What are the common diseases in outpatient service in one year?

Common diseases in outpatient department and their treatment

Eyelid and lacrimal apparatus (eyelid &; Lacrimal organ)

Eyelash trichiasis

1. Cause: chronic blepharitis, or trauma, surgery, eye scar? It is caused by eyelid scar caused by sunburn and trachoma.

2. Symptoms? And symptoms:? In severe cases, corneal epithelial defect (SPK), insensitivity, red eye and conjunctival congestion may occur.

3. cure? With what?

Epilepsy with inverted eyelashes

Cure? SPK: bacitracin or erythromycin point. 1 TB tid

Blepharitis/blepharitis

1. Cause: Chronic inflammation of eyelid margin, Machiavellian adenitis, blepharitis and chronic conjunctivitis often coexist.

2. Symptoms? Symptoms: itching, burning sensation, Physically, hard crusts will appear around the eyelids (especially when getting up in the morning), blood vessels at the eyelid margin will dilate (blepharitis), and lipid-like glands at the eyelid margin will concentrate (Maxwell's adenitis).

3. cure? With what?

Wash your hair with a baby? Clean the eyelid edge with a cotton swab (twice a day)

Hot compress (10-15min bid-qid), massage.

Eye drops: bacitracin or erythromycin. 1 TB tid。

For what? Oral antibiotics (tetracycline, 250 mg, qid or doxycycline, 100 mg, bid) can be used to treat 1 to 2 weeks.

Note: Pregnant women, lactating women and children under 8 years old? Tetracycline and doxycycline can be given, or erythromycin, 250 mg, qid can be replaced.

Cystitis (dacryocystitis)

1. Reason:? Purulent inflammation caused by cyst infection.

2. Symptoms? Tenderness, swelling, painful nodules or lumps can be felt in the inner canthus of the eye. Serious people will succeed.

Cellulitis.

3.？ Sick bed examination

Gap lamp inspection

External eye examination, especially the movement of extraocular muscles.

Integral? Smear examination and bacterial culture

Computed tomography (for antibiotic therapy? Invalid disease? )

4. cure? With what? ：

Hot compress (15-20min), massage

Eye drops: trimethoprim/polymyxin (such as polytrim) qid.

Drugs:

● Children:

Light? : Amoxicillin/clavulanate (such as Ogmentin),

20-40mg/kg/day, q8h orally, or cefaclor (such as Cecolor),

20-40mg/kg/day, taken orally for 8h.

Heavy? : cefuroxime, 50- 100 mg/kg/day, iv, q8h

● Adults:

Light? : cefalexin (for example, Keflex), 500mg Poq6h, or amoxicillin/clavulanate (for example, ogmentin),

500 mg oral q8h

Heavy? : cefazolin (such as Ancef), 1 g intravenous injection q8h.

Surgical treatment? I-AMPD, dacryocystorhinostomy (DCR) combined with silicone tube implantation

conjunctiva

Chronic conjunctivitis; Chronic conjunctivitis

1. Symptoms? Conjunctival congestion, points? Things? Physical sensation, eyelid patch, burning sensation, photophobia, and the course of disease is more than 4 weeks.

2.？ Sick bed examination

Gap lamp inspection

Integral? Object smear examination

3. cure? With what? ：

Bacterial conjunctivitis (bacterial conjunctivitis)

● Often? Pathogens include Staphylococcus aureus and Staphylococcus epidermidis.

Streptococcus pneumoniae and Haemophilus influenzae (especially children)

● Rules? : trimethoprim/polymyxin (such as polytrim) qid, ciprofloxacin or

Ofloxacin syrup qid, or bacitracin ointment qid

Haemophilus influenzae conjunctivitis should be treated with amoxicillin/clavulanic acid orally.

(20-40mg/kg/day, three times a day)

trachoma

● Rules? : tetracycline or erythromycin, 250-500mg poqid, doxycycline,

100 mg of po, bid, or clarithromycin 250-500 mg of po, bid for 3-6 weeks.

contagious soft wart

● Rules? : ? In addition to I&C. Cryotherapy?

Toxic conjunctivitis; Toxic conjunctivitis

● Etiology: chemistry and substance? Sex? Exciting substances, such as chlorine contained in swimming pools, eye drops (especially

Use time exceeds 1 month)

● Rules? : avoid contact? Exciting substances, artificial preservatives? The liquid is used four times a day.

To eight times

cornea

Corneal ulcer

1. reason: corneal stroma infiltration combined with the above epithelial defects is usually caused by infection (such as bacteria, viruses or molds), but it may also be aseptic. Contact lenses are most commonly used? Reason.

2. Symptoms? And symptoms: pain, Physical feeling, red eye, photophobia, may be divided? Objects, usually with low vision, can be found in corneal epithelial defects? Fluorescent staining, can serious patients? Empyema in anterior chamber.

3.？ Sick bed examination

Do you see it?

Slit lamp examination and corneal fluorescence staining

Corneal smear and bacterial culture

Contact lens bacteria culture

Cornea? Film censorship

4. cure? With what?

Repeatable contact lens

Medication? For corneal ulcer with unknown etiology, bacterial infection is usually used first? )

Ciliary muscle paralysis agent (for example, scopolamine, 0.25%, three times a day, or atropine, 1%, three times a day).

● Light? (The cornea is small with no fluorescent staining and peripheral infiltration, with slight anterior chamber reaction, very slight.

What is the difference? Things): tobramycin or fluoroquinolones (ciprofloxacin or

Ofloxacin) Q2-6h; Tobramycin or ciprofloxacin ointment

● Medium? (Pericorneal infiltration

Medium? What is the difference? ): fluoroquinolones (ciprofloxacin or ofloxacin) agents.

qh

● heavy? (Pericorneal infiltration >; 1.5 mm or ulcer, medium? Most important? Anterior chamber reaction,

Purulent? Object, invading visual axis): enhanced tobramycin or gentamicin.

(15mg/ml) QH, enhanced cefazolin (50mg/ml) or vancomycin (25

Mg/ml) qh is used alternately.

● For very serious diseases? Or if local antibiotics cannot be given in a short time, they can be given.

Antibiotics were injected under the conjunctiva: gentamicin (20-40 mg) and cefazolin (100mg).

Or vancomycin (25 mg)

● Enhanced amikin (10) is considered for atypical mycobacterial infection.

Mg/ml) q2h for one week, then qid? one month

● Mold infection: Natamycin, 5% drops, q 1-2h,? Can deepen the department infection.

Amphotericin b, 0.15% (1.5 mg/ml) dropqh (candida infection), miconazole.

Or clotrimazole, 0.1%-1.0% (1-10 mg/ml) drops, QH (Aspergillus infection),

Oral itraconazole (400 mg load, then 200 mg qd), remember? Available? solid

alcohol

● Oral painkillers

Surgical treatment? Conjunctival flap, penetrating keratoplasty. Corneal perforation tissue adhesive

5. Complications

Corneal scar

Secondary glaucoma (secondary glaucoma)

Secondary cataract (secondary cataract)

Corneal perforation

Endophthalmitis; entophthalmia

nubecula

1. Diagnostic requirements

□ depending on? Next?

□ Corneal opacity, neovascularization and whitening

2.？ Sick bed examination

Do you see it?

Gap lamp inspection

fundus examination

Intraocular pressure examination

Ophthalmic ultrasound examination

Retinal electricity? Graphics (electrophoresis; ERG)

Visual evoked potential test (visual evoked potential; VEP)

3. Complications

amblyopia

4. cure? With what?

Keratoplasty (keratoplasty, lamellar).

Combined anterior vitreous body? Anterior surgery, lens extraction and intraocular lens implantation (lens extraction &; IOL implantation)

Uvea and sclera (uveal tract &; Scleral)

Uveitis (uveitis)

1. Diagnostic requirements

overlook

Conjunctiva: Cilia? hyperaemia

Corneal endothelium: keratin? Keratinized precipitate

Anterior chamber: cells &; Flare, fibrin-like exudate

Rainbow color: adhesion

vitreous opacity

Secondary glaucoma

Secondary cataract

Macula: Capsule? Edema (cystic edema)

chorioretinitis

Retinal and vitreous hemorrhage

Retinal vascular resistance? (retinal vascular occlusion)

2.？ Sick bed examination

Do you see it?

intraocular pressure

Gap lamp inspection

fundus examination

Fundus fluorescein angiography

Visual field measurement

Serum and blood tests, immunological tests

3. Complications

Keratitis and keratopathy

Secondary glaucoma

Corner neovascularization

Secondary cataract

Capsule? Macular edema (cystoid macular edema)

Do you see it? Menstrual edema

4. cure? With what?

observe

Medication?

● Eyelids? Muscle Paralysis Agent-Relieve Pain and Avoid Posterior Adhesion of Iris?

● Cortex? Sterol-topical eye drops, ointment, tenon's subcapsular injection, oral or intravenous injection.

inject

Immunosuppressants-alkylating agents, antimetabolites, T cell inhibitors.

Surgical treatment?

Lens (lens)

Acquired cataract

1. Diagnostic requirements

Do you see it? drip

Crystal opacity

2. integral?

● According to morphological credits?

□ Posterior posterior subcapsular cataract (anterior capsule and posterior capsule)

□ Nuclear cataract (nuclear)

Cortical cataract

□ Christmas tree waterfall

● Based on maturity? Integral?

□ Immature

□ Expiration

□ Overcooked (overripe)

Liquefaction (Morganian)

3. Other reasons

Disease (diabetes)

□ ? Atopic dermatitis (atopic dermatitis)

□ Myotonic dystrophy.

□ Trauma (trauma)

-drugs (such as steroids, chlorpromazine, long-acting drugs, amiodarone,

busulphan)

4.？ Sick bed examination

Do you see it?

Gap lamp inspection

fundus examination

Ophthalmic ultrasound examination

5. Differential diagnosis

White pupil (white pupil)

6. Complications

Glaucoma; glaucoma

Uveitis (uveitis)

7.rules? With what?

Big? Cataract extraction (extracapsular extraction)

The key steps of operation: anterior capsule → complete incision → extrusion of nucleus pulposus → cortical cleaning → injection of viscoelastic substance → insertion of filler. Or haptic and optic → insert the upper haptic → set the IOL to the horizontal position.

Phacoemulsification of cataract; Lens emulsification

The key steps of operation: lens capsule → hydraulic slicing → nucleus pulposus carving → nucleus pulposus rupture → emulsification in each quadrant → cortical cleaning and intraocular lens implantation.

Vitreous body and retina (vitreous body &; Retina)

Vitreous hemorrhage or opacity.

1. Diagnostic requirements

Do you see it? punch-drunk

Sudden, painless loss of vision

2.？ Sick bed examination

□ depending on?

□ ? Gap lamp inspection

□ Fundus examination

□ Eye ultrasound examination

3. Differential diagnosis

Posterior uveitis; posterior uveitis

4. Complications

Glaucoma; glaucoma

Medullary atrophy

5. cure? With what?

Medication?

Radiation solidification

Surgical treatment? : vitreous body? Surgery; Intraocular? Radiation solidification; Retinal fixation with or without gas

Retinal detachment? (retinal detachment)

1. Diagnostic requirements

Do you see it? Vague, like what? Curtain vision, floaters

Fundus: retina? rise

2. integral?

□ ? Rhegmatogenous retinal detachment? (Kongyuan Road)

□ Traction retinal detachment? (research and development)

□ exudative retinal detachment? (exudative RD)

3. Pathogenic mechanism

□ ? Rhegmatogenous retinal detachment? -

Acute posterior vitrectomy? Peripheral retinal degeneration

□ Traction retinal detachment? -

Pathological retinopathy

□ exudative retinal detachment? -

● Retinal pigment epithelium damage caused by subretinal diseases.

● Choroidal fluid infiltrates into subretinal space-

Choroidal tumor (primary or metastatic), intraocular inflammatory reaction (Harada's disease,

Posterior scleritis), systemic diseases (toxemia of pregnancy, hypoproteinemia), background

Membrane neovascularization, uveal exudation syndrome

4.？ Sick bed examination

□ depending on?

□ ? Gap lamp inspection

□ Fundus examination

□ Eye ultrasound examination

3. Differential diagnosis

Retinal degeneration score? (Degenerative retinoschisis)

Choroidal detachment? (choroidal detachment)

Intraocular tumor (intraocular tumor)

4. Complications

Vitreous hemorrhage (vitreous hemorrhage)

Retinal degeneration

5. cure? With what?

Surgical treatment?

● ? Cryotherapy? And scleral buckling (cryotherapy &; Scleral buckling)

A. Key operation steps: perioperative period → inserting bird's-eye suture →

Positioning the fissure with indirect ophthalmoscope → Cryotherapy

(Freeze until the retina turns white) → Insert locally.

Explants (radial, segmental circumferential, circumferential)

B. subretinal fluid? Indications:? Will float it

Retina, long-term retinal detachment? , ? It is difficult to locate this hole and the retina below it.

Peel?

● Through the flat vitreous body? Flat operation

A. Timing of use: huge? Huge tear, proliferative vitreoretinopathy

(PVR), traction retinal detachment?

B. Pneumatic retinopexy (gas-liquid exchange)

Applicable to? Retinal detachment with holes in it?

C. intraocular? Internal photocoagulation; Internal photocoagulation

Retinopathy of premature infants.

1. Diagnostic requirements

Premature birth history

Peripheral retinal vessels at any stage of the disease? May expand or bend.

Iris vasodilation, pupil response? okay

Second step

□ Stage 1: A thin and flat dividing line separates the avascular anterior part from the vascular anterior part.

Retina with blood vessels in the back

□ Phase II: What is the gray-white boundary? And the width? Extend to form a pink ridge.

Stage III: Retinal neovascular plexus enters the spine, resulting in severe external retinal fiber vessels.

Extra regeneration and proliferation (extra regeneration and proliferation)

□ Ⅳ stage: Due to retinal infiltration, fibrovascular hyperplasia extends from the crista to the vitreous body or the posterior part of the crista.

Retinal detachment caused by object and retinal traction? (eventually detached) and

Cicatricial vitreoretinopathy (cicatricial vitreoretinopathy)

(Add "+"[add disease] after retinal peripheral blood vessels dilate or bend)

3.？ Sick bed examination

fundus examination

4. Differential diagnosis

White pupil

5. cure? With what?

Early stage: use? Cryotherapy? Or? Radiocoagulation therapy?

Retinal detachment? The law of time? Scleral buckling, vitreous? Vitrectomy

Glaucoma; glaucoma

Glaucoma; glaucoma

1. Diagnostic requirements

Elevated intraocular pressure

visual field defect

Do you see it? Cupping enlargement of video disc.

2. integral?

□ Primary open angle glaucoma; POAG)

□ Primary angle-closure glaucoma; PACG)

□ Secondary glaucoma (secondary glaucoma)

□ Congenital glaucoma

3.？ Sick bed examination

Do you see it?

Ophthalmoscopy

Tonometer: Goldmann, Perkins, Schiotz, Air-puff, Tono-Pen.

Anterior gonioscope): Goldman, Zeiss

Schaefer scale—

A. Level 4 (35-45): cilia? Is the ciliary body light? Is it okay?

B. Grade 3 (25-35): At least? Scleral spur

C. Grade 2 (20): Only? Trabecular; Mushroom stalk

D.grade 1 (10): Can I only use Schwartz's line or trabecular apex?

E grade 0 (0): iris is in contact with cornea.

Humphrey's perimetry

A. Early stage: small bow? Arcuate scotoma, alone? Central dark spot, nasal ladder? Nasal step

B. course of disease: bow? Defect, nasal staircase? The defect becomes bigger, leading to temporal wedge? Incomplete

(temporal wedge)

D. later stage: generating annual rings? Keywords annular scotoma, residual central island,

Residual temporal island

4. Differential diagnosis

Acute iriditis; Acute iriditis

Acute keratoconjunctivitis (acute keratoconjunctivitis)

5. Complications

Retinal vascular occlusion (CRAO or CRVO)

optic atrophy

6. cure? With what?

Medication?

A.poag: beta blockers, sympathetic nerves? Sympathetic drugs, mydriatic drugs? Before? Prostaglandin analogues, local or systemic carbonic anhydrase inhibitors.

B.PACG: intravenous mannitol, local use of 2% pilocarpine, beta blockers and? sterol

Laser trabeculoplasty (laser trabeculoplasty)

Jacob. Shoot the iris? YAG laser iridectomy): PACG PACG acute attack drug.

Cure? After use

Liang Xiao? Trabeculectomy; Trabeculectomy

Key operation steps: conjunctival incision &; Latent dissection → dissection

Scleral flap → puncture → incision cutting before deep block → deep block resection → peripheral iridectomy → flap suture. Anterior chamber reconstruction → conjunctival suture

Other operations: trabeculotomy, goniotomy, iridectomy, etc.

Strabismus; squint

Strabismus; squint

1. Diagnostic requirements

Do you see it? Normal or declining?

diplopia

2.？ Sick bed examination

Do you see it?

A. Learning children-

Gap lamp inspection

fundus examination

Hirschberg test (oblique angle? Big? The estimated corneal light reflection position is 1mm= 7 or 15 PD. : light reflection position pupil edge = 15 PD, light reflection position? Department = 45 PD)

Coverage test (detecting squint when shielding, measuring tilt position when removing shielding, alternating shielding test and? Mirror mask test time? Total offset? )

Other (? Somatosensory test, Voss four-point test)

3. Complications

amblyopia

Nystagmus (nystagmus)

4. cure? With what?

Medication?

Surgery ([[resection]], shortened).

wear glasses

involve

Direct vision training

rail

Orbital inflammation

1. Diagnostic requirements

Severe redness and swelling of eyelid

Conjunctival congestion and edema

Primitive vision

Ophthalmoplegia (painful ophthalmoplegia)

Have a fever, all over? , weak

2.？ Sick bed examination

Do you see it?

Gap lamp inspection

fundus examination

Ophthalmic ultrasound examination

Computed tomography (CT) or magnetic resonance imaging (MRI)

Serum and blood tests

Integral? Smear and bacterial culture

3. Differential diagnosis

Orbital tumor

4. Complications

Exposure keratitis (keratitis)

Elevated intraocular pressure

Retinal vascular resistance?

Do you see it? Menstrual lesion

5. cure? With what?

Medication? (systemic antibiotic therapy? )

Monitoring? Meridian function

Surgical treatment? : antibiotic treatment? Invalid, or orbital or subperiosteal abscess, depending on? Implemented during the lesion.

Endophthalmitis; entophthalmia

1. Diagnostic requirements

Pain and vision? lose

Eyelid redness and swelling

Conjunctiva is obviously hyperemia and edema.

Corneal edema is blurred

There is obvious inflammatory reaction in the anterior chamber, cellulosic exudate, with or without hyphema.

vitreous opacity

The red reflection deteriorates or disappears.

2.？ Sick bed examination

Bacterial culture of eyelid and conjunctiva

Smear and bacterial culture of anterior chamber and vitreous humor

3. Complications

nubecula

cataract

glaucoma

choroiditis

Retinal detachment?

Do you see it? atrophy

Tuberculosis of eyeball

4. Differential diagnosis

Uveitis associated with residual lens material.

Aseptic fibrin reaction

5. cure? With what?

Intravitreal injection of antibiotics: (g (+) → vancomycin [1mg/0.1ml];

G(-)→ amikacin [0.4 mg/0. 1 ml], cefotaxime [2 mg/0. 1 ml])

Surgical treatment? : vitreous body? In addition to surgery (visual only? Only when the LP leaves)

Follow-up medication ：

A. local antibiotic therapy? ：

1) eye injection: vancomycin 25mg+ cefotaxime 100mg or gentamicin 20mg+ cefuroxime125 mg; Betamethasone 4mg (1 ml)

2) local treatment? Preparation of gentamicin (15 mg/ ml) and vancomycin (50 mg/ml) eye drops; Dexamethasone 0. 1% eye drops

B. systemic antibiotic therapy? Generally helpless? But what about the cerebral cortex? Is sterol used for serious diseases? Can reduce the reaction of fibroblasts

Eye and orbital tumors (eye and; Orbital tumor)

1. Diagnostic requirements

Do you see it? Maybe?

Exophthalmos; highlight

Elevated intraocular pressure

Strabismus or affect eye movement

White pupil

2.？ Sick bed examination

Do you see it?

Gap lamp inspection

fundus examination

Ophthalmic ultrasound examination

Fundus fluorescein angiography

Visual field measurement

Computed tomography (CT) or magnetic resonance imaging (MRI)

Angiography; angiography

3. Differential diagnosis

Graves disease (Graves disease)

Carotid cavernous fistula

4. Complications

Systemic metastasis of sexual tumor

5. cure? With what?

Radiocoagulation therapy?

Surgical treatment? (local? In addition, or enucleation)

Radiotherapy? Chemical treatment?

Neuroophthalmology

Do you see it? Optic neuropathy

1. Diagnostic requirements

Look down or lose.

Emotional pupil conduction defect-the pupil is the same size, and the same side directly reflects light? Low or disappear, sympathetic reflex is normal.

Acquired color vision? Acquired pigment abnormality

A faint feeling? low

visual field defect

2.？ Sick bed examination

Do you see it?

Gap lamp inspection

fundus examination

Fundus fluorescein angiography

Visual field measurement

Visual evoked potential examination

Computed tomography (CT) or magnetic resonance imaging (MRI)

angiography

blood test

3. Complications

Do you see it? After the contraction and merger? Loss of warp fiber bundle

4. cure? With what?

Medication?

Surgical treatment? : narrowing of optic canal, etc.