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MINISTRY OF HEALTH PROTECTION THE REPUBLIC OF UZBEKISTAN
TASHKENT MEDICAL ACADEMY
by
Protector on the academic work
Prof. Teshaev O.R.
“Approved”
_______________________________
«_____»_________________2012 у.
Department: Eye diseases (Diseases of vision organs)
Subject: Ophthalmology
THEME: “DISEASES OF EYELIDS, LACRIMAL ORGANS AND
CONJUCTIVITIS”.
Education Methodic Elaboration
(for instructors and students of the Higher Medical Schools)
Tashkent -2012
THEME: “DISEASES OF EYELIDS, LACRIMAL ORGANS AND
CONJUCTIVITIS”.
1. Place and facilities for the
classes.
- Department of vision organs diseases;
- Patients, magnifier 13 Dpt., desk lamp, ophthalmoscope, anti-inflammatory drugs,
antibiotics, slides, video films
- TSO, slide scope, TV-Video
2. Period of time neede d
Period of time 5,5 hours
3. The aim
Every doctor should know such visual organs pathology as blepharapathy and disease of
lacrimal organs. They often are the result of manifestation general diseases as follows:
avritaminasis, diabetis, helminthic intoxication, chronic and acute infectious diseases,
the thyrioid gland pathology, etc. Physicians should be able to diagnose and treat the
patients suffering from this pathology. Praphylaxis of the development of possible
complications in these cases is necessary.
Tasks
A student should know:
Characteristics of eyelids structure and classification of their diseases.
Clinical manifestation and treatment of the eyelid diseases
Characteristic structure of the lactimal organs
Clinical manifestation and treatment of the lacrimal organ diseases
A student must have:
Practical skills in: external examination of the eyeballs making ordinary ectropia
4. M otivation
A lot of disease of the lacertus eye organs are connected with the general impairments of
a organism. Existence of these diseases and methods of their treatment depend on these
organs structure. Future physicians are to diagnose these diseases to know their clinical
manifestations and give the patients proper treatment. These diseases may sometimes
cause serious complications leading to letal outcome.
5 . Inter organ ic and inters ubject
l inks.
-
Knowledge of students on this theme should be good enough and integrated with the
other related subjects vertically and horizontally. The theme is vertical integration with
anatomy ( the neve system and sensory organs, physiology of the nerve system),
histology (ontogenesis and histology of the nerve system and sensory organs),
deontology ( in the aspects of a doctor-patient interrelation), history of medicine and
ophthalmology, pharmacotherapy in ophthalmology.
The horizontal integration with:
Otorhinolaryngology (the anatomic neighboring and correlation of various ORL
diseases and vision organ diseases)
Infection diseases and connected with them probable complications in the visual
analyzer
Diseases of Inner organs ( pathology of AD , diseases of blood and kidneys,
collagenoses and others diseases associated with the impairment of visual analyzer)
Endocrinology ( diavetes mellitus, hypo and hyperthuy disease of hypophysis (pituitary
gland) and either endocrinopathy.
6. Content of the lesson.
6.1 Theory.
Purulent
inflammation
of
the
eyelids
Preseptalny cellulitis - a generalized inflammation of tissue age (phlegmon century).
When the disease affects only the tissue inflammation century, located anterior to the
orbital septum, and does not extend to the structure of the orbit. Cellulitis most often
occurs in children under 3 years old, suffered inflammation of the upper respiratory tract
infection or otitis media, the agent of the disease is usually Haemophilias influenzae. In
adults, cellulitis develops as a complication of barley (Fig. 7.7), with an abscess century,
the spread of infection to the facial tissues of the orbit, paranasal sinuses, as well as after
injury, operations, biting insects and animals is usually caused by Staphylococcus
aureus,
or
mixed
flora.
Objectively determined skin redness and swelling of the dense whole century, marked
tenderness to palpation. Vision and pupillary reactions are not violated. Usually the
disease occurs with high fever, headache, marked tenderness of regional lymph nodes.
The appearance of exophthalmos, confusion and loss of mobility of the eyeball,
ghosting, chemosis, visual disturbances, severe condition of the patient shows the
distribution of inflammation in the tissues of the orbit (orbital cellulitis). When the
localization process in the region of the medial canthus may develop thrombosis of the
cavernous sinus, meningoencephalitis, and sepsis with a fatal outcome. Differential
diagnosis is carried out with an allergic swelling of eyelids, heavy-blefarokonyunktivi
that dakrioadenitom, trauma, brilliant-farohalazisom, thyroid ophthalmopathy.
Conservative treatment. Antibiotics are used inside and intramuscularly (klaforan).
When
you
flyuktua-tion
abscess
century
opened.
In the absence of complications prognosis is good. In connection with gross scarring in
the
delayed-term
period
may
be
required
eyelid.
Abscess century - a limited focus of painful infiltrative-purulent inflammation. Often
develops after minor skin injuries, insect bites, inflammation of the paranasal sinuses
after the extrusion of barley. Clinically an abscess (Fig. 7.8) is characterized by diffuse
hyperemia of the skin and dense edema, ptosis of the century, chemosis, swelling and
tenderness of regional lymph nodes. Later the skin becomes thinner century, there is a
fluctuation. In most cases the body temperature does not rise, changes in the blood
during the clinical analysis did not reveal. Perhaps inadvertently opening the abscess. In
debilitated people develop sepsis, purulent metastasis may lead to death. When you
localize an abscess in the medial part of the century, perhaps the development of orbital
cellulitis or cavernous sinus thrombosis. Differential diagnosis is carried out with
preseptalnym cellulose and that polnadkostnichnym abscess (displacement of the
eyeball). Diagnosis is confirmed by the results of X-ray computed tomography.
Treatment is the same as cellulite. Local - dry heat, physiotherapy, disinfect-ing drop in
the conjunctival sac. If necessary, treatment is carried out in conjunction with the ENT
specialist. Antibiotics taken orally and intravenously. Opening of the abscess produced
when a fluctuation or receiving tomography of data confirmed the presence of an
abscess.
Prognosis is usually good.
Diseases and injuries of the lacrimal
Pathology of the lacrimal organs may be due to developmental abnormalities, injury,
disease-tions and tumor growths as slezoprodutsiruyuschego. and lacrimal apparatus.
Diseases of the lacrimal passages - one of the most frequent pain adnexa eye. The range
of complaints - from mild periodic clezotecheniya to continually ongoing Xia-pus from
the lacrimal sac.
Pathology slezoprodutsiruyuschego apparatus
Malformations of the lacrimal gland manifested its underdevelopment, and lack of bias.
The absence or underdevelopment of the lacrimal gland leads to severe and often
irreversible changes in the anterior segment of the eye 13 - kssrozu and vision loss.
Treatment - surgical implanted into the outer office konyuktivalny cavity parotid duct
(duct murals). This is possible because the biochemical composition of saliva and tears
is similar. Mixing lacrimal gland occurs when weakened supporting ligaments gland.
Treatment operative - to strengthen the lacrimal gland in his bed. Weather favorable.
Damage to the lacrimal gland are rare, usually observed in injuries orbit, upper eyelid.
Surgery is required only when the destruction of cancer, loss of her wound.
Acute inflammation of the lacrimal gland is rare, usually on one side arises as a
complication of common infections - influenza, acute respiratory infections, sore throat,
mumps, etc., characterized by a sharp swelling, tenderness and hyperemia of the outside
of the upper eyelid, fever, headache, general malaise. There have been changes and
swelling of the conjunctiva of the eyeball. Eye can be mixed, the mobility is limited by
it. Frequently observed increase in morbidity and parotid limfanicheskih nodes.
Treatment: antibiotics, sulfonamides, desepsibziruyushie funds. analgesics, drugs
zharoponizhayushie; dry heat. UHF-therapy. When abetsedirovanii abscess opened and
drained hearth.
Neoplasm of the lacrimal gland are rare. From benign mixed tumors more often exhibit.
They appear one-sided painless gradual increase in cancer, little mixing of the eye
inwards and down. Visual disturbances are rare. Mixed tumors in 4-10% of cases
degenerate into malignant tumors. In the case of scrap tumor invades the surrounding
tissue. captures the eyeball, causing severe pain, disturbed vision, there are distant
metastases. Radiotherapy and surgical treatment is not always successful, so the
prognosis is always serious.
Hyperfunction of the lacrimal gland is manifested lacrimation in normal condition
slezoot-ducting apparatus due to the different reflex stimuli. Increased slezootdedefinition (watery eyes, or epiphora) may be caused by bright light, wind, cold, etc. (eg,
irritation of the nasal mucosa, conjunctiva), may be due to susceptibility palitelnoy
reaction itself gland. At constant epiphora requires inspection otorin-Golog for the
detection and treatment of specific pathology in the nasal cavity and paranasal sinuses. If
tearing resistant and can not be treated conservatively, sometimes con-dyat injection of
alcohol in the lacrimal gland, elektroagulyatsiyu or partial adenotomija, blockade
pterygopalatine site.
Hypofunction of the lacrimal gland (Sjogren's syndrome) is a disease with more severe
are the consequences. Refers to the connective tissue. Characterized by hypofunction of
lacrimal, salivary and sweat glands. More common in women in menopause, proceeds
with the growing acuteness niyami and remissions. Clinically manifested as dry
keratokonyuktivit. Pathology of the ordinary but bilateral. Patients concerned about a
miracle, foreign body sensation in the eye, photophobia, sous-host in the throat. Age
hyperemic conjunctiva with papillary hypertrophy and drawling "Nitche-th" secret. The
cornea in the lower part of the mat, rough.
Treatment should be integrated with a doctor-rheumatologist and an ophthalmologist.
Used mainly corticosteroids and cytostatics. Local treatment of dry keratoconjunctivitis cortico-roidy, gel Actovegin, substitutes tears - 0.25% lysozyme, a drop of "Vitasik,"
"Gel follows-za" (USA). We propose a blocked tear ducts to keep the tears in
konyunktival-cavity through tubes Guericke, etc.
Pathology of the lacrimal apparatus
Narrowing of the lower lacrimal point - one IC frequent causes of persistent epiphora.
On narrowing the lacrimal point we can say when its diameter is less than 0.1 mm. If
you can not expand the diameter of the lacrimal point disgraceful introduction of conical
probes, it is possible for the operation - an increase in the lumen of the dissection of a
small triangular or square flap in the back of the initial part of the tubule (Fig. 8.3).
Eversion lower lacrimal point is innate or acquired, may occur when a chronic
blefarokonyunktivite, senile atony age, etc. plaintive point is not immersed in the
lacrimal lake, and turned outwards. In mild cases, ectropion can be eliminated by
excision of the flap of mucous membrane of the conjunctiva under the lower lacrimal
point and then overlay tightening joints (Fig. 8.4). In severe cases, carry out cosmetic
surgery,
while
eliminating
the
eversion
of
the
lower
eyelid.
Lacrimal duct obstruction often develops due to inflammation of the mucous membrane
of the tubules and age with conjunctivitis. Small in length (1 - 1,5 mm) obliteration can
be eliminated by probing with the subsequent introduction of a probe into the lumen of
tubule Alexeyev for a few weeks buzhiruyuschih filaments and tubules.
When unavoidable violations of the function of the lower lacrimal canaliculus shows the
operation - the activation of the upper lacrimal canaliculus. The essence of the operation
lies in the fact that, starting from the upper lacrimal point, excised a strip of the inner
wall of tubule to the inner canthus. In this case, a tear of the lacrimal lake will
immediately fall into the opened upper lacrimal canaliculus, which will prevent tears-
state.
Inflammation of the tubule (dakriokana-Likulia) often occurs secondary to the
background of inflammatory eye conjunctiva. The skin of the tubules becomes inflamed.
A marked lacrimation, mucopurulent discharge from the lacrimal points. For fungal
kanalikulitov characterized by a strong expansion of tubule filled with pus and fungal
concrements. Kanalikulitov conservative treatment, depending on the result of the
reason. Fungal kanalikulity treat splitting tubule and removing concretions, followed by
lubrication of the walls of the opened tubule tincture of iodine and the appointment of
nystatin.
Damage to the lacrimal duct may be an injury inside of eyelids. Need timely
debridement, or there is not just a cosmetic defect, but also tears. During primary
surgical wound treatment compare damaged the lower edge of the lacrimal canaliculus,
which conducted the probe through the lower lacrimal Alekseeva point and the tubule,
the mouth of the lacrimal ducts, the upper lacrimal canaliculus and display its end of the
upper lacrimal point (Fig. 8.5, a). After the introduction of a needle probe silicone
capillary tube extract a backward motion and its place in the lacrimal paths is a capillary.
The slant-cut ends of the capillary is fixed by one suture - formed a ring ligation. The
soft tissues at the site of their break impose skin sutures (Fig. 8.5, b). Skin sutures are
removed after 10-15 days, the ring ligature was removed after a few weeks. Congenital
dacryocystitis. His main reason is that at the time of birth does not open (due to
abnormal development) nose mouth of the nasolacrimal duct, which ends in such cases
the blind pouch. A few days after birth appears slight muco-purulent discharge from the
conjunctival sac. In children, diseases of lacrimal tract often cause chronic
conjunctivitis, cellulitis lacrimal sac and orbit, the destruction of the cornea,
pyosepticemia etc. untreated dacryocystitis gradually lead to irreversible anatomical
changes lacrimal system, which will eventually preclude the success of conservative
treatment.
Treatment is recommended to start with a vigorous massage the lacrimal sac outside of
the inner canthus down. From jerky pressure on the contents of the lacrimal sac is torn
membrane covering the exit of the nasolacrimal duct, and restored patency of lacrimal
pathways. In the absence of a positive effect transition to endonasal retrograde sensing,
which must begin with two months of age. Without anesthesia under the supervision of a
surgical probe bellied, curved at the end of a right angle, is introduced at the bottom of
the nose to half the length of the lower nasal passage (Fig. 8.6). When fading bellied
probe tightly pressed to the body of the lower nasal passage deflected end of the probe
and perforated barrier at the mouth of the nasolacrimal duct, then remove the probe.
After probing the tear path was washed with an antibiotic solution. This speeds up the
process of restoring normal slezootvedeniya. In the absence of the effect of repeated
probing is carried out at intervals of 5-7 days. Triple probe is justified up to 6 months of
age. Lack of effect of retrograde probing forces move to the treatment of sensing the
outside probe Bowman number 0 or number 1. Following the expansion of the lacrimal
point of a conical probe is introduced horizontally Bowman's probe of tubules in the
bag, then turn it into a vertical position and pushing down the nasolacrimal channel,
punching in the lower part nerassosavshuyusya the time of birth membrane. In the
absence of this effect, and treatment for children over 2 years producing
dakriotsistorinostomiyu
(see
below).
Acute purulent dacryocystitis or lacrimal sac phlegmon - a purulent inflammation of the
lacrimal sac and surrounding tissue. The disease may develop without preceding chronic
inflammation of the lacrimal ducts in infection control from the inflammatory focus in
the nasal mucosa or paranasal sinuses.
When cellulitis lacrimal sac in the inner canthus and on the respective side of the nose or
cheeks appear red skin and thick sharply painful swelling. The eyelids are swollen, eye
gap narrows or closes his eyes completely. Distribution of inflammation in the
surrounding tissue is accompanied by a violent sack total response of the body (fever,
impaired general condition, fatigue, etc.). In the midst of inflammatory prescribe
antibiotics, sulfonamides, analgesics and antipyretic drugs. Gradually infiltrate becomes
softer, forming an abscess. Fluctuating abscess opened and drained purulent cavity. The
abscess may open their own, after which the inflammation gradually subsides.
Sometimes on the spot revealed the ulcer remains unhealed fistula, from which stand out
the pus and tear. After acute dacryocystitis a tendency to repeated outbreaks
phlegmonous inflammation. To avoid this, in a quiet period, perform a radical operation
- dakriotsistorinostomiyu (see below).
Chronic purulent dacryocystitis. Chronic dacryocystitis (dakriotsi-Stith) develops more
often as a result of impaired patency of the nasolacrimal duct. Delay in tears in the bag
gives rise to its micro-organisms, usually staphylococci and pneumococci. Formed a
purulent exudate. Patients complain of epiphora and purulent discharge. Conjunctiva
century, semilunar fold tearful caruncle hyperemic. Marked swelling of the lacrimal sac,
with pressure on that of the lacrimal points allocated muco-purulent or purulent fluid.
Constant epiphora and purulent discharge from sleznop bag into conjunctival cavity is
not only a disease, "dis comfort, but also a factor in reducing disability. They limit the
ability to perform certain occupations (engravers, jewelers, surgeons, transport drivers,
people
working
with
computers,
artists,
athletes,
etc.).
Zabrlevaniyu susceptible to more people of middle age. Women dacryocystitis occurs
more frequently than men. Tearing increases sharply at the open air, especially when onthe
Moro
and
the
wind,
the
bright
light.
Dacryocystitis frequently lead to severe complications and disabilities. Even the slightest
defect in the epithelium of the cornea in contact mote can become a gateway for the
cook-kovoy flora from the stagnant contents of the lacrimal sac. There is a creeping
ulcer of the cornea, leading to permanent visual impairment. Severe complications can
occur and if purulent dacryocystitis remains unrecognized prior abdominal surgery on
the
eyeball
In the etiopathogenesis dacryocystitis play the role of
many factors: occupational hazards, sharp
fluctuations in ambient temperature, diseases of the
nose and paranasal sinuses, trauma, low immunity,
the virulence of microorganisms, diabetes, etc.
Blockage of the nasolacrimal duct is most often arises
as a result of inflammation of the mucous membrane
at its rhinitis. Sometimes the cause of impaired
patency of the nasolacrimal duct is damage in trauma,
surgery is often (for maxillary sinus puncture,
gaymorotomii). However, most authors consider the
main cause of dacryocystitis pathological processes in
the nasal cavity and paranasal sinuses.
Currently, chronic dacryocystitis is treated mainly by
surgery:
perform
radical
surgery
dakriotsistorinostomiyu
with
which
restores
slezootvedenie in the nose. The essence of the
operation is to create a fistula between the tear-nym
bag and nasal cavity. The operation was performed
with external or intranasal sufficient pom.
The principle of outdoor operation was proposed in
1904, rhinology Toti, she later committed-sponded.
Dupuis-Dyutan
and
other
writers produce
dakriotsistorinostomiyu under local infiltration
anesthesia-tional. Perform malacotomy to the bone
length of 2,5 cm, departing from the months-that the
attachment of internal ligament century toward the
nose of 2-3 mm. Raspatory pushing the soft tissue
and periosteum is cut, peeled it, together with the
lacrimal sac from the bone side wall of the nose and
the lacrimal fossa to the nasolacrimal canal and push outwards. Bone-forming window
size 1,5 x 2 cm with mechanical, electrical or ultrasonic cutter. Cut in the longitudinal
direction of the nasal mucosa in the bone "window" and the wall of tears Nogo-sac (Fig.
8.7, a) impose catgut sutures, first on the rear flaps of the nasal mucosa and the sack,
then - on the front (Fig. 8.7, b- c). Before applying the front stitches in the region of the
anastomosis is introduced drainage in the direction of the nasal cavity. Skin edges sewn
with silk nitya-mi. Aseptic impose a pressure bandage. In the nose injected gauze. First
ne-revyazku produce in 2 days. Sutures are removed in 6-7 days.
Endonasal dakriotsistorinostomiya of Vesta with modifications also performed under the
Inter-stnoy anesthesia.
For proper orientation in the position of lacrimal sac medial wall of lacrimal sac and
lacrimal bone puncture probe, inserted through the inferior lacrimal canaliculus. End of
the probe, which will be visible in the nose, tear a corner meets lowback fossa (Fig. 8.8).
On the side of the nose, ahead of middle nasal concha, cut out the projections of the
lacrimal fossa flap of the nasal mucosa measuring 1 x 1.5 cm and removed it. In place of
the projection of lacrimal sac is removed the bone fragment, measuring 1 x 1.5 cm
Vypya-chennuyu probe inserted through the lacrimal canaliculus, lacrimal sac wall cut
through the letter "c" within the bone windows and plastic materials used for the
anastomosis. This opens an outlet for the contents of the lacrimal sac into the nasal
cavity.
Both methods (external and intra-nasal) ensure high cure rates (95-98%). They have as
evidence,
and
limitations.
Intranasal operation on the lacrimal sac observed little traumatic, of an ideal
kosmetichnostyu, less disturbed physiology of slezootvedeniya. Odnomoment, but with
the basic operation can be eliminated by the anatomical and pathological rhinogenous
facto-ry. Such operations are successfully carried out at any stage flegmonoz-Nogo
dacryocystitis.
In recent years, developed endoscopic methods of treatment: endokanalikulyarnaya laser
and internal rinosovaya surgery using operating microscopes and monitors.
When combined violations patency of lacrimal ducts and nasolacrimal duct developed
operations with external and internal rinosovym approach - kanalikulo-rinostomiya with
the introduction of long-term path of lacrimal intubation materials - tubes, filaments, etc.
When complete destruction or obliteration of the lacrimal tract operates lakorinostomiyu
- creating a new way of lacrimal lacrimal lake in the nasal cavity with lakopro-synthesis
of silicone or plastic (Fig. 8.9), which is administered over a long period of time. After
epithelial polarization of the walls lakostomy prosthesis was removed.
Diseases
of
the
iris
and
ciliary
body
Inflammatory
disease
iridocyclitis
Inflammation in the anterior part of the vascular tract can begin with the iris (iritis) or
the ciliary body (cycle). In connection with a common blood supply and innervation of
these departments disease passes from the iris to the ciliary body, and vice versa - is
developing
Iridium-cycle.
The above-mentioned structural features of the iris and ciliary body explain the high freTautou inflammatory diseases of anterior segment eye. They can be of different nature:
bacterial,
viral,
fungal,
parasitic.
A dense network of large vessels of uveal tract with slow blood flow is practically a
sump for microorganisms, toxins, and immune complexes. Any infection that developed
in the body can cause iridocyclitis. The most severe inflammation observed viral and
fungal nature. Often the cause of inflammation is a focal infection in the teeth, tonsils,
paranasal
sinuses,
gall
bladder,
etc.
Endogenous iridocyclitis. By etiopathogenetic basis of their share on infectious in kind,
in-infectious-allergic and allergic non-infectious, autoimmune and developing other
pathological conditions of the organism, including for violations of Mena.
Infectious-allergic iridocyclitis occur against a background of chronic sensitization of
the organism to internal bacterial infection or bacterial toxins. Often infectious-allergic
iridocyclitis develop in patients with metabolic disorders in obesity, diabetes, renal and
hepatic
insufficiency,
vascular
dystonia.
Noninfectious allergic iridocyclitis may occur when drug and food allergies after blood
transfusions,
the
introduction
of
serums
and
vaccines.
Autoimmune inflammation develops in the presence of systemic diseases of the body:
rheumatism, rheumatoid arthritis, childhood chronic polyarthritis (Still's disease), etc.
Iridocyclitis may occur as symptoms of a complex syndromic pathology: ophthalmiastomatogeni-tal - Behcet's disease, офтальмоуретросиновиальной - Reiter's disease,
neyrodermatouveita - disease Vogt
- Koyanagi - Harada et al
Exogenous iridocyclitis. Of the causes of development externalities iridocyclitis may
serve as a concussion, burns, trauma, often accompanied by the introduction of in-large
unfinished
agenda.
The clinical picture of inflammation distinguish serous, exudative, fibrinous, pus-nye
and Hemorrhagic iridocyclitis, by the nature of the flow - acute and chronic, according
to maritime fologicheskoy picture - focal (granulomatous) and diffuse
(negranulematoznye) form we inflammation. Focal pattern of inflammation typical of
hematogenous
metastatic
introduction
of
infection.
Morphological substrakt main focus of granulomatous inflammation in iridotsiklite
represented by a large number of leukocytes, mononuclear phagocytes are also available,
epithelioid, giant cells and a zone of necrosis. From such a focus can be identified
pathogens.
Infectious-allergic and toxic-allergic iridocyclitis occur in the form of diffuse
inflammation. In this case, primary eye disease may be outside the co-sudistogo tract
and located in the retina or optic nerve, where the process propagates in the front part of
the vascular tract. In cases where toxic-allergic-time mapping of the vascular tract is the
primary, it will never have the character of this susceptibility palitelnoy granulomas, and
there is suddenly growing rapidly as hyperergic inflammation-determination.
The main manifestations - microcirculation disturbance with the formation of fibrinoid
Nabu-damping of the vascular wall. In combustion reactions hyperergic marked edema,
fibrinous ex-sudatsiya iris and ciliary body, plasma, or lymphoid polinuklearnaya infiltradio.
Acute iridocyclitis. The disease begins abruptly. The
first subjective symptoms Mamie are a sharp pain in
the eye, irradiiruyushaya the corresponding half of
the head and the pain that arises in The Touch to
eyeball in the area of projection of the ciliary body.
Excruciating pain caused by abundant sensitive
innervation. At night, the pain intensifies due to
stagnation of blood and passing-leniya nerve endings,
in addition, during the night increases the influence of
the parasympathetic nervous system. If the disease
starts with iritis, the pain is determined solely by The
Touch to the eyeball. After joining ZC pain is greatly
enhanced. The patient complains also photophobia, lacrimation, difficulty in opening
eyes. This rogo-mary triad of symptoms (photophobia, lacrimation, blepharospasm)
comes from the fact that the plethora of the vessels in the basin of the large arterial circle
of iris vessels passed petlistoy regional networks around the cornea, as they have
anastomoses.
An objective examination of paying attention to light swelling of the eyelids. It increases
due to light toboyazni and blepharospasm. One of the major and very characteristic signs
of inflammation pa-bow, and the ciliary body (as well as the cornea) is perikornealnaya
injection vessels. It is visible even when viewed from outer ring-shaped pink-bluish
color around the dial: a thin layer of translucent sclera hyperemic vessels petlistoy
regional network of the cornea. In protracted inflammation that halo becomes purple.
Kaleidoscope-ka edematous, thickened, due to increased blood flow radially going
vessels they may become more direct and long, so the pupil narrows, it becomes
inactive. When compared with the healthy eye can see color changes fulfilling the iris.
Overstretched the inflamed blood vessels pass blood cells, in which the fracture shenii
Iris
acquires
shades
of
green.
In the inflamed appendix ciliary body increases the porosity of thin-walled capillaries.
Changing the composition of produced fluids: it appear protein, blood cells,
desquamated epithelial cells. With mild abuse of vascular permeability in the exudate
dominated by albumin, when zrachitelnyh changes through the wall of the capillary
lyarov are large protein molecules - globulin and fibrin. In the light cut a slit lamp
moisture anterior chamber opalescent due to the reflection of light floating suspension of
new protein flakes. When serous inflammation, they are very small, subtle, and
exudative dense mist. Fibrinous process is characterized by less acute course and
produce sticky protein substance. Easily formed adhesions of iris to the front surface of
the lens. This is facilitated by the limited mobility of narrow pupil and intimate contact
with the thickened iris lens. Can form a complete fusion of the pupil in a circle, and soon
after this fibrinous exudate and the lumen closes the pupil. In this case, the intraocular
fluid produced in the posterior chamber of the eye, has no access into the anterior
chamber, as a result of what appears bombazh Iris - her bulging anteriorly and a sharp
increase vnutriglaz-partial pressure (Fig. 14.7). Adhesions pupillary edge of the iris with
the lens called the posterior synechiae. They are formed not only at fibrinopurulent
plastic iridocyclitis, but in other forms of inflammation, they are rarely circular. If you
were formed local epithelium lialnoe immedi-generalization, it comes off with dilated
pupils. Hoary, coarse stromal-nye synechia not come off and change the shape of the
pupil. The reaction of the pupil at the unaltered sites may be normal.
When exudate purulent inflammation has a yellowish-green tint. It can delaminate due to
sedimentation of leukocytes and protein fractions, forming at the bottom of the anterior
chamber of sediment from the horizontal level - gipopion. If the moisture in the anterior
chamber enters the blood, the formula-recurrent elements of the blood and settle to the
bottom
front
of
the
camera,
forming
gifemu.
Under any form of inflammatory response protein suspension of intraocular fluid
accumulates in all tissues of the eye, "denoting the" symptoms of iridocyclitis. If the
cellular elements and mills lightest pigment chips, glued together with fibrin, deposited
on the rear surface of the cornea, they are called precipitates (Figure 14.8). This is one of
the characteristic symptoms iridoiiklita. Precipitates can be colorless, but sometimes
they are yellow or gray tint. In the initial phase of the disease they have a rounded shape
and clear boundaries between resorption - get rough, as if obtayavshie edge. Precipitates
are usually located in the lower half of the cornea, and the larger ends up lower than the
smaller ones. Exudative-on expansion at the surface of the iris ever stay her drawing, the
gaps become less deep-mi. The protein slurry is deposited on the surface of the lens and
the fibers of the vitreous, which may result in significantly reduced visual acuity.
Number of overlapping depends on the etiology and severity of the inflammatory
process. Any, even small, suspension in the vitreous body is difficult absorbed. When
fibro-venous-plastic iridotsiklite small flakes of
exudate gum fibers of the vitreous body in the grave
moorings that reduce visual acuity, if located in a
central department. Peripherally located mooring
sometimes lead to the formation of retinal
detachment.
Intraocular pressure in the initial stage of the disease
may increase due to hyper-perproduktsii intraocular
fluid in terms of increased vascular blood flow resborder processes and reduce the rate of outflow of a
viscous fluid. After a prolonged inflammation of the
oxidative process of hypertension is often replaced
by hypotension due to partial bonding and atrophy of
ciliary processes. This is a terrible symptom, as in hypotension, slow-Xia metabolism in
tissues of the eye, reduced function of the eye, causing a threat subatrophy eyeball.
With proper treatment promptly initiated iridocyclitis may be stopped for 10-15 days,
but persistent cases, treatment is more time-consuming - up to 6 weeks. In most cases,
the eye does not remain traces of the disease: dissolve the precipitates, normal
intraocular pressure, reduced visual acuity
Acute iridocyclitis need to differentiate from an
acute attack of glaucoma (Table 14.1).
Features of some forms of acute iridocyclitis.
Influenzal iridocyclitis usually develops during the
flu epidemic. The disease begins with an acute pain
in the eye, then quickly appear all the typical
symptoms. In each season, the disease has its own
characteristics, which manifest themselves
primarily in the nature of the exudative response,
with or without a hemorrhagic component, duration
of disease. In most cases, timely treatment outcome
is favorable. The following diseases of the eye does
not
remain.
Rheumatoid iridocyclitis occurs in acute form is
characterized by intermittent relapses, accompanied
by a joint attack of rheumatism. Can be affected
both
eyes
simultaneously
or
alternately.
In clinical attention is drawn to the bright perikorne-cial injection vessels, a large
number of small bright precipitates on the posterior surface of the cornea, opalescence
moisture anterior chamber, iris limp, swelling, pupil constricted. Easily formed surface
epithelial rear si-nehii. Nature of serous fluid, a small amount of fibrin, and therefore do
not form strong adhesions pupil. Adhesions easily broken. Length of inflammation 3 - 6
weeks. The outcome is usually favorable. However, after frequent recurrences gradually
increases the severity of signs of atrophy of the iris, becomes sluggish reaction of the
pupil, are formed first boundary and then the junction seam between the iris with the
lens, the number of thickened fibers in the vitreous body, decreased visual acuity
Chronic iridocyclitis. Tuberculous iridocyclitis characterized by recurrent course.
Usually leads to an exacerbation of activation of the underlying disease. Inflammatory
carried begins sluggishly. Pain and redness of the eyeball are mild. The first subjective
symptoms include decreased visual acuity and the appearance of floating "mu-nis"
before your eyes. When viewed from observed multiple large "greasy" precipitates on
the posterior surface of the cornea, the newly formed blood vessels of iris, opalescence
moisture anterior chamber opacities in the vitreous body. For tuberculous iridocyclitis is
typical appearance of a yellowish-gray or pink inflammatory bumps (granulomas) on the
edge of the pupil the iris, which suited the newly formed blood vessels. This metastatic
foci of infection - the true tubercles. Mycobacterium tuberculosis can be enrolled in
primary and in poslepervichnoy stage of tuberculosis. The bumps in the iris may be
several months or even years, the size and number of them gradually increased. The
process
can
move
to
the
sclera
and
cornea.
In addition to the true tubercular infiltrations, on the edge of the pupil periodically
appear and disappear quickly, "volatile" small gun-like flakes of wool, which are located
on the surface-. This peculiar precipitates deposited on the edge of the sluggish slowmoving pupil. For chronic iridocyclitis characterized by the formation of gross
adhesions. When unfavorable disease course, a complete fusion and imperforate pupil.
Adhesions can be planar-Gut. They lead to the complete immobility and atrophy of the
iris. Novoob-cated vessels in such cases are transferred from the iris to the surface
buried
pupil.
At
present,
this
form
of
the
disease
is
rare.
Diffuse form of tuberculous iridocyclitis occurs without the formation of tubercles in the
form of persistent, often exacerbated by the plastic process with the characteristic
"greasy" precipi-mat and cannons, located on the edge of the pupil.
Accurate etiologic diagnosis of tuberculous iridocyclitis complicated. Active pulmonary
tuberculosis is extremely rare combined with metastatic ocular tuberculosis. Diagnosis
should be conducted jointly tuberculosis and an ophthalmologist in the light of
cutaneous tuber-Linova samples, immune status, the nature of the flow characteristics of
common
diseases
and
ocular
symptoms.
Brucellosis iridocyclitis usually takes the form of chronic inflammation without severe
pain, with a weak perikornealnoy injection of blood vessels and severe allergic reactions. The clinical picture has all the symptoms of iridocyclitis, but first they develop
unnoticed and the patient turns to the doctor only when detects a deterioration in vision
solution in the affected eye. By that time it has a union with the lens pupil. The disease
may
be
bilateral.
Relapses
occur
within
a
few
years.
To establish the correct diagnosis is very important medical history of contact with the
animal and animal products in the past or at present, indicate carry over-hay in the past
arthritis, orchitis, spondylitis. The main importance are the results of laboratory studies positive reactions Wright, Huddleson. When the latent forms of diseases, it is
recommended
to
perform
test
Coombs.
Herpetic iridocyclitis - one of the most severe inflammatory diseases of the iris and
ciliary body. It has a characteristic clinical picture, which in some cases difficult to
diagnose. The process may begin with the occurrence of acute severe pain, severe
photophobia, bright perikornealnoy vascular injection, and then the flow becomes
sluggish and stubborn. Exudative reaction is usually serous type, but may be fibrinous.
For herpetic iridocyclitis nature characterized by a large number of major merging with
each other precipitates, iris and corneal edema, hyphema appearance, reducing the
sensitivity of the cornea. Prognosis is much worse in the transition of the inflammatory
process in the cornea - appears keratoiridotsik-lit (uveokeratit). The duration of the
inflammatory process, which captures the entire anterior eye, no longer limited to a few
weeks, sometimes it drags on for many months. With the ineffectiveness of conservative
measures to carry out surgical treatment - excision of corneal melts, containing a large
number of viruses, and therapeutic transplantation of donor graft.
Basic principles of treatment of iridocyclitis. Depending on the etiology of the
inflammatory process of conducting a general and local treatment.
During the first examination the patient is not always possible to determine the cause of
iridocyclitis. The etiology of the process can be installed in the coming days, and
sometimes it is not known, but the patient needs emergency care: the delay in the
appointment of treatment even at 1-2 h could seriously complicate the situation. Front
and rear chamber of the eye are small volume, and 1-2 drops of fluid or pus may fill
them, na-ralizovat exchange fluid in the eye, pupil and lens of the glue.
When inflammation of the iris and ciliary body of any nature first aid is aimed at
maximally dilated pupils, which allows to solve several problems. First, while
expanding the pupil the iris vessels are compressed, hence, the formation of ex-sudata
while paralyzed accommodation, the pupil becomes fixed, thus providing peace of organ
damage. Secondly, the pupil is removed from the most central part of the convex lens,
which prevents the formation of posterior synechiae and provides a gap existing
adhesions. Third, the pupil opens wider access to the anterior chamber for the fluid
accumulated in the rear of the chamber, thereby prevents the adhesion processes of the
ciliary body, and the distribution of exudate in the posterior segment of the eye.
To improve pupil instilled 1% solution of atropine sulfate 3-6 times a day. When
inflammation of the duration of the mid-riatikov many times less than in the healthy eye.
If at first examination had already detect adhesions, then add to atropine midriatiki
others, such as adrenaline 1:1000 solution, a solution midria-tsila. To enhance the effect
of eyelid lay the narrow strip of cotton wool soaked in midriatikami. In some cases, you
can put a lid dry crystal of atropine. Nonsteroidal anti-inflammatory drugs in the form of
drops (for Clophen, diklof, indomethacin) increase the action midriatikov. Number of
combinable midriatikov and burrowing in each case are determined individually.
Next measure the ambulance - subconjunctival injection of steroid (dexamethasone 0.5
ml). When purulent inflammation beneath the conjunctiva and intramuscularly
administered broad-spectrum antibiotic. To eliminate the pain prescribed analgesics, the
wing-palatal-orbital
procaine
blockade.
After clarification of the etiology iridrtsiklita reorganize identified foci of infection,
develop a scheme of general treatment, choosing the means acting on the source of
infec-tion or toxic-allergic effects. Shall adjust the immune status. As a non-required use
of
analgesics
and
antihistamines.
When local treatment is required daily adjustment of therapy, depending on the reaction
of the eye. If by conventional instillation can not break the rear adhesions, we also
received enzyme replacement therapy (trypsin, lidazu, lekozim) as parabul-bar,
subconjunctival injection, or electrophoresis. Perhaps the use of medical leeches-ray in
the temporal region of the affected eye. Pronounced analgesic and anti-inflammatory
effect gives the course pterygopalatine-orbit closures with steroid, enzyme preparations,
and
analgesics.
With abundant exudative reaction may form the rear adhesions even when dilated pupils.
In this case, you must promptly cancel midriatiki and briefly designate miotikami. Once
the spikes come off and the pupil is narrowed again, denotes midriatiki (gymnastics
pupil "). After achieving adequate mydriasis (6.7 mm) and divide adhesions atropine
midriatikami replace short-acting, which does not increase equal to or lower intraocular
pressure for prolonged use and do not give adverse reactions (Su-host of the mouth,
psychotic reactions in the elderly). In order to eliminate side effects of the drug on the
patient's body, it is advisable for instillation of atropine at 1 min to squeeze your finger
domain lower lacrimal point and lacrimal sac, then the drug is not pro-niknet a tearful
way
to
the
nasopharynx
and
gastrointestinal
tract.
At the stage of calm eyes, you can use magnetic therapy, the helium-neon laser,
electron-tro-and phonophoresis with medications for a more rapid resorption of the
remaining
fluid
and
adhesions.
Treatment of chronic iridocyclitis long. Tactics of the specific etiology-logical therapy
and restorative treatment of produce with the therapist or phthisiology. Local activities
in tuberculosis iridotsiklitah meet as well as in diseases of other etiologies. They are
aimed at eliminating the source of inflammation, race-syvanie exudate and preventing
overgrown pupil. With full seam and buried pupil first try to break the adhesions, using
conservative means (midriatiki and physiotherapy effects). If this fails, then surgical
adhesions share-symmetric way. To restore communication between the anterior and
posterior chambers of the chapter, using a laser pulsed radiation by means of which
make holes in the iris-stie (coloboma). Laser corectomy usually produced in the upper
root zone, because this part of the iris is covered by a century and the newly formed hole
will
not
give
too
much
glare.
Degenerative
processes
in
the
iris
and
ciliary
body
Degenerative processes in the iris and ciliary body occur rarely. One of these diseases is
in-Fuchs dystrophy or Fuchs' syndrome geterohromny. Usually it is, there arises in one
eye and consists of three compulsory symptom - protein precipitates on the cornea,
changing the color of the iris and cataract. As the process of acceding Xia other
symptoms - anisocoria (different width of the pupils) and secondary glaucoma. Friends
and relatives of the patient first diagnosed in him signs of the disease: notice the
difference in the neighborhood of Rusk iris right and left eye, then paying attention to
different widths of pupils. The patient aged 20-40 complained of decreased visual
acuity,
arises
when
the
cataract.
All the symptoms are caused by progressive atrophy of iris stroma and the res-border
bodies. Thinning outer layer of the iris is lighter and the gap - wider than in fellow eyes.
Through them begins to shine through a piece of the iris pigment. By this stage of the
disease affected eye is darker than the healthy. Dystrophic process in the processes of
ciliary body leads to a change in the capillary walls and the quality of produced fluid.
Moisture in the anterior chamber appears white, yielding small flakes on posterior
surface of her cornea. Eruptions of precipitates can disappear at any period of time-and
then appear again. Despite the long-term, for several years, the existence of a symptom
of precipitation, with Fuchs' syndrome is not formed posterior synechia. Changing the
composition of the intraocular fluid leads to a clouding of the lens. Develops secondary
glaucophane-ma.
Previously syndrome Fuchs believed inflammation of iris and ciliary body due to the
presence of precipitates - one of the main symptoms ZC. However, in the described
clinical picture missing four of the five general clinical signs of inflammation, known
since the days of Celsus and Galen: redness, swelling, pain, fever, there is only the fifth
symptom
impaired
function.
Currently, Fuchs syndrome is considered as neurovegetative pathology-added due to a
violation of innervation at the level of the spinal cord and cervical sympathetic nerve,
which manifests itself as a dysfunction of the ciliary body and iris.
Treatment is aimed at improving the trophic processes, it is ineffective. When the strip
up, the lens equation lead to a decrease in visual acuity, perform removal of complicated
cataract. With the development of secondary glaucoma also showed surgical treatment.
The new pedagogic technology used at this lesson: “Black box”, “Web-Net”
The “Black box” method
It provides the interconnected activity and active participation of every student, the tutor
(teacher) involves the whole group in this activity.
Every student pulls out a card from the box. In the card there are writer in short
complaints and clinical manifestations of a disease ( Variants are given)
Students should determine this preparation, give their answer in details and groud it.
To think over the answer it is given 3 minutes. Then the answer is discussed and
additional information on clinical characteristics and ways of the disease are given. At
the end of this part of classes teacher comments the answers ( its correctness, grounded
and level of the students’ activity)
This method helps to improve the students’ speech, to obtain the vases of critical
thinking as the students are taught to advocate their opinion, analyze answers given by
their group-mates participated in the competition.
Variants of cards:
1.
Diagnosing a disease: ordinary blepharitis
Treatment: local therapy with antibiotics, massage of eylids
2.
Diagnosing: Blephoroptosis
Treatment: surgery
Usage of the “web” method
Steps:
1.
First, students are given some time for composing questions to the studied theme.
2.
The participants sit in a circle
3.
One of the participants who is given a clew puts his question ( he should know the
detailed answer to it) and holding the end of the thereoat passes the clew
4.
A student who has received the clew must answer this question ( the student who
has put the question should comment the given answer) and passes the clew to some
other student. The participants must go on with asking and answering the questions until
all of them are involved in the web.
5.
As soon as every student has put his question, the last participant who keeps the
clew should return it to the previous one who put him a question and son. The game
continues until the “web” is “unfailed”: completely.
Note: students should be warned to listen attentively every answer because they don’t
know who will be the next.
6.2.
Situation tasks.
Analytic part.
1.
A patient 16 years old complains on pains and swelling timidity in the left upper
eyelid
Anamnesis: Feels the pains for two last days and considers it to be the result of
overcooling.
Make diagnosis considering the complaints.
Indicate principles for treatment.
Answer: OS- Hardeolum (sty) of the upper eyelid. Opening of the purulent capitulum,
antibacterial therapy (local and general)
2.
A patient aged 20. Complaints: on painless formation in left upper eyelid area.
Anamnesis morbi: she considers herself to be ill during 3-4 months period after she had
had hordeolum.
Vis OD/OS= 1.0/1.0
Intraoccular pressure (IOP) OD.OS= 18 mercuric pressure
Diagnose the disease basing on the complaints and indicate possible outcomes
Answer: OS-Chalazion of the upper eyelid. Spontaneous opening, suppuration.
3.
First, the patient had lacrimation and then, during the last month there was
purulent discharge. The eye anterior part was unchanged. Purulent discharge from the
lacrimal area released when the lacrimal sac was pressed.
Your diagnosis.
Methods of treatment (therapy).
Answer: Purulent dacryocystitis. Expectant (conservative) therapy of the lacrimal pass
ways, surgery (dacryocystorhinostomia)
4.
The external examination of a patient has demonstrated edema in the upper
external squaer of the upper eyelid. At palpation the eyelid was dense, painful and
hyperemic. The eyelid conjunctiva was edematic. Limited mobility of the eyeball
upwards andoutward, tumenscence and tenderness were revealed when the parotid
lymphatic nodules were palpated. The body temperature was high.
Your diagnosis.
Therapy.
Answer: Dacryoadenitis, antibiotic therapy, desansebilazation treatment,
vitaminotherapy, local dry heating
6.3. Practical part
1. The external examination of an eye at the lateral illumination.
The aim: The external examination of an eye at the lateral illumination
Steps:
Points
Noncomplete
answer
№
Content of answer
Complete
answer
1
Necessary facilities: a desk lamp,
magnifying glass of 13,0 D – are
required.
10
5
0
2
A desk lamp is to be adjusted at the
lateral side and a little bit in front of
the patient; a magnifying glass must
be kept between the patient’s eye and
the light source.
30
15
0
3
This method is used to concentrate
light beams at the examined object,
these allowing seeing distinctly the
anterior part of the eye.
30
15
0
4
This method is used to examine the
skin and mucosa of eyelids, lashes,
lacrimal areas, eyeball conjunctiva,
cornea, limb, sclera, anterior chamber
of an eye, iris, pupil and its reaction,
lens.
30
15
0
No
answer
100 points
Total
2. Ectropia of upper and lower eyelids.
The aim: Ectropia of upper and lower eyelids.
Steps:
Content of answer
№
Complete
answer
Points
Noncomplete
answer
No
answer
1
To examine the lower eyelid a patient
is asked to look upwards.
20
10
0
2
The skin of the lower eyelid of the
patient should be drawn downwards
by right or left thumb.
20
10
0
3
To examine the upper eyelid a patient
is asked to look downwards.
10
5
0
4
The skin of the eyelid should be
drawn backwards by the right or left
thumb.
10
5
0
5
The eyelid should be drawn
downwards and forwards by thumb
and index finger.
10
5
0
6
Skin folding should be made by the
left thumb.
10
5
0
7
The cartilage of the upper eyelid is
pressed and the upper eyelid is
moved upwards.
10
5
0
8
This method allows to examine the
conjunctiva of eyelids, eyeballs and
fornices.
10
5
0
100 баллов
Total
7. Forms of controlling the level of
knowledge, practice and skill.
 Oral
 Tests
 Demonstration of practical skills
8. Criteria for estimation of the current control.
№
Results
№
in
percents
and
Marks
Graduation of a student’s
knowledge
points
196-100%
Excellent
“5”
2 91-95%
Excellent “5”
3 86- 90%
Excellent
“5”
4 81-85%
Good “4”
5 76-80%
Good “4”
Full and correct answer to questions on
etiopatogonesis, classification, clinics, principles of
treatment, complications and prevention of sickness
of eyelids and lacrimal organs. Summarizes and takes
a decision, creative thinking, analyzes independently.
Properly solves situational challenges with creative
approach, with full explanation of the answer.
Takes part actively in interpersonal games, properly
takes grounded decisions and summarizes, analyzes.
Implementation of practical skills in all stages is error
free and complete.
Full and correct answer to questions on
etiopatogonesis , classification, clinics, principles of
treatment, complications and prevention of sickness
of eyelids and lacrimal organs. Creative thinking,
analyzes independently. Properly solves situational
challenges with creative approach, with explanation
of the answer. Takes part actively in interpersonal
games, properly takes decisions. Implementation of
practical skills in all stages is error free and complete.
Fully highlighted questions on
etiopatogonesis ,
classification,
clinics, principles of treatment,
complications and
prevention of
sickness of eyelids and lacrimal
organs but 1-2 uncertainties in
answer.
Analyzes
independently.
Uncertainties while taking decision
in solving case studies but with
correct approach.
Takes part
actively in interpersonal games,
properly takes decisions.
One
mistake during whole stages of
implementation of practical skills.
Fully highlighted questions on etiopatogonesis ,
classification, clinics, principles of treatment,
complications and prevention of sickness of eyelids
and lacrimal organs but there are 2-3 uncertainties
and mistakes. Puts into practice, understands point of
question, retells confidently, has an exact ideas. Case
studies are solved correctly but explanations are not
full.
Answer is correct but not fully highlighted. A student
knows etiopatogonesis , classification, clinics,
principles of treatment, complications but is not good
at prevention of sickness of eyelids and lacrimal
organs.
Understands point of question, retells
confidently, has an exact ideas. Takes part actively
in interpersonal games. Incomplete decisions to case
studies. Incomplete implementation of 1st level while
taking practical skills.дает неполные решения.
6 71-75%
Good “4”
7 66-70%
“3”
8 61-65%
“3”
Answer is correct but not
fully highlighted.
A student
knows
etiopatogonesis
,
classification,
clinics,
sickness
of
eyelids
and
lacrimal organs but is not
good
at
principles
of
treatment, complications and
prevention. Understands point
of
question,
retells
confidently, possesses exact
ideas. Incomplete decisions to
case studies. 1st stage was not
completed while implementing
practical
skills
along
the
stages.
Correct answer to half of
the question. A student knows
inetiopatogonesis
,
classification of sickness of
eyelids and lacrimal organs
but not good at in clinics,
principles
of
treatment,
complications and prevention.
Understands point of question,
retells confidently, possesses
insight
of
particular
questions. Case studies are
solved correctly but without
explanation. 2 stages were not
completed while implementing
practical skills.
Correct answer to half of
the
question.
Mistakes
in
etiopatogonesis
,
classification of sickness of
eyelids and lacrimal organs,
bad at clinics and principles
of
treatment,
confuses
in
complications and prevention.
Retells
unconfidently,
possesses
exact
ideas
in
separate
themes.
Makes
mistakes while solving case
studies.
2
stages
were
9 55-60%
“3”
1 50-54%
“2”
1 46-49%
“2”
absolutely
incomplete
while
implementing practical skills.
Answer is with mistakes
to half of the question. A
student
makes
mistakes
in
etiopatogonesis
,
classification of sickness of
eyelids and lacrimal organs,
bad at clinics and principles
of
treatment,
confuses
in
complications and prevention.
Retells
unconfidently,
possesses
ideas
of
theme
partially. Case studies are
solved incorrectly. Incomplete
implementation
of
3
stages
while taking practical skills.
Correct answer to 1/3 of
the question. A student does
not know in etiopatogonesis ,
classification of sickness of
eyelids and lacrimal organs,
bad at clinics and principles
of
treatment,
confuses
in
complications and prevention.
Case
studies
are
solved
incorrectly
with
wrong
approach.
Absolutely
incomplete
3
stages
while
implementing practical skills
along the stages.
Correct answer to 1/4 of
the question. A student does
not know in etiopatogonesis ,
classification of sickness of
eyelids and lacrimal organs,
bad at clinics and principles
of
treatment,
confuses
in
complications and prevention.
Case
studies
are
solved
incorrectly
with
wrong
approach.
Absolutely
incomplete
4
stages
while
implementing practical skills
along the stages.
1 41-45%
“2”
1 36-40%
“2”
1 31-35%
“2”
1/5
of
the
question
highlighted with mistakes.
A
student does not know
in
etiopatogonesis
,
classification of sickness of
eyelids and lacrimal organs,
principles
of
treatment,
confuses in complications and
prevention.
Absolutely
incomplete
4
stages
while
implementing practical skills
along the stages.
1/10
of
the
question
highlighted with mistakes on
wrong approach.
A student
does
not
know
in
etiopatogonesis
,
classification of sickness of
eyelids and lacrimal organ,
clinics
and
principles
of
treatment,
Almost
does
not
know
complications
and
prevention
eyelid
diseases
lacrimal
organs.
Outrage
mistake
while
implementing
practical
skills
along
the
stages.
No answer to questions.
Does not know etiopatogonesis
,
classification, clinics,
principles
of
treatment,
complications and
prevention
of sickness of eyelids and
lacrimal organs. Does not know
to implement practical skills
along the stages.
9. Chronologic Charta of the classes.
№
Sequence
Kind of the
lesson
Period
(225)
1
2
3
4
5
6
7
8
Prologue of the teacher (explanation of the
theme)
Discussion the theme of practical lessons, usage
of new pedagogical technologies ( small groups,
discussions, case studies, “snowballs” method,
round table and etc.) and checking students’ basic
knowledge, using visual aids ( slides, audio,
video cassettes , wax figures, phantoms,
electrocardiogram, X-ray pattern and etc.)
Summarizing the discussion
Providing tasks for performing in practical part of
the lesson.
Mastering practical skills with the help of teacher
(treatment of patient on this field)
Analyzing laboratory results, instrumental
investigation of the patient in this field,
differential diagnosis, composing treatment plan
and health improvement, preparing prescription
and etc)
Discussion the level of goal achievement of
lessons on the basis of mastered theoretical
knowledge and on the basis of practical work of
the student. Taking into consideration above
mentioned evaluation of the activity of the group.
Conclusion of the teacher on this lesson.
Evaluating the knowledge of the students on the
basis of 100 point system and pronouncing it.
Giving tasks to next lessons ( set of questions)
15 min
Oral test,
explanation
40 min
30 min
40 min
Case report,
games and
clinical case
studies
Working
with
instruments
of clinic and
laboratory
Oral test,
test,
discussion,
discussing
the results of
practical
work
Information,
questions for
independent
preparation
30 min
20 min
30 min
20 min
10. Questions.
1. Eyelids, their structure, blood, blood circulation, innervations, functions.
2. Lacrimal organs, blood circulation, innervations, methods of investigation
3. Diseases of neuro-muscular apparatus of eyelids, clinical manifestations,
diagnostics, classification, clinical manifestations, diagnostics, treatment,
complications
4. Diseases of the eyelid margins, classification, clinical manifestations, diagnostics,
treatment, complications
5. Name 4 layers in the upper eyelid.
6. Name modes of treatment of blepharitis related to its foms( types)
7. What complications may be the result of squeezing out the Hardeolum?
8. Indicate all the parts of lacrimal pathways
9. Indicate your actions in the case of the lacrimal sac phlegmon
11. Literature
Basic
1.
Eroshevsky T.I,Borkareva A.I. “Eye Disease”, 1989. 263 pp
2.
Khamidova M.KH. “Kuz Kasalliklari”, 1996, 334 pp
3.
Kovalevskiy E.I. “Eye Diseases” 1995, 280 pp
4.
Fedorov S.N. et al “Eye Disease” M. 2000, 125 pp
5.
The materials given in the lectures
Supplementary
1.
Sidarenko E.I. “Ophthalmology” M 2003, 404 pp
2.
Chentsov O.B. “Tuberculasis of the eyes”
3.
Kapaeva L.A. “Ophthalmic diseases” M. 202, 512 pp
4.
Astakhov Yu.S. “ Ophthalmic Diseases” Atlas,Moscow “Medicina” 1985, 273 pp
5.
Nesterov A.P “ Glaukoma” 1995, 168 pp
6.
The data have been obtained from the internet sites:
www.ophthalmology.ru/articles/120_html,www.nedug.ru/ophthalmology/34art html www.eyenews.ru/html- 67,www.helmholthzeyeinstitute.ru/articles/1.2html
www.eyeworld.com/ophth.articles/html-89,www.scientific-vision.com/html-ophth