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前房角的检查及分类
前房角位于前房的最周边 前房角的构成： 前壁—角巩膜缘 房角隐窝—睫状体前端 后壁—虹膜根部
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第二节 原发性青光眼

原发性闭角型青光眼—眼压升高 Primary angle-closure glaucoma
房角关闭

原发性开角型青光眼—眼压升高 Primary Open-angle glaucoma
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闭角青光眼前房和前房角
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急性闭角型青光眼发作
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Acute onset sequela:
Visual acuity get better KP Iris: atrophy, pigmentation defects and limited sticky The pupil can't return to normal Cloudy-glaucoma spot on the anterior lens capsule Anterior chamber Angle extensive stick
1.临床前期：没有自觉症状，具有浅前房，房角窄，虹膜膨隆。 一眼发作，另眼没发作。
Precursor stage: Transient Ease fast
2.先兆期：一过性，多次小发作，自行缓解。
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Acute stage:
Symptom: eye: pain, photophobia, tears, severe vision loss. with headaches, nausea and vomiting. Sign: Eyelid edema, Conjunctival congestion, Corneal epithelium edema, Anterior chamber extremely shallow, The pupil dilated and light reflection disappeared, Anterior chamber angle closed. Intraocular pressure increased > 50 mmHg.
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Intraocular pressure(IOP) : the pressure of the eye content to the eye wall 眼压:眼球内容物作用于眼球内壁的压力
Normal IOP: 10—2l mmHg Double IOP difference<5mmHg IOP curve day and night<8mmHg 正常眼压： 10—2lmmHg 双眼压差＜5mmHg 昼夜眼压曲线＜8mmHg。
临床：无自觉症状，晚期发现。 眼压升高，房角开放。 视乳头损伤C/D>0.6或双眼差＞0.2(火焰状出血) 视野缺损(旁中心暗点、鼻侧阶梯、弓形暗点、 环形暗点、向心性性缩小、管状、颞侧视岛)
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Diagnosis: High IOP Optic disk damage Visual field defects 2 of the 3 signs +anterior chamber angle opening Others: electric physiology exam, family history, etc. Treatment: Drug therapy: Laser therapy: Operation:
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Primary open angle g1aucoma 二、原发性开角型青光眼
Features: When IOP increased the anterior chamber angle keep opening The trabecular meshwork organization structure is abnormal
临床症状：年龄较急性为早、渐进性、可无明确发病史。 一般无急性发作史，房角粘连和眼压增高逐渐进展。 眼压<50mmHg
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Signs: Optic atrophy and physiological concave expand Visual field gradually damage.
体征： 视神经萎缩，生理凹扩大， 视野进行性损害。
特点：眼压升高，房角开放。 小梁网内组织结构异常
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Clinical: No self-conscious symptom and be found late. Intraocular pressure increased with angle open Depending on the optic disk damage C/D>0.6 Visual field defects
Eye disease: Conjunctivitis, Anterior uveitis Systemic disease: gastrointestinal disease, brain disease, hypertension, etc
眼病：结膜炎、前部葡萄膜炎。 全身病：胃肠道疾病、颅脑疾患、高血压病等。
急性发作后遗症： 视力好转 角膜后色素沉着 虹膜阶段性萎缩、色素脱失、局限后粘 瞳孔不能恢复正常 晶体前囊下片状白色混浊---青光眼斑 房角广泛粘连
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Remission stage : symptoms to ease and anterior chamber angle open Chronic stage: anterior chamber angle extensive stick Final stage: the continuous high intraocular pressure, poor eyesight or no light feeling.
Secondary glaucoma: Congenital glaucoma: Infantile
glaucoma
Juvenile glaucoma
Congenital glaucoma accompanied by other congenital anomaly glaucoma 原发性：闭角型:急性闭角型青光眼 慢性闭角型青光眼 开角型：原发性开角型青光眼 正常眼压性青光眼 继发性： (眼病、全身) 先天性：婴幼儿型 青少年型 先天性青光眼伴有其他先天异常
房角开放
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Primary angle-closure glaucoma
一.原发性闭角型青光眼
Acute angle-closure glaucoma
（一） 急性闭角型青光眼
Etiology: genetic anatomy incentive Clinical features: age>50y female pain red eye vision loss with headache nauTreatment of primary angle-closure glaucoma
原发性闭角型青光眼的治疗
Drugs: increased aqueous eduction : myotic inhibit aqueous generated high permeability agent adjuvant treatment: calm or sleeping, purge, hormone reduce inflammation response. Laser: Operation:
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房水循环途径: Aqueous cycle way:
Ciliary process
睫状突(产生房水)
posterior chamber
后房
pupil
瞳孔
Anterior chamber Angle
前房角(排出房水)
Anterior chamber
前房
房水产生率 维持正常眼压
房水排出率
大多数青光眼眼压升高的原因为房水排出受阻
GLAUCOMA
Chapter 11
第十一章
青光眼
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第—节
概述
Definition: Glaucoma is a group of characteristic in optic atrophy and visual field defects as the common characteristic disease. Pathologic intraocular pressure heighten is one of the main risk factors. 青光眼定义：是一类以特征性视神经萎缩和视野 缺损为共同特征的疾病 . 病理性眼压增高是其主 要的危险因素.
3.急性发作期： 症状：眼部：眼痛、眼胀、畏光、流泪、严重视力下降。 全身：头痛、恶心、呕吐。 体征：眼睑水肿、 结膜混合充血、 角膜上皮水肿、角膜后色素沉着、 前房极浅、虹膜严重缺血、房水浑浊、絮状渗出、 瞳孔中等大、竖椭 圆、光反射消失、局限后粘连、 房角关闭、 眼底不清、视网膜动脉 搏动, 眼压明显升高>50mmHg。
大多数青光眼眼压升高的原因是房水外流阻力增高
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Classification
Primary glaucoma:
分
类
Chronic angle-closure glaucoma
Angle-closure glaucoma: Acute angle-closure glaucoma Open-angle glaucoma: Primary open angle glaucoma normal tension glaucoma
4 间歇期：小发作后自行缓解，房角开放，不用药或少量缩瞳药。 5 慢性期：房角广泛粘连 > 半周，眼压中度升高，视盘病理凹陷，视 野缺损。
6 绝对期：持续高眼压，视力极差或无光感。
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诊断