《医学英语》五年制教学课件
医学英语五年制教学课件,医学英语,医学,英语,五年制,教学,课件
CHAPTER 10 THE EYE Who would believe that so small a space could contain the images of all the universe?O mighty process!Leonardo da Vinci(14521519)ophthalmology,OPH,Ophth 眼科学right eye,RE,oculus dexter,OD 右眼left eye,LE,oculus sinister,OS 左眼oculus uterque,OU 双眼visual acuity,VA,vision,V 视力naked vision 裸眼视力corrected vision 矫正视力binocular vision 双眼视力monocular vision 单眼视力visual field,Vf 视野External landmarks of the eye57corneaAnterior segment910Normal eye GlaucomaAge-related macular degenerationBRVO-branch retinal vein occlusionsThe lacrimal apparatusChronic dacryocystitis16tearsExtraocular muscle2011-09-20The pupillary light reflexWith advancing age,there is the gradual loss of elasticity of the skin around the eyes.The cornea may show an infiltration of degenerative material around the limbus,which is known as an arcus senilis(角膜老年环)The lens consistency changes from plastic to rigid,making it progressively more difficult to change its shape to focus on near objects.This condition is presbyopia.The lens may undergo changes resulting from metabolic disorders that cause its opacification;this condition is called a cataract.The vitreous humor may develop condensations,called floaters(飞蚊症)The retinal arteries may develop atherosclerosis,with resultant retinal ischemia or infarction.动脉粥样硬化 缺血 梗死Review of Specific SymptomsThe major symptoms of eye disease are the following:1.Loss of vision2.Eye pain3.Diplopia(double vision)4.Tearing or dryness5.Discharge6.RednessLoss of VisionWhen a patient complains of loss of vision,the following two questions must be asked:1.Did the loss of vision occur suddenly?2.Is the eye painful?Loss of VisionIt is extremely important to ascertain the acuteness of the loss of vision and the presence or absence of pain.Sudden,painless loss of vision may result from a retinal vascular occlusion or a retinal detachment.Sudden,painful loss of vision occurs in attacks of acute narrow-angle glaucoma.Gradual,painless loss of vision commonly occurs in chronic simple glaucoma.Eye PainEye pain may result from a variety of causes.Ask the patient the following questions:Can you describe the pain?Did the pain come on suddenly?Does the light bother your eye?Do you have pain when you blink?Eye PainDo you have the sensation of something in the eye?Do you have headaches?Do you have pain on movement of the eye?Do you have pain over the brow on the same side?Do you wear contact lenses?Pain may be experienced as burning,aching,throbbing,tenderness,or pain behind the eye.Each of these descriptions may have a range of causes.It is important to determine whether the patient has the sensation of a foreign body in the eye.Pain in the eye while blinking occurs in corneal abrasions and with foreign bodies in the eye.Eye PainEyePhotophobia is eye pain associated with light,as seen in inflammations of the uveal tract(i.e.,iris,ciliary body,or choroid).Inflammations of the conjunctiva,conjunctivitis,produce a gritty sensation.Diseases of the cornea are associated with significant pain because the cornea is so richly innervated.EyeHeadaches and eye pain are common in acute narrow-angle glaucoma.Pain on motion of the eye occurs in optic neuritis.Eye pain associated with brow or temporal pain may be an indication of temporal arteritis.Contact lens wearers may have corneal irritation and may complain of eye pain.DiplopiaDiplopia,or double vision,is a common complaint.Diplopia results from a faulty alignment of the eyes.Normally,when the eyes fixate on an object,the object is seen clearly,despite the fact that the two retinal images are not exactly superimposed.These slightly different images,however,are fused by the brain;it is this fusion that produces binocular vision,or the perception of depth.When the eyes are misaligned,the two images fall on different parts of the retinas,only one falling normally on the fovea.The field of vision of the deviated eye is different,so that its image is not projected on its fovea;therefore,this second image is different and not superimposable.DiplopiaDiplopiaThe patient may close one eye to relieve this distressing situation.A compensatory head posture may be used by the patient to relieve the double vision.Elevation or depression of the patients chin is used to overcome a vertical deviation.Tilting of the head is often used to counteract the torsional and vertical deviation.Tearing or Dryness Excessive tearing or dryness of the eyes is a common complaint.Abnormal tearing may be caused either by overproduction of tears or by an obstruction of outflow.Dryness results from faulty secretion by the lacrimal or accessory tear glands.A common cause is Sjogrens syndrome,which is generalized failure of the secretory glands.This syndrome is associated with a variety of disease states.Tearing or DrynessDischargeDischarge from the eye can be watery,mucoid,or purulent.A watery or mucoid discharge is often associated with allergic or viral conditions,whereas a purulent discharge occurs in association with bacterial infections.RednessThe symptom of the red eye is very common.The interviewer should ask the following questions:Have you had any injury to the eye?Does anyone else in the family have a red eye?Have you had any recent coughing spells?vomiting?Have you had any associated eye pain?Does light bother your eyes?Is there any associated discharge?Do you wear contact lenses?RednessThe eye may appear bloodshot.Redness may result from trauma,infection,allergy,or increased pressure in the eye.Severe coughing spells or recurrent vomiting may cause a patient to have a conjunctival hemorrhage.A family member or friend with viral conjunctivitis may be the source of a patients red eye.RednessThe combination of eye pain and red eye may indicate acute narrow-angle glaucoma.Uveitis,inflammation of the uveal tract,which is associated with a red eye,can manifest with light sensitivity.Patients wearing contact lenses may suffer from corneal irritation and may have eye redness.General SuggestionsIt is important to determine the medications that a patient is taking,because many drugs have deleterious effects on the eye.Some antimalarial,antituberculous,antiglaucoma,and anti-inflammatory drugs can cause eye disorders.General SuggestionsA thorough family history reveals familial disease tendencies such as glaucoma,cataracts,retinal degeneration,strabismus,or corneal dystrophies.There are many specific symptoms related to eye disease.Impact of Blindness on the PatientThe loss of sight is a terrifying experience.The sighted person lives mostly in a visual and auditory world illuminated by lights and colors.When blindness occurs,the person loses not only the ability to see but the perceptual center of the world.This center must now be replaced by hearing and touch.Because light is often equated with life,the inability to see light is associated with death.The newly blinded patient must take a new place in society.He or she can no longer read ordinary books,can no longer receive visual stimuli,and is unable to appreciate the world of visual communication.This can result in a reactive depression.The clinician must show genuine care for blind patients and try to understand their feelings of discouragement and despair.Impact of Blindness on the PatientImpact of Blindness on the PatientThe person who is blind from birth or early childhood has little or no conception of the visual world.Having never been able to see,this patient has no visual frame of reference.On occasion,a blind individual recovers sight as a result of a surgical procedure later in life.Many difficulties may arise owing to the reorganization of the patients perception.Impact of Blindness on the PatientHis or her frame of reference has been shifted from touch to sight.Surprisingly,many of these patients become depressed after attaining vision.Facial expressions mean nothing because only with experience can people understand them.Impact of Blindness on the Patient The following quote from a case history by Gregory and Wallace illustrates the response of such an individual:He suffered one of the greatest hardships(blindness)and yet he lived with energy and enthusiasm.When his handicap was apparently swept away,as by a miracle,he lost his peace and self-respect.Impact of Blindness on the PatientSimilarly,the patient with normal vision may develop psychosomatic eye problems as a result of anxiety.Loss of vision also can accompany panic disorders.Such individuals can have either partial or complete vision loss in one or both eyes.Supportive care of the primary problem usually results in the return of vision.Physical ExaminationThe equipment necessary for the examination of the eye is as follows:an ophthalmoscope,a penlight,a pocket visual acuity card,and a 3*5 inch card.The physical examination of the eye includes the following:Visual acuityVisual fieldsOcular movementsExternal and internal eye structuresOphthalmoscopic examinationlacrimation 流泪foreign body sensation 异物感conjunctival secretion 结膜分泌物asthenopia,Asth 视疲劳ophthalmalgia 眼痛photophobia 畏光counting fingers,CF 数指 曾用名“指数”hand movement,HM 手动light projection 光定位 light perception,LP 光感no light perception,no LP 无光感simulated blindness 伪盲 曾用名“诈盲”hemianopsia 偏盲physiological blind spot 生理盲点achromatopsia,color blindness 色盲color weakness 色弱conjunctival congestion 结膜充血keratic precipitates,KP 角膜后沉着物nyctalopia 夜盲diplopia 复视 THANK YOU!THANK YOU!
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