预防。
在眼科的实习过程中，我有幸接触到了许多常见的眼疾，并积累了一些鉴别与治疗经验。
在本文中，我将分享我在眼科实习中所学到的常见眼疾的鉴别与治疗经验，希望对读者有所帮助。
1. 神经性眼疾神经性眼疾是指由于神经系统疾病引发的眼部疾病，包括面神经麻痹、脑卒中性眼肌麻痹等。
在鉴别面神经麻痹时，我们首先会观察患者的面部表情是否有明显的不对称，进一步了解病史是否有与面神经麻痹相关的疾病，如病毒感染等。
治疗方面，常采用口服类固醇激素、眼霜按摩等方法，帮助患者尽快康复。
2. 细菌性眼炎细菌性眼炎是指由细菌感染引起的眼部疾病，如结膜炎、角膜炎等。
在鉴别细菌性眼炎时，我们会注意患者的症状，如眼红、结膜充血、眼睑肿胀等，进一步进行相关检查，如眼结膜涂片，以确定细菌的种类，并针对性地使用抗生素眼药水进行治疗。
3. 白内障白内障是眼部较为常见的疾病之一，指的是晶状体透明度下降引发的视力减退。
在鉴别白内障时，我们会注意患者近视眼史、眼睛出现白色混浊等症状，进一步进行视力检查和眼底检查，确定白内障的类型和程度，并根据患者的年龄和症状选择手术与保守治疗的方法。
4. 眼外伤眼外伤包括眼球受伤、眼睑创伤等。
在鉴别眼外伤时，我们首先会了解患者的外伤原因、力度和部位，观察眼部是否有明显损伤，进一步进行眼球压力检查和眼底检查，以确定损伤程度，并进行相应处理，如使用抗生素眼药水、局部冰敷、外科手术等。
5. 角膜病变角膜病变是指角膜受损引发的眼部疾病，如干眼症、角膜溃疡等。
在鉴别角膜病变时，我们会注意患者的视力下降、异物感、流泪等症状，进一步进行角膜染色和角膜地形图检查，以确定角膜病变的类型和严重程度，并采取相应的治疗措施，如人工泪液、角膜修复手术等。
总结起来，眼科实习中的常见眼疾鉴别与治疗需要我们熟悉不同疾病的症状、检查方法和治疗原则。
通过实际操作和病例观察，我逐渐学会了正确判断眼疾的类型，并了解了相应的治疗方案。
眼科常见疾病中医诊疗规范目录概说溃疡性睑缘炎麦粒肿霰粒肿目割上睑下垂泪溢急性结膜炎慢性结膜炎沙眼春季结膜炎泡性结膜炎巩膜炎单纯疱疹性角膜炎角膜溃疡虹膜睫状体炎老年性白内障玻璃体混浊视网膜静脉阻塞视网膜静脉周围炎中心性浆液性脉络膜视网膜病变糖尿病性视网膜病变视神经炎原发性视神经萎缩老年性黄斑变性概说眼为视觉器官，属五官之一。
它通过经络，与内在脏腑和其他组织器官保持着密切的联系。
五脏六腑的精气皆上注于目，肝藏血而开窍于目，肝气通于目，诸脉者皆属于目，十二经脉都直接或间接地与眼发生联系。
这种脏腑、经络与眼的有机联系，保证了眼的正常功能。
如果脏腑功能失调，可以反映于眼部，引起眼病。
反之,眼部疾病也可通过经络影响相应的脏腑，以致引起脏腑的病理反应。
因此，在诊治眼病时，必须从整体观念出发，运用局部辨证与全身辨证相结合的辨证方法，因证论治，调整人体内部与眼病有关的脏腑、气血之间的相对平衡而达到治疗目的。
一、五轮学说中医眼科的五轮学说，就是将眼分为五个部分，分属于五脏，藉以说明眼的生理、病理与脏腑的关系。
实际上是一种从眼局部进行脏腑辨证的方法，至今仍有其一定的临床实用意义。
1 .肉轮指胞睑（包括皮肤、肌肉、睑板和睑结膜），在脏属脾，因脾主肌肉，故称肉轮。
因脾与胃相表里，故肉轮疾病常责之于脾与胃。
2 .血轮指两眦（包括两眦的皮肤、结膜和泪器），在脏属心，因心主血，故称血轮。
因心与小肠相表里，故血轮疾病常责之于心与小肠。
3 .气轮指白睛（包括球结膜与巩膜），在脏属肺，因肺主气，故称气轮。
因肺与大肠相表里，故气轮疾病常责之于肺与大肠。
4 .风轮指黑睛（包括角膜、虹膜、睫状体），在脏属肝，因肝主风，故称风轮。
因肝与胆相表里，故风轮疾病常责之于肝与胆。
5 .水轮指睡神（包括瞳孔与瞳孔以后的眼内组织，如晶状体、玻璃体、脉络膜、视网膜与视神经等），在脏属肾，因肾主水，故称水轮。
因肾与膀胱相表里，故水轮疾病常责之于肾与膀胱。
但由于瞳神结构复杂，其生理病理还与其他脏腑有着相当密切的关系。
November 2010ICO International Clinical GuidelinesThis document contains 24 International Clinical Guidelines defined by the International Council of Ophthalmology (ICO).The Guidelines are designed to be translated and adapted by ophthalmologic societies to help ophthalmologists assess how they are treating patients. They are intended to serve a supportive and educational role and ultimately to improve the quality of eye care for patients.Below is a list of the Guidelines available with links to each Guideline in this document, followed by the Preface to the Guidelines. Also see the Introduction to the ICO International Clinical Guidelines/enhancing_eyecare/international_clinical_guidelines.html.For the latest information on the ICO Clinical Guidelines and to download individual Guidelines as separate PDF files, see the resources listings.List of Guidelines Available∙Age-Related Macular Degeneration (Initial and Follow-up Evaluation)∙Age-Related Macular Degeneration (Management Recommendations)∙Amblyopia (Initial and Follow-up Evaluation)∙Bacterial Keratitis (Initial Evaluation)∙Bacterial Keratitis (Management Recommendations)∙Blepharitis (Initial and Follow-up Evaluation)∙Cataract (Initial and Follow-up Evaluation)∙Conjunctivitis (Initial Evaluation and Therapy)∙Diabetic Retinopathy (Initial and Follow-up Evaluation)∙Diabetic Retinopathy (Management Recommendations)∙Dry Eye Syndrome (Initial Evaluation)∙Dry Eye Syndrome (Management Recommendations)∙Esotropia (Initial and Follow-up Evaluation)∙Exotropia (Initial and Follow-up Evaluation)∙Eye Disease in Leprosy (Initial Evaluation and Management)∙Idiopathic Macular Hole (Initial Evaluation and Therapy)∙Keratorefractive Surgery (Initial and Follow-up Evaluation)∙Ocular HIV/AIDS Related Diseases (Initial and Follow-up Evaluation)∙Posterior Vitreous Detachment, Retinal Breaks and Lattice Degeneration (Initial and Follow-up Evaluation)∙Primary Open-Angle Glaucoma (Initial Evaluation)∙Primary Open-Angle Glaucoma (Follow-up Evaluation)∙Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation) ∙Primary Angle Closure (Initial Evaluation and Therapy)∙TrachomaPreface to the GuidelinesInternational Clinical Guidelines are prepared and distributed by the International Council of Ophthalmology.These Guidelines are to serve a supportive and educational role for ophthalmologists worldwide. These guidelines are intended to improve the quality of eye care for patients. They have been adapted in many cases from similar documents (Benchmarks of Care) created by the American Academy of Ophthalmology based on their Preferred Practice Patterns.While it is tempting to equate these to Standards, it is impossible and inappropriate to do so. The multiple circumstances of geography, equipment availability, patient variation and practice settings preclude a single standard.Guidelines on the other hand are a clear statement of expectations. These include comments of the preferred level of performance assuming conditions that allow the use of optimum equipment, pharmaceuticals and/or surgical circumstances. Thus, a basic expectation is created and if the situation is optimum, the optimum facets of diagnosis, treatment and follow up may be employed. Excellent, appropriate and successful care can also be provided where optimum conditions do not exist.Simply following the Guidelines does not guarantee a successful outcome. It is understood that, given the uniqueness of a patient and his or her particular circumstance, physician judgment must be employed. This can result in a modification in application of a guideline in individual situations.Medical experience has been relied upon in the preparation of these guidelines, and they are whenever possible, evidence-based. This means these Guidelines are based on the latest available scientific information. The ICO is committed to provide updates of these guidelines on a regular basis (approximately every two to three years).(Also see the Introduction to the ICO International Clinical Guidelines at/guide/guideintro.html and the list of other Guidelines at/guide/guidelist.html.)Age-Related Macular Degeneration(Initial and Follow-up Evaluation)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History (Key elements)∙Symptoms (metamorphopsia, decreased vision) (A:II)∙Medications and nutritional supplements (B:III)∙Ocular history (B:II)∙Systemic history (any hypersensitivity reactions) (B:II)∙Family history, especially family history of AMD (B:II)∙Social history, especially smoking (B:II)Initial Physical Exam (Key elements)∙Visual acuity (A:III)∙Stereo biomicroscopic examination of the macula (A:III)Ancillary TestsIntravenous fundus fluorescein angiography in the clinical setting of AMD is indicated: (A:I)o when patient complains of new metamorphopsiao when patient has unexplained blurred visiono when clinical exam reveals elevation of the RPE or retina, subretinal blood, hard exudates or subretinal fibrosiso to detect the presence of and determine the extent, type, size, and location of CVN and to calculate the percentage of the lesioncomposed of or consisting of classic CNVo to guide treatment (laser photocoagulation surgery or verteporfin PDT)o to detect persistent or recurrent CNV following treatmento to assist in determining the cause of visual loss that is not explained by clinical examEach angiographic facility must have a care plan or an emergency plan and a protocol to minimize the risk and manage any complications. (A:III)Follow-up Exam History∙Visual symptoms, including decreased vision and metamorphopsia (A:II) ∙Changes in medications and nutritional supplements (B:III)∙Interval ocular history (B:III)∙Interval systemic history (B:III)∙Changes in social history, especially smoking (B:II)Follow-up Physical Exam∙Visual acuity (A:III)∙Stereo biomicroscopic examination of the fundus (A:III)Follow-up Treatment after Neovascular AMD∙Discuss risks, benefits and complications with the patient and obtain informed consent (A:III)∙Examine patients treated with ranibizumab intravitreal injections approximately 4 weeks after treatment (A:III)∙Examine patients treated with bevacizumab intravitreal injections approximately 4 to 8 weeks after treatment (A:III)∙Examine patients treated with pegaptanib sodium injection approximately 6 weeks following the treatment (A:III)∙Examine and perform fluorescein angiography at least every 3 months for up to 2 years after verteporfin PDT (A:I)∙Examine patients treated with thermal laser photocoagulation approximately2 to 4 weeks after treatment and then at 4 to 6 weeks (A:III)∙Optical coherence tomography, (A:III) fluorescein angiography,(A:I) and fundus photography (A:III) may be helpful to detect signs of exudation andshould be used when clinically indicated∙Subsequent examinations should be performed as indicated depending on the clinical findings and the judgment of the treating ophthalmologist (A:III) Patient Education∙Educate patients about the prognosis and potential value of treatment as appropriate for their ocular and functional status (A:III)∙Encourage patients with early AMD to have regular dilated eye exams for early detection of intermediate AMD (A:III)∙Educate patients with intermediate AMD about methods of detecting new symptoms of CVN and about the need for prompt notification to anophthalmologist (A:III)∙Instruct patients with unilateral disease to monitor their vision in their fellow eye and to return periodically even in absence of symptoms, but promptlyafter onset of new or significant visual symptoms (A:III)∙Instruct patients to report symptoms suggestive of endophthalmitis, including eye pain or increased discomfort, worsening eye redness, blurred ordecreased vision, increased sensitivity to light, or increased number offloaters promptly (A:III)∙Encourage patients who are currently smoking to stop (A:I) because there are observational data that support a causal relationship between smoking and AMD (A:II) and other considerable health benefits of smoking cessation ∙Refer patients with reduced visual function for vision rehabilitation (see /smartsight) and social services (A:III)* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Age-Related Macular Degeneration(Management Recommendations)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Treatment Recommendations and Follow-up Plans forAge-Related Macular DegenerationAMD = Age-related Macular Degeneration; AREDS = Age-related Eye Disease Study; CNV = choroidal neovascularization; MPS = Macular Photocoagulation Study; PDT = photodynamic therapy; TAP = Treatment of Age-related Macular Degeneration with Photodynamic Therapy; VIP = Verteporfin in Photodynamic Therapy* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Amblyopia (Initial and Follow-up Evaluation)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History (Key elements)∙Ocular symptoms and signs (A:III)∙Ocular history (A:III)∙Systemic history, including review of prenatal, perinatal, and postnatal medical factors (A:III)∙Family history, including eye conditions and relevant systemic diseases (A:III)Initial Physical Exam (Key elements)∙Assessment of visual acuity and fixation pattern (A:III)∙Ocular alignment and motility (A:III)∙Red reflex or binocular red reflex (Brückner) test (A:III)∙Pupil examination (A:III)∙External examination (A:III)∙Anterior segment examination (A:III)∙Cycloplegic retinoscopy/refraction (A:III)∙Funduscopic examination (A:III)∙Binocularity/stereoacuity testing (A:III)Care Management∙Choose treatment based on patient's age; visual acuity; compliance with previous treatment; and physical, social, and psychological status. (A:III) ∙Treatment goal is to achieve equalization/normalization of fixation patterns or visual acuity. (A:III)∙Once maximal visual acuity has been obtained, treatment should be tapered and eventually stopped. (A:III)Follow-up Evaluation∙Follow-up visits should include:o Interval history (A:III)o Tolerance to therapy (A:III)o Examinations and testing as indicated (A:III)Amblyopia Follow-up Evaluation Intervals During Active Treatment Period(A:III)Patient Education• Discuss diagnosis, severity o f disease, prognosis and treatment plan with patient, parents and /or caregivers. (A:III)• Explain the disorder and recruit the family in a collaborative approach to therapy.(A:III)* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Bacterial Keratitis (Initial Evaluation)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History∙Ocular symptoms (A:III)∙Contact lens history (A:II)∙Review of other ocular history (A:III)∙Review of other medical problems and systemic medications (A:III)∙Current and recently used ocular medications (A:III)∙Medication allergies (A:III)Initial Physical Exam∙Visual acuity (A:III)∙General appearance of patient (B:III)∙Facial examination (B:III)∙Eyelids and eyelid closure (A:III)∙Conjunctiva (A:III)∙Nasolacrimal apparatus (B:III)∙Corneal sensation (A:III)∙Slit-lamp biomicroscopyo Eyelid margins (A:III)o Conjunctiva (A:III)o Sclera (A:III)o Cornea (A:III)o Anterior chamber (A:III)o Anterior vitreous (A:III)∙Contralateral eye (A:III)Diagnostic Tests∙Manage majority of community-acquired cases with empiric therapy and without smears or cultures. (A:III)∙Indications for smears and cultures:o Sight-threatening or severe keratitis of suspected microbial origin prior to initiating therapy (A:III)o A large corneal infiltrate that extends to the middle to deep stroma (A:III)o Chronic in nature (A:III)o Unresponsive to broad spectrum antibiotic therapy (A:III)o Clinical features suggestive of fungal, amoebic, or mycobacterial keratitis (A:III)∙The hypopyon that occurs in eyes with bacterial keratitis is usually sterile, andaqueous or vitreous taps should not be performed unless there is a highsuspicion of microbial endophthalmitis. (A:III)∙Corneal scrapings for culture should be inoculated directly onto appropriate culture media to maximize culture yield. (A:III). If this is not feasible, placespecimens in transport media. (A:III). In either case, immediately incubatecultures or take promptly to the laboratory. (A:III)Care Management∙Topical antibiotic eye drops are preferred method in most cases. (A:III)∙Use topical broad-spectrum antibiotics initially in the empiric treatment of presumed bacterial keratitis. (A:III)∙For central or severe keratitis (e.g., deep stromal involvement or an infiltrate larger than 2 mm with extensive suppuration), use a loading dose (e.g., every5 to 15 minutes for the first 1 to 3 hours), followed by frequent applications(e.g., every 30 minutes to 1 hour around the clock).(A:III) For less severekeratitis, a regimen with less frequent dosing is appropriate.(A:III)∙Use systemic therapy for gonococcal keratitis. (A:II)∙In general, modify initial therapy when there is a lack of improvement or stabilization within 48 hours. (A:III)∙For patients treated with ocular topical corticosteroids at time of presentation of suspected bacterial keratitis, reduce or eliminate corticosteroids untilinfection has been controlled. (A:III)∙When the corneal infiltrate compromises the visual axis, may add topical corticosteroid therapy following at least 2 to 3 days of progressiveimprovement with topical antibiotics. (A:III) Continue topical antibiotics athigh levels with gradual tapering. (A:III)∙Examine patients within 1 to 2 days after initiation of topical corticosteroid therapy. (A:III)* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Bacterial Keratitis(Management Recommendations)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Follow-up Evaluation∙Frequency depends on extent of disease, but follow severe cases initially at least daily until clinical improvement or stabilization is documented. (A:III) Patient Education∙Inform patients with risk factors predisposing them to bacterial keratitis of their relative risk, the signs and symptoms of infection, and to consult anophthalmologist promptly if they experience such warning signs or symptoms (A:III)∙Educate about the destructive nature of bacterial keratitis and need for strict compliance with therapy. (A:III)∙Discuss possibility of permanent visual loss and need for future visual rehabilitation. (A:III)∙Educate patients with contact lenses about increased risk of infection associated with contact lens, overnight wear, and importance of adherence to techniques to promote contact lens hygiene. (A:III)∙Refer patients with significant visual impairment or blindness for vision rehabilitation if they are not surgical candidates (see/smartsight). (A:III)Antibiotic Therapy of Bacterial Keratitis [A:III]*Fewer gram-positive cocci are resistant to gatifloxacin and moxifloxacin than other fluoroquinolones.**Ciprofloxacin 3 mg/ml; gatifloxacin 3 mg/ml; levofloxacin 15 mg/ml; moxifloxacin 5mg/ml; ofloxacin 3 mg/ml, all commercially available at these concentrations.***For resistant Enterococcus and Staphylococcus species and penicillin allergy. Vancomycin and Bacitracin have no gram-negative activity and should not be used as a single agent empirically in treating bacterial keratitis.**** Systemic therapy is necessary for suspected gonococcal infection.***** Data from Chandra NS, Torres MF, Winthrop KL. Cluster of Mycobacterium chelonae keratitis cases following laser in-situ keratomileusis. Am J Ophthalmol 2001; 132:819-30. * Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Blepharitis (Initial and Follow-up Evaluation)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History∙Ocular symptoms and signs (A:III)∙Time of day when symptoms are worse (A:III)∙Duration of symptoms (A:III)∙Unilateral or bilateral presentation (A:III)∙Exacerbating conditions (e.g., smoke, allergens, wind, contact lens, low humidity, retinoids, diet, alcohol consumption, eye makeup) (A:III) ∙Symptoms related to systemic diseases (e.g., rosacea, allergy) (A:III)∙Current and previous systemic and topical medications (A:III)∙Recent exposure to an infected individual (e.g., pediculosis) (C:III)∙Ocular history(e.g., previous intraocular and eyelid surgery, local trauma, including mechanical, thermal, chemical, and radiation injury) (A:III) ∙Systemic history (e.g., dermatological diseases, such as rosacea, atopic disease, and herpes zoster ophthalmicus) (A:III)Initial Physical Exam∙Visual acuity (A:III)∙External examinationo Skin (A:III)o Eyelids (A:III)∙Slit-lamp biomicroscopyo Tear film (A:III)o Anterior eyelid margin (A:III)o Eyelashes (A:III)o Posterior eyelid margin (A:III)o Tarsal conjunctiva (A:III)o Bulbar conjunctiva (A:III)o Cornea (A:III)∙Measurement of IOP (A:III)Diagnostic Tests∙Cultures may be indicated for patients with recurrent anterior blepharitis with severe inflammation as well as for patients who are not responding to therapy.(A:III)∙Biopsy of the eyelid to exclude the possibility of carcinoma may be indicated in cases of marked asymmetry, resistance to therapy or unifocal recurrentchalazia that do not respond well to therapy. (A:II)∙Consult with the pathologist prior to obtaining the biopsy if sebaceous cell carcinoma is suspected.(A:II)Care Management∙Treat patients with blepharitis initially with a regimen of warm compress and eyelid hygiene. (A:III)∙For patients with staphylococcal blepharitis, a topical antibiotic such as erythromycin can be prescribed to be applied one or more times daily or atbedtime on the eyelids for one or more weeks. (A:III)∙For patients with meibomian gland dysfunction, whose chronic symptoms and signs are not adequately controlled with eyelid hygiene, oral tetracyclines can be prescribed. (A:III)∙ A brief course of topical corticosteroids may be helpful for eyelid or ocular surface inflammation. The minimal effective dose of corticosteroids should be utilized and long-term corticosteroid therapy should be avoided if possible.(A:III)Follow-up Evaluation∙Follow-up visits should include:o Interval history (A:III)o Visual acuity (A:III)o External exam (A:III)o Slit-lamp biomicroscopy (A:III)∙If corticosteroid therapy is prescribed, re-evaluate patient within a few weeks todetermine the response to therapy, measure intraocular pressure, andassess treatment compliance (A:III)Patient Education∙Counsel patients about the chronicity and recurrence of the disease process.(A:III)∙Inform patients that symptoms can frequently be improved but are rarely eliminated. (A:III)∙Advise patient that if warm compress and eyelid hygiene treatment is effective, symptoms often recur if treatment is stopped so may be necessary long term (A:III)* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Cataract (Initial and Follow-up Evaluation)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History∙Symptoms (A:II)∙Ocular history (A:III)∙Systemic history (A:III)∙Assessment of visual functional status (A:II)Initial Physical Exam∙Visual acuity, with current correction (A:III)∙Measurement of BCVA (with refraction when indicated) (A:III)∙Ocular alignment and motility(A:III)∙Pupil reactivity and function (A:III)∙Measurement of IOP (A:III)∙External examination (A:III)∙Slit-lamp biomicroscopy (A:III)∙Evaluation of the fundus(through a dilated pupil) (A:III)∙Assessment of relevant aspects of general and mental health (B:III)Care Management∙Treatment is indicated when visual function no longer meets the patient's needs and cataract surgery provides a reasonable likelihood of improvement.(A:II)∙Cataract removal is also indicated when there is evidence of lens-induced diseases or when it is necessary to visualize the fundus in an eye that has the potential for sight. (A:III)∙Surgery should not be performed under the following circumstances: (A:III) glasses or visual aids provide vision that meets the patient's need s’, surgery will not improve visual function; the patient cannot safely undergo surgerybecause of coexisting medical or ocular conditions; appropriatepostoperative care cannot be obtained.∙Indications for second eye surgery are the same as for the first eye. (A:II) (with consideration given to the needs for binocular function) Preoperative CareOphthalmologist who is to perform the surgery has the following responsibilities: ∙Examine the patient preoperatively (A:III)∙Ensure that the evaluation accurately documents symptoms, findings and indications for treatment (A:III)∙Inform the patient about the risks, benefits and expected outcomes of surgery(A:III)∙Formulate surgical plan, including selection of an IOL (A:III)∙Review results of presurgical and diagnostic evaluations with the patient (A:III)∙Formulate postoperative plans and inform patient of arrangements (A:III)Follow-up Evaluation∙High-risk patients should be seen within 24 hours of surgery. (A:III)∙Routine patients should be seen within 48 hours of surgery. (A:III)∙Frequency and timing of subsequent visits depend on refraction, visual function, and medical condition of the eye.∙More frequent follow-up usually necessary for high risk patients.∙Components of each postoperative exam should include:o Interval history, including new symptoms and use of postoperative medications (A:III)o Patient's assessment of visual functional status (A:III)o Assessment of visual function (visual acuity, pinhole testing) (A:III)o Measurement of IOP (A:III)o Slit-lamp biomicroscopy (A:III)Nd:YAG Laser Capsulotomy∙Treatment is indicated when vision impaired by posterior capsular opacification does not meet the patient's functional needs or when it critically interferes with visualization of the fundus. (A:III)∙Educate about the symptoms of posterior vitreous detachment, retinal tears and detachment and need for immediate examination if these symptoms are noticed. (A:III)Patient Education∙For patients who are functionally monocular, discuss special benefits and risks of surgery, including the risk of blindness. (A:III)* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2010 ()Conjunctivitis (Initial Evaluation and Therapy)(Ratings: A: Most important, B: Moderately important, C: Relevant but not critical Strength of Evidence: I: Strong, II: Substantial but lacks some of I, III: consensus of expert opinion in absence of evidence for I & II)Initial Exam History∙Ocular symptoms and signs (e.g., itching, discharge, irritation, pain, photophobia, blurred vision) (A:III)∙Duration of symptoms (A:III)∙Exacerbating factors (A:III)∙Unilateral or bilateral presentation (A:III)∙Character of discharge (A:III)∙Recent exposure to an infected individual (A:III)∙Trauma (mechanical, chemical, ultraviolet) (A:III)∙Contact lens wear (e.g., lens type, hygiene and use regimen) (A:III)∙Symptoms and signs potentially related to systemic diseases (e.g., genitourinary discharge, dysuria, upper respiratory infection, skin andmucosal lesions) (A:III)∙Allergy, asthma, eczema (A:III)∙Use of topical and systemic medications (A:III)∙Use of personal care products (A:III)∙Ocular history (e.g., previous episodes of conjunctivitis (A:III) and previous ophthalmic surgery) (B:III)∙Systemic history (e.g., compromised immune status, current and prior systemic diseases) (B:III)∙Social history (e.g., smoking, occupation and hobbies, travel and sexual activity) (C:III)Initial Physical Exam∙Visual acuity (A:III)∙External examinationo Regional lymphadenopathy (particularly preauricular) (A:III)o Skin (A:III)o Abnormalities of the eyelids and adnexae (A:III)o Conjunctiva (A:III)∙Slit-lamp biomicroscopyo Eyelid margins (A:III)o Eyelashes (A:III)o Lacrimal puncta and canaliculi (B:III)o Tarsal and forniceal conjunctiva (A:II)o Bulbar conjunctiva/limbus (A:II)o Cornea (A:I)o Anterior chamber/iris (A:III)o Dye-staining pattern (conjunctiva and cornea) (A:III)Diagnostic Tests∙Cultures, smears for cytology and special stains are indicated in cases of suspected infectious neonatal conjunctivitis. (A: I)∙Smears for cytology and special stains are recommended in cases of suspected gonococcal conjunctivitis. (A:II)∙Confirm diagnosis of adult and neonate chlamydial conjunctivitis with immunodiagnostic test and/or culture. (A:III)∙Biopsy the bulbar conjunctiva and take a sample from an uninvolved area adjacent to the limbus in an eye with active inflammation when ocular mucous membrane pemphigoid is suspected. (A:III)∙ A full-thickness lid biopsy is indicated in cases of suspected sebaceous carcinoma. (A:II)Care Management∙Avoid indiscriminate use of topical antibiotics or corticosteroids because antibiotics can induce toxicity and corticosteroids can prolong adenoviralinfections and worsen herpes simplex virus infections (A:III)∙Treat mild allergic conjunctivitis with an over-the-counterantihistamine/vasoconstrictor agent or second-generation topical histamine H1-receptor antagonists. (A:III) If the condition is frequently recurrent orpersistent, use mast-cell stabilizers (A:I)∙For contact lens-related keratoconjunctivitis, discontinue contact lens wear for 2 or more weeks (A:III)∙If corticosteroids are indicated, prescribe the minimal amount based on patient response and tolerance (A:III)∙If corticosteroids are used, perform baseline measurement of intraocular pressure (A:III)∙Use systemic antibiotic treatment for conjunctivitis due to Neisseria gonorrhoeae(A:I) or Chlamydia trachomatis. (A:II)∙Treat sexual partners to minimize recurrence and spread of disease when conjunctivitis is associated with sexually transmitted diseases and referpatients and their sexual partners to an appropriate medical specialist. (A:III) ∙Refer patients with manifestation of a systemic disease to an appropriate medical specialist. (A:III)Follow-up Evaluation∙Follow-up visits should include:o Interval history (A:III)o Visual acuity (A:III)o Slit-lamp biomicroscopy (A:III)∙If corticosteroids are used, perform periodic measurement of intraocular pressure andpupillary dilation to evaluate for cataract and glaucoma (A:III)。
眼科常见疾病的医疗指南
引言
眼科常见疾病是指那些经常被医生诊断和治疗的眼部疾病。
本文档旨在提供一份简明的眼科常见疾病的医疗指南，以帮助患者了解和应对这些疾病。
眼科常见疾病
以下是一些常见的眼科疾病及其医疗指南：
白内障
白内障是眼睛晶状体混浊导致视力模糊的疾病。
治疗白内障的主要方法是手术，即晶状体摘除术。
手术后需要注意眼部卫生，避免眼睛受到外界刺激。
青光眼
青光眼是一种眼内压过高导致视神经受损的眼病。
治疗青光眼的方法包括药物治疗和手术治疗。
药物治疗一般采用降低眼内压的药物，手术治疗则包括激光手术和过滤手术等。
视网膜脱离
视网膜脱离是指视网膜与眼球后壁之间的分离。
治疗视网膜脱离的方法包括激光治疗、冷冻治疗和手术复位等。
手术复位是最常用的治疗方法，术后需要注意休息和避免剧烈运动。
干眼症
干眼症是指眼球表面缺乏足够的泪液润滑导致不适的病症。
治疗干眼症的方法包括使用人工泪液、热敷和避免长时间使用电子设备等。
同时，保持良好的眼部卫生也是预防干眼症的重要措施。
视力矫正
视力矫正包括近视、远视和散光等。
根据不同的屈光度，可以选择配戴眼镜或隐形眼镜进行视力矫正。
手术矫正方法如LASIK 也可考虑，但需要在医生的指导下进行决策。
结论
本文档提供了眼科常见疾病的医疗指南，希望能帮助患者更好地了解和应对这些疾病。
在面对眼科问题时，建议及时就医并遵循医生的建议进行治疗。
保持良好的眼部卫生和注意眼睛的休息也是预防眼科疾病的重要措施。
中医眼科常见病诊疗指南概述及解释说明1. 引言1.1 概述本文旨在介绍中医眼科的常见病诊疗指南。
随着现代社会对眼睛健康的重视度不断提高，中医作为一种传统而综合性的医学理论和实践体系，在眼科领域发挥了重要作用。
本文将从疾病概述、诊断要点以及治疗方法等方面，介绍中医眼科对于近视和青光眼这两个常见眼科疾病的诊疗指南。
1.2 文章结构本文分为五个主要部分进行展开讨论。
引言部分是全文的开篇，通过概述和文章结构简要说明本文的目的以及各个部分内容安排。
接下来是第二部分，即“中医眼科常见病诊疗指南”，其中包含了关于这两个常见眼科疾病的总体介绍、诊断要点和治疗方法等内容。
第三部分和第四部分则具体针对近视和青光眼这两个常见眼科疾病展开讨论，包括其病因及发病机制、临床表现和诊断准则，以及中医治疗常用方法等。
最后的结论部分将对全文进行总结回顾，并展望未来中医眼科的发展方向。
1.3 目的本文的目的是通过介绍中医眼科常见病诊疗指南，增加人们对于中医在眼科领域的了解和认识。
近视和青光眼是两种常见且对人们生活有影响的眼科疾病，在现代社会高度普遍。
通过阐述这两个疾病的概况、诊断要点和治疗方法，我们希望读者能够更好地了解中医在眼科领域的应用，从而提升他们对于心理健康重要性的认识，并进一步促使人们主动关注并采取预防措施，保护自己的视力健康。
2. 中医眼科常见病诊疗指南2.1 疾病概述中医眼科常见病包括近视、远视、弱视、斜视、散光等。
这些疾病主要由于先天遗传因素和后天环境因素引起，其中近视和青光眼是最为常见的两种眼科疾病。
2.2 诊断要点对于中医眼科常见病的诊断，首先需要全面了解患者的病史和临床表现，包括视力变化、眼睛干涩或沙眼感等。
同时还需要进行详细的眼部检查，如裸眼视力检查、屈光度测量、眼前节检查等。
在诊断时要注意与其他相似表现的眼科疾病进行区别。
2.3 治疗方法中医对于中医眼科常见病采用综合治疗方法，包括内服药物和外治法。
内服药物主要是通过调节气血运行来改善眼部组织营养，增加抵抗力，并纠正身体内部的失调。
临床实践中的眼科疾病诊治与关注眼科疾病是指发生在眼球及其附属器官上的疾病，涵盖了各种不同类型的眼部问题，如屈光不正、结膜炎、角膜疾病、白内障、青光眼等。
眼科疾病的诊断和治疗对于维护人们的眼健康至关重要。
本文将以临床实践为基础，探讨眼科疾病的诊治与关注。
一、常见眼科疾病及其临床症状1. 屈光不正屈光不正是指人眼对焦能力异常，造成近视、远视或散光等问题。
常见症状包括视力模糊、眼疲劳、眼干涩等。
在临床实践中，我们可以通过进行屈光度检查，配制适当的眼镜或隐形眼镜来纠正屈光不正。
2. 结膜炎结膜炎是指结膜发生炎症反应，常见症状包括红眼、异物感、眼睑水肿等。
在诊治过程中，我们应关注患者的病史、眼部症状以及进行结膜涂片检查，合理选用抗生素眼药水或抗病毒药物进行治疗。
3. 角膜疾病角膜是眼球的透明前表层，角膜疾病会引起视力下降和各种不适感。
常见的角膜疾病包括角膜炎、角膜溃疡、干眼症等。
在临床实践中，我们可以通过角膜显微镜检查和角膜地形图检查来评估角膜状况，采取相应的治疗措施，如使用人工泪液、角膜塑形镜等。
4. 白内障白内障是指眼内晶状体透明度下降或混浊，常见症状包括视力模糊、强光敏感等。
在白内障的诊治中，我们需进行眼底镜检查、裂隙灯检查等，建议患者接受白内障手术，并选择合适的人工晶体进行置换。
5. 青光眼青光眼是指眼压升高导致的视神经损伤性疾病，是引起不可逆性视力丧失的重要原因之一。
临床上，我们需要测量眼压、进行视野检查以及眼底检查等，以判断是否患有青光眼。
治疗上，可以选用降眼压药物、激光治疗或青光眼手术等方式予以控制。
二、眼科疾病诊治的注意事项1. 全面的病史询问在诊断和治疗眼科疾病时，全面了解患者的病史非常重要。
例如，了解患者是否有过眼外伤史、药物使用史、手术史等，这些信息对于正确判断疾病的原因和选择合适的治疗方法有着重要的指导作用。
2. 细致入微的眼部检查对于眼科疾病的诊断，眼部检查是必不可少的环节。
我们需要仔细观察患者的视力、眼球运动、瞳孔等，并结合裂隙灯显微镜等设备进行眼底检查、角膜显微镜检查等，以获取尽可能全面的眼部信息，从而准确诊断疾病。
中山大学临床医学眼科总结中山医眼科重点名词解释睑外翻：是指睑缘离开眼球，向外翻转，睑结膜不同程度暴露在外，常合并睑裂闭合不全。
并发性白内障：是指由于眼部疾病引起的白内障。
由于眼部炎症或退行性病变引起眼内环境的改变，导致晶状体营养和代谢发生障碍，产生白内障。
沙眼：是由A、B、C型或Ba抗原型沙眼衣原体感染所致的一种慢性传染性结膜角膜炎，是导致盲目的主要疾病之一。
后发性白内障：是指白内障囊外摘除〔包括超声乳化摘除〕术后或晶状体外伤后，残留的晶状体皮质或晶状体上皮细胞增生，形成混浊。
青光眼斑：高眼压可以引起瞳孔区之晶状体前囊小片灰白色改变，多呈椭圆形、圆形或点状，称之为青光眼斑。
常沿晶体纤维缝合处分布，排列呈放射状。
青光眼斑、虹膜节段或扇形萎缩及瞳孔散大变形，临床上称为\青光眼发作后三联征\。
房水闪辉：炎性渗出物进入房水，在裂隙灯窄光带斜照下，可见闪光及渗出颗粒在浮动，这种现象称为房水闪辉。
孔源性视网膜脱离：由于视网膜神经上皮萎缩、玻璃体牵拉或受挫伤，视网膜出现全程裂孔，通过玻璃体的变性、牵引，液化的玻璃体经裂孔进入视网膜神经上皮下积存，形成孔源性视网膜脱离。
是眼科较常见的严重致盲的眼病。
生在视网膜裂孔形成根底上的，神经上皮与色素上皮的别离。
临床最常见的视网膜脱离类型视路：是指视觉纤维由视网膜到达大脑皮质视觉中枢的传导径路。
包括视神经、视交叉、视束、外侧膝状体、视放射和视皮质视盘全称视神经盘，也叫视神经乳头，视网膜由黄斑向鼻侧约3mm处有一直径约1.5mm，境界清楚的淡红色圆盘状结构，称为视神经盘，简称视盘。
这是视网膜上视觉纤维聚集穿出眼球的部位，是视神经的始端。
电光性眼炎是因眼睛的角膜上皮细胞和结膜吸收大量而强烈的紫外线所引起的急性炎症霰粒肿是睑板腺排出管道阻塞、腺体分泌物潴留形成无菌性慢性肉芽肿炎症翼状胬肉; 翼状胬肉(眼科)是睑裂部球结膜及结膜下组织发生变性、肥厚、增生，向角膜内开展，呈三角形，如翼状，故名。
眼科常见疾病的医疗指南目录1. 简介2. 疾病一：青光眼3. 疾病二：白内障4. 疾病三：干眼症5. 疾病四：视网膜脱离6. 结论1. 简介眼科常见疾病涵盖了多种眼部疾病，包括青光眼、白内障、干眼症和视网膜脱离等。
本文将为读者提供一份简要的医疗指南，以帮助了解和应对这些常见眼科疾病。
2. 疾病一：青光眼青光眼是一种慢性眼病，通常由眼内压力升高引起。
以下是一些简单的策略来管理青光眼：- 定期进行眼压检查，以监测压力变化。
- 遵循医生的处方使用眼药水或药物来控制眼压。
- 避免剧烈运动和劳累，以减少眼内压力。
- 定期进行眼科检查，以确保病情得到控制。
3. 疾病二：白内障白内障是一种常见的眼部疾病，主要表现为晶状体透明度下降。
以下是一些简单的策略来处理白内障：- 定期进行眼科检查，以监测白内障的进展。
- 如果白内障严重影响视力和生活质量，可以考虑手术治疗。
- 遵循医生的建议，使用眼药水和药物来缓解症状。
- 注意保持眼部清洁，避免刺激眼睛。
4. 疾病三：干眼症干眼症是一种常见的眼部疾病，通常由眼部泪液不足或质量变差导致。
以下是一些简单的策略来缓解干眼症的症状：- 使用人工泪液来保持眼睛湿润。
- 避免长时间用眼，定期休息并远离干燥环境。
- 保持室内湿度适宜，使用加湿器或湿毛巾。
- 避免过度使用电子屏幕，减少眼睛疲劳。
5. 疾病四：视网膜脱离视网膜脱离是一种严重的眼部疾病，需要及时治疗以避免视力丧失。
以下是一些简单的策略来处理视网膜脱离：- 在发现视网膜脱离症状时，立即就医。
- 遵循医生的建议，进行手术治疗或其他治疗方法。
- 定期进行视力检查和眼底检查，以及时发现并处理潜在的视网膜问题。
6. 结论眼科常见疾病的医疗指南提供了简单的策略来管理青光眼、白内障、干眼症和视网膜脱离等疾病。
然而，这些策略仅为一般参考，具体治疗方案应基于医生的诊断和建议。
及时就医和定期眼科检查对于眼健康至关重要。
1、老年性白内障概述老年性白内障即年龄相关性白内障,就是指中老年开始发生得晶状体混浊,随着年龄增加,患病率明显增高。
由于其主要发生于老年人,以往习惯称之为老年性白内障、本病得发生与环境、营养、代谢与遗传等多种因素有关、临床表现１.皮质性年龄相关性白内障皮质性白内障就是年龄相关性白内障中最常见得一种类型,其特点就是混浊自周边部浅皮质开始,逐渐向中心部扩展,占据大部分皮质区、根据其临床发展过程及表现形式,皮质性白内障可分为4期:初发期、进展期、成熟期与过熟期、(1)初发期最早期得改变就是在靠周边部前后囊膜下,出现辐轮状排列得透明水隙或水疱。
水隙或水疱主要就是由于晶状体上皮细胞泵转运系统失常导致液体在晶状体内积聚所致、液体积聚可使晶状体纤维呈放射状或板层分离、在前者,液体可沿晶状体纤维方向扩展,形成典型得楔形混浊,底边位于晶状体赤道部,尖端指向瞳孔区中央、散瞳检查在后照或直接弥散照射下,呈典型得辐轮状外观。
这种辐轮状混浊最初可位于皮质表浅部位,然后向深部扩展,各层次间可互相重叠掩映,终于以晶状体全面灰白色混浊取代辐轮状混浊外观,代表年龄相关性白内障进入进展期阶段、(2)进展期晶状体纤维水肿与纤维间液体得不断增加,使晶状体发生膨胀,厚度增加,因此也被称作膨胀期。
一方面因以混浊为背景得囊膜张力增加而呈现绢丝样反光;另一方面,由于膨胀得结果而使前房变浅。
后者在一个有青光眼体质得患者,很容易诱发青光眼得急性发作、但并非所有皮质性白内障患者都要经历膨胀期发展过程。
即使有,其持续时间及严重程度个体间存在相当大得差异,不一定都会诱发青光眼发作。
这一阶段患者主要症状为视力逐渐减退,有时伴有眩光感,偶有单眼复视者。
由于尚有一部分皮质就是透明得,因此虹膜新月影投照试验就是阳性。
(3)成熟期这一阶段以晶状体全部混浊为其特点。
裂隙灯检查仅能瞧到前面有限深度得皮质,呈无结构得白色混浊状态。
此时虹膜新月影投照试验转为阴性。
晶状体纤维经历了水肿、变性、膜破裂等一系列病理过程,最终以晶状体纤维崩溃,失去正常形态为结局。
眼科诊疗指南原发性急性闭角型青光眼临床路径一、原发性急性闭角型青光眼临床路径标准住院流程（一）适用对象。
第一诊断为原发性急性闭角型青光眼（ICD-10: H40.203）行小梁切除术(ICD-9-CM-3：12.64)（二）诊断依据。
根据《临床诊疗指南-眼科学分册》（中华医学会编著，人民卫生出版社），《临床技术操作规范-眼科学分册》（中华医学会编著，人民军医出版社），《我国原发性青光眼诊断和治疗专家共识》（中华眼科杂志）1.症状：眼痛、头痛，恶心、呕吐，视力下降等。
2.体征：眼压高，前房浅，结膜充血，角膜水肿，色素KP，青光眼斑，虹膜节段萎缩，前房角狭窄或关闭等。
（三）治疗方案的选择。
根据《临床诊疗指南-眼科学分册》（中华医学会编著，人民卫生出版社），《临床技术操作规范-眼科学分册》（中华医学会编著，人民军医出版社），《眼科临床指南（PPP）》（美国眼科学会编），《我国原发性青光眼诊断和治疗专家共识》（中华眼科杂志）1.小梁切除术：房角关闭超过1/2圆周。
2.激光/手术周边虹膜切除术：房角关闭小于1/2圆周，无青光眼性视神经损害。
（四）标准住院日为5-7天。
（五）进入路径标准。
1.第一诊断必须符合ICD-10：H40.203原发性急性闭角型青光眼疾病编码。
2.当患者同时具有其他疾病诊断，但在住院期间不需要特殊处理也不影响第一诊断的临床路径流程实施时，可以进入路径。
（六）术前准备（术前评估）1-2天。
1.必需的检查项目：（1）血常规、尿常规;（2）肝肾功能，凝血功能，感染性疾病筛查（乙肝、丙肝、艾滋病、梅毒等）；（3）心电图，X线胸片。
2.眼部常规检查：视力、眼压、前房、晶体、视盘情况，前房角镜检查。
3.根据病情选择AB超、UBM、视野。
（七）预防性抗菌药物选择与使用时机。
1.按照《抗菌药物临床应用指导原则》（卫医发〔2004〕285号）执行，根据患者病情合理使用抗菌药物。
2.选用抗菌药物滴眼液，预防性用药时间可1-3天。
