Encyclopedia of Family Medicine

Chapter 47 Prevention of Common Diseases (8)
(2) Viral conjunctivitis
Easy to cause outbreaks.Vision loss is common, because most viral conjunctivitis is accompanied by corneal inflammation.The discharge was watery, and the corneal staining was mostly positive.

Patients should be dripped with antiviral eye drops.It can be applied with a cold compress.If the cornea is already involved, the medication time should be extended, not less than one month.

(3) Allergic conjunctivitis
Divided into two types: one is called bullous conjunctivitis, which is characterized by nodular infiltration of lymphocytes in the subconjunctival mucosa, forming a herpes with localized congestion around it.The etiology is a delayed conjunctival allergic reaction caused by bacterial toxins.

Patients with adrenal corticosteroids and streptomycin eye drops, or subconjunctival injection better.

The second is vernal conjunctivitis, which may be an allergic reaction caused by free pollen or other substances in the air in spring.More common in young children.It is manifested as a flattened and hypertrophic papilla in the upper eyelid conjunctiva, shaped like a peeled pomegranate.Or the conjunctiva at the limbus shows a grayish-yellow jelly-like bulge, and sometimes the lesion is purple-dark red.Lesions of the palpebral and bulbar conjunctiva can occur simultaneously.

Patients can relieve symptoms by applying cortisone eye drops plus epinephrine eye drops or sodium chromate eye drops.The disease usually heals itself after adulthood.

(4) Trachoma

A chronic infectious conjunctivitis caused by Chlamydia trachomatis infection.Mild trachoma is mostly asymptomatic, with occasional foreign body sensation or astringent itching and dryness.Severe cases have obvious foreign body sensation and vision damage.Anyone with the first of the following four items and any of the others can be diagnosed as trachoma: ① blurred blood vessels in the upper fornix and upper eyelid conjunctiva, papillary hyperplasia, follicle formation, or both. ② There is pannus on the cornea. ③Scars appear on the upper fornix and upper eyelid conjunctiva. ④Conjunctival smear examination revealed inclusion bodies.

The main complications of trachoma are: ① entropion and trichiasis. ② corneal opacity. ③ eye dryness. ④ chronic dacryocystitis.

All kinds of antibiotic eye drops have a good effect.The key is to take medicine for a long time, and severe cases need to take medicine for more than half a year.

2.Pterygium

Pterygium mainly occurs in the bulbar conjunctiva at the palpebral fissure, among which the intouch is the most common, and often occurs in both eyes at the same time.There is a disease called false pterygium. After corneal inflammation or injury, the conjunctival tissue adheres to the wound surface, which is very similar to the true pterygium. It needs to be distinguished.Pseudoptyge can occur anywhere on the limbus.

Pterygium is usually surgically removed.It has been reported that local injection of pingyangmycin and prednisolone can cure the disease.

Corneal disease
1.bacterial corneal ulcer

Bacterial corneal ulcer is caused by secondary infection after corneal trauma, and the common features are: photophobia, lacrimation, obvious eye pain and severe visual impairment.Common creeping corneal ulcers, fungal corneal ulcers and Pseudomonas aeruginosa corneal ulcers.Clinical manifestations vary.

Crawling corneal ulcer: grayish-yellow pus on the surface, dirty base, curly edges, creeping progression to the surrounding and deep layers, hypopyon.After the ulcer is perforated, the iris prolapses, forming adhesive leukoplakia.

Pseudomonas aeruginosa corneal ulcer: circular yellow-green infiltration appears in the cornea, and soon forms an ulcer, with a large amount of yellow-green purulent secretions on the surface, the ulcer develops in depth, large-scale perforation occurs, iris prolapse, often accompanied by endophthalmitis, destroying the entire eyeball .

Fungal corneal ulcer occurs after the cornea is damaged, and the corneal surface is a gray-white raised infiltration foci, forming a rough gray-white or yellow-white ulcer with an irregular shape but a clear edge, and the exudate is like toothpaste.

Treatment of bacterial corneal ulcers: First, debridement, dilation, prevention of iris inflammation, and control of ulcer perforation.Depending on the type of lesions, bacterial-sensitive antibiotic eye drops or systemic application and local injection of sensitive antibiotics are used.

2.keratitis
Allergic inflammation of the corneal stroma due to syphilis or tuberculosis infection.

Those caused by syphilis often involve both eyes, and the main features are ciliary congestion and centripetal diffuse opacity of the corneal stroma.There are limited nodular infiltrating lesions in the corneal stroma, grayish yellow, with new blood vessels growing in, and severe corneal opacity in the late stage.

On the basis of application of corticosteroids, systemic plum removal or anti-tuberculosis treatment is carried out.Pay attention to mydriasis and prevent secondary infection.For advanced patients, Dioning eye drops and Xiaomeng ointment can be used to promote the absorption of inflammatory turbidity.

3.corneal softening disease
This disease is the ocular clinical manifestation of severe vitamin A deficiency, which is more common in infants and young children, and can be divided into four stages:

(1) Night blind period.

(2) In the early stage of dryness: the bulbar conjunctiva loses its normal luster and elasticity, there are centripetal folds when the eyeballs turn, the cornea loses its luster, and the sensation decreases.

(3) Drying period: Foamy dry spots appear in the palpebral fissure of the bulbar conjunctiva, which are not moistened by tears.The cornea is gray-white and cloudy, and the epithelium is dry and keratinized.

(4) Corneal softening stage: rough and thick bulbar conjunctiva forms wrinkles, corneal ulcer perforation, iris prolapse, leading to corneal staphyloma.

Patients should be supplemented with vitamin A in large quantities.To prevent secondary infection of the cornea, mydriasis, hot compress, eye wrapping and other treatments to prevent the occurrence of complications.

白内障

A transparent crystal that becomes cloudy for some reason is called a cataract.According to different causes, it is divided into: senile cataract, congenital, traumatic, complicated and metabolic.

1. Senile cataract
Occurs more than 50 years old, often bilateral.Clinically, according to the main part of the lens opacity, it can be divided into nuclear and cortical.

Primary cataracts are generally treated with drugs, such as eye drops such as Zhishangning, Shapuaisi, Bai Neiting, and Kalin U, and oral free radical scavengers, vitamin E, and cod liver oil.The blind eye produced in our country is a kind of Chinese patent medicine, which has a certain curative effect on early cataract.Cataracts after the expansion phase must be treated surgically. After the middle of the 20th century, with the development of intraocular lens and eye microsurgery, extracapsular cataract extraction combined with intraocular lens implantation is the perfect treatment method for contemporary cataract.

2.congenital cataract
14% of infant blindness is due to congenital cataracts.20% of them are due to congenital genetic factors; 20% are due to rubella or endocrine disorders when the mother is pregnant, and more than half of the causes are unknown.

Most congenital cataracts are static. If children have better vision, they are not in a hurry for surgery.If vision is poor, surgery should be performed as soon as possible to avoid disuse amblyopia.

3.traumatic cataract
Direct or indirect mechanical damage acts on the crystal to change the opacity.Generally divided into blunt impact trauma, penetrating trauma and electric shock cataract.

Treatment: If the localized extremely mild traumatic cataract has little effect on vision, it can be treated with drugs.More serious cases are treated with surgery.

4.complicated cataract
In a broad sense, cataracts caused by systemic or eye diseases are all complicated.However, clinically referred to as concurrent cataract refers to the type of cataract secondary to local ocular lesions, especially inflammatory and degenerative diseases.

Treatment: On the basis of fully considering the primary disease, take surgical treatment or drug treatment.

5.metabolic cataract
Cataracts caused by biochemical abnormalities in the internal environment of the human body due to endocrine disorders or other metabolic abnormalities.Diabetic cataracts, galactose cataracts, hypocalcic cataracts, and nutritional disorder cataracts are more common clinically.

Metabolic cataract is one of the clinical manifestations of the primary disease, some of which have little effect on vision, and the primary disease is mainly treated.Such as poor vision can consider surgery.

Strabismus and amblyopia

When the eyeball movement cannot be coordinated, the binocular single vision function is lost, and when one eye looks forward, the other eye deviates, which is called strabismus.Amblyopia is a condition in which no organic lesions are found upon examination of the eyeball, but the vision cannot be corrected to normal.Constant deviation of one eye can lead to amblyopia in that eye.Monocular amblyopia can also lead to strabismus, and the two are closely related.

1.strabismus

Strabismus is divided into communal strabismus and paralytic strabismus according to different causes.According to the location of the deviation, it is divided into exotropia, esotropia and vertical squint.

(1) Common strabismus is regarded as abnormal function of the extraocular muscles, which is caused by the imbalance of the strength of the antagonistic muscles, but there is no organic disease in the extraocular muscles and their innervating nerves.

Clinical features: Concomitant esotropia mostly occurs in children around 3 years old. It is intermittent at the beginning and becomes constant in the later stage. Vision is normal, eye movements are normal, and squint angles are equal in all directions.Common exotropia mostly occurs in adolescence, starts intermittently, and becomes constant with age.When looking forward, the eye position of one eye is biased to the temporal side.The rest of the features are the same as the common esotropia.

Found common strabismus should be treated as early as possible.The first is the treatment of the cause.Patients with fundus diseases should be treated with fundus diseases, and those with refractive errors should wear appropriate glasses.Children need glasses when they are around 3 years old, which should not be delayed due to their young age. Next, vision enhancement therapy and occlusion therapy can be used to increase the visual acuity of amblyopic eyes, correct abnormal retinal correspondence, generate fusion, increase the scope of fusion, and establish binocular vision.If the above method is used for half a year, if the eye position still cannot be corrected, surgical treatment should be performed, and correction training should be continued after surgery.Try to strive for binocular vision.Most adult strabismus patients have formed a strong abnormal binocular visual reflex; monovision and amblyopia, the vision of their strabismus is often difficult to improve, and surgical correction can only improve the appearance.

(2) Paralytic strabismus: It is mostly caused by lesions of the extraocular muscles or the innervating nerves of the extraocular muscles.Congenital cases are mostly caused by abnormal development of extraocular muscles or damage during childbirth.

Clinical manifestations: one eye gazes, the other eye deviates; eye movement disorder, the more you gaze towards the direction of action of the paralyzed muscle, the greater the oblique angle of view; there are obvious diplopia, dizziness, headache, nausea, and vomiting, and the patient often has forced head position , ocular torticollis, after covering one eye, these signs can disappear.

Find the cause and treat it.Cover one eye alternately to eliminate the general discomfort caused by diplopia, apply B vitamins, corticosteroids, etc., to promote the recovery of nerve and muscle functions.If the cause has been removed and conservative treatment fails for half a year, surgical treatment may be considered.

2.amblyopia

Vision loss in one or both eyes, external eye and eyeball examination showed no obvious organic lesions.More than half are related to strabismus.Amblyopia can lead to strabismus, a constant deviation of one eye, which can lead to amblyopia in that eye.According to the etiology, it is divided into five categories: congenital, refractive error, anisometropic, disuse and strabismic amblyopia.

Clinical manifestations: visual acuity loss is often below 0, which cannot be corrected to 3; the resolution of optotypes arranged in rows is worse than that of a single optotype; deviated eye position, nystagmus; paracentral fixation.

Patients should eliminate inhibition and train macular fixation and fusion.Correct strabismus as soon as possible, improve vision, and achieve binocular single vision.

Otitis media
According to different causes, otitis media can be divided into catarrhal otitis media and suppurative otitis media.According to the clinical characteristics, it is divided into acute otitis media and chronic otitis media.

1.acute catarrhal otitis media
The patient feels a sense of ear blockage, accompanied by low-pitched tinnitus, and intermittent deep ear pain like acupuncture.He often feels that his own voice has increased, but his hearing has declined.When there is fluid in the middle ear, there is a sound of water in the ear when changing the head position.There may be systemic symptoms such as low fever, drowsiness, and loss of appetite.

(1) Etiological treatment.

(2) Intranasal drops of mucous membrane contracting agents, such as 1% ephedrine solution, are helpful for the recovery of Eustachian tube function.

(3) Local hot compress can relieve pain, reduce inflammation, improve local circulation, and promote the absorption of phlegm effusion.Tympanic massage can improve hearing and prevent tympanic adhesions and ossicular chain rigidity.

(4) When there is effusion in the tympanic cavity, the fluid can be punctured and drawn under strict disinfection.If repeated aspiration is ineffective, catheter placement can be considered.

(5) Under the synergy of antibiotics, use hormone therapy.

(6) Eustachian tube insufflation can be performed after inflammation is controlled.

2.chronic nonsuppurative otitis media
Mostly because acute catarrhal otitis media has not been treated in time, or because the lesions in the nose and throat have not been removed, resulting in repeated acute attacks.

Hearing is good and bad, showing a progressive increase, initially conductive deafness, followed by mixed, such as the oval window and the round window closed by the connective tissue, neurological deafness may appear.Tinnitus is low-pitched in the early stages.Late high-pitched.

Early treatment can improve hearing, and later treatment is less effective.The treatment method is the same as that of acute catarrhal otitis media.Otosclerosis can do artificial stapes surgery.Patients who are not suitable for surgery can be equipped with suitable hearing aids to help improve their hearing.

3.acute suppurative otitis media
Pain deep in the ear, throbbing, or throbbing in line with the pulse.It can radiate to the pharynx, teeth, and ipsilateral temporal region, and the pain is relieved after the tympanic membrane is perforated and pus is discharged.Low-pitched tinnitus and hearing loss. When the tympanic membrane perforated pus flowed out, the hearing improved, but the tinnitus still existed.The pus from tympanic membrane perforation is bloody at first, and then it can turn into mucopurulent or purulent.Often headache, general malaise, fever.Infants and toddlers often cry at night when they are sick, their body temperature can be as high as 40°C, and symptoms of vomiting, convulsions, lethargy, and meningeal irritation may occur.After pus in the external auditory canal, the above symptoms disappeared immediately.

(1) Systemic treatment: Early and timely administration of sufficient effective antibiotics combined with hormone application.Give symptomatic analgesia and physical cooling to prevent complications.

(2) Local treatment: before perforation of the tympanic membrane, use 2% carbolic acid glycerin to reduce inflammation and relieve pain. If there is obvious empyema in the tympanic cavity, the tympanic membrane should be incised to facilitate drainage.After the perforation of the tympanic membrane, the pus should be removed in time, and antibiotic ear drops should be used.The acute inflammation was cured, and two weeks after the perforation was closed, Eustachian tube insufflation and tympanic membrane massage were started to prevent tympanic adhesions.Ephedrine nasal drops are applied to the nose to facilitate the recovery of Eustachian tube function.

4.chronic suppurative otitis media
This disease is mostly caused by untimely or incomplete treatment of acute suppurative otitis media.According to the pathological changes and clinical manifestations, it can be divided into three types: simple type, bone ulcer type, and cholesteatoma type. The common features are repeated ear discharge, deafness, and perforation of the tympanic membrane.

Simple otitis media: After thoroughly removing the secretions, use ear drops with bacteria-sensitive antibiotics. After the pus is reduced, use boric acid alcohol ear drops. Pay attention to radically cure the inflammatory lesions of the nose and pharynx.One to three months after the cessation of ear pus, if the Eustachian tube is functioning well, tympanic membrane repair is feasible.Bone ulcer otitis media: Thoroughly remove middle ear granulation and smooth drainage.Such as long-term treatment, or mastoid film confirmed bone destruction, radical surgery should be performed.Cholesteatoma otitis media: Surgical treatment should be performed as soon as possible to prevent serious complications.

5.Complications of suppurative otitis media
(1) Extracranial complications mainly include: acute mastoiditis, subperiosteal abscess behind the ear, subdigastric abscess, otogenic facial paralysis, labyrinthitis.

Therapeutic principles: radically cure middle ear and mastoid lesions, smooth local drainage, systemic and local application of effective antibiotics, generally can be cured.For otogenic facial paralysis, if the facial nerve has been interrupted, facial nerve transplantation or anastomosis may be considered.

(2) Intracranial complications mainly include: otic meningitis, sigmoid sinus thrombophlebitis and otic brain abscess.

Therapeutic principles: use bacteria-sensitive drugs in sufficient doses, strengthen supportive therapy, and pay attention to water and electrolyte balance.Surgical removal of the lesion.Such as radical mastectomy, brain puncture and pus extraction, sigmoid sinus incision, etc., please consult with neurosurgery if necessary.

deaf
1.耳聋的分级：一般按纯音听力损失的分贝数将耳聋分为轻、中、重和全聋。损失90db以上为全聋，损失60~90db为重度聋，损失30~60db为中度聋，10~30db之间为轻度聋。

2.Classification of deafness: (1) Conductive deafness: Deafness caused by sound conduction structural lesions, most of which are in the external auditory canal and middle ear, accompanied by low-pitched tinnitus. (2) Nervous deafness: The lesion occurs in the inner ear, auditory nerve or auditory cortical center.Make sensory sound process obstacles. (3) Mixed deafness: The auditory organs have obstacles to sound transmission and sensory hooks.

3.Treatment for deafness:
(1) Treatment of conductive deafness: actively treat otitis media, and prevent ossicular chain stiffness and tympanic adhesions for non-suppurative otitis media.For suppurative otitis media, hearing reconstruction surgery should be performed after the inflammation is controlled.Otosclerosis should be treated with fenestration or stapes surgery.For patients with congenital atresia of the external auditory canal and middle ear deformity, plastic surgery is feasible.Surgery should be performed as early as possible to avoid cochlear dysfunction and poor surgical results.

(2) Treatment of sensorineural deafness: early detection and early treatment will have a certain effect.Vasodilators, multivitamins, and appropriate hearing aids can be used.Acupuncture therapy in traditional Chinese medicine has a certain effect.There is also desensitization treatment, and some patients can be cured.

Nasal polyps

Nasal polyps are the result of long-term chronic inflammatory stimulation of the nasal cavity and sinus mucosa, or allergic swelling of the mucosa.The pathological changes are expansion of water in the submucosal tissue space, edema and hypertrophy, so that the mucosa sags.Occur in the ethmoid sinus, middle turbinate and maxillary sinus.Single or multiple can occur in one or both nasal cavities.

Small polyps are often asymptomatic.The polyps gradually increased, and the nasal congestion increased, accompanied by a large amount of mucus nasal discharge and olfactory disturbance, dry throat, and head fullness and discomfort.If combined with sinusitis, the secretion is purulent and accompanied by headache and dizziness.Large nasal polyps protrude forward of the nostrils.It can hang down into the nasopharynx backwards, and even widen and deform the back of the nose.Examination shows that there are single or multiple translucent neoplasms with smooth surface, off-white or reddish color in the nasal cavity.Shaped like fresh lychee meat.Soft to the touch, easy to move, painless, and not easy to bleed.

Treatment can remove the cause, surgical removal of polyps.

(End of this chapter)