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    Anh Van
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    KHÁM MẮT

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    4 views18 pages

    Khám Mắt

    Uploaded by

    Anh Van

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    9 KHAM Mi cy sara stung dase dun cu ke 1, OM ian doth late bang bdng thi tye 1 PH ohh dp Bg tay vt bag nd 3 MetT apg the mi Fak q dan pit dE OA gid ml md, két mao, ‘ 5 Sa ged so dy mdr ip ‘ «Sefer NOP TE ink gi m im md thon th Snellen va ink 1, Min dp Mé Mactatoy ide mae, BMC mabe Pha a thy ing the, i 8 hoot dong nA mdng 0 guye dink ade whtng oh ot 220 vn hin 4 ly ‘tie mat vt chin thucomg ma, gt inl BENHNHAN VA DUNG ff gui MAT THONG THUONG ich bi ba wm “ain gid thai 40 cm thong va boa nha ipitiép xe v6i bénh aban, | him hSi vé IY do dn khém bénh, tah st va tién sif bénh. Bésh nbn ngéi ngang bing hodc hoi phon gui kh, Gai tich Khi khém ning dng tée ‘tim khém bing dén pin va soi day nit mye tiép dé bénh nhan ngéi yén, ab mit to, khOng oS nhdm mat va ‘bing do mat thudng xuyén, 12 Chuin bi dung cu khdm mit thong ting Lo cén 90° (s4t tring tay) va béng gon vo khudn, Dénpin khém mat, Bing thir thi Ie Snellen, miéng che adtva Ki 16, dung cu do nhiin dp Maclakov gém “thse té, hép my, qua cén, giutng ova den chi€u sang, Bins dey mat te tgp, ~~ ll {ih hung bt nd hong “hong rhc mir dl, 8 md dh, 2. KHALTHAC BEN sit 2A. Trung hyp a8 mit dn tha dn BO mat xudt hign ti khi nao, Trong gia dinb hoje xung quanh c6 ai bi 8 mat twong ty khong, Chit tit ©6 dang mi nhdy hay dich ‘wong nhu nue mit, > BS mit e6 kem dau nite, cém xdn ode m& mét khong. ~ C6 dau ving trtéc tai Khong. C6 du higu vim hong cp khong. 2.2. Trufing hyp 8 mit, dau vi mi mit > Tht ty xuft ign ofa céc du bigu md amt, dau nite m&t va 43 mat. + Dau higu dau nhite 6 gia ting Khi ra nh sng khong? = C6 bj chiin thuong mat hay vt gi bay vao mat tude 46 khong? - C6 kém budn nn hod non vot khong? = C6 dau higu nbvte mét lan lén nia ddu cng bén khong. - Tién can c6 bi 43, dau nbie va md mat tudng ty Hain ndo chia, Todn than e6 bj bénh ly ty mia nhw viém khdp, Lupus, viém than... khong? 281 KVNANG Y KHOA 25. Trg hp eh 0 14 Tesnghepn at tit naidénrtyg ty, ~ Tim at bienayoag ~‘Toabingty ig ‘ow hay din din m8 chin | Ma mt nha hay td hac a | i 48 yy - atte a tine ee ny ny cnn cin at i pve ED Su Nib dn ‘ie ibn rey King? en thug md og igh — aut kik rat de sh A 06 a ttn pi Shi Hf iid ing bo tb mang Kn KE? ait, 8, tea, | : cd ei ~ Vibe ml tf ban diy 4; “e bing? thénio, te = 06 dw higu ade dv thutng mye 3, pOTHILUC aes hing? : : hn cinch tng tay VO Sul Che bude the haa anja ung? Ie qua bing th een afta én tng hoe ming uén gide mac ‘Bénh akan ngéi ch _ Boe i nid diatiéa! nu ob tid xudt hign Khi mo. ‘5m (Hinh 3.1). gf ea Tea tho bi ah I ao nyt, a ti ding, im mach... King? Pes 124, Trg hop song tiv 1é mit _ Thjlue cla = Thoi dig xudt ign song thi cola ng chi 1 Song th nbd bug nba no eda ington 06 mit, Ghia ai SOE Tay mt vt thin ait nm gang Sow abba © tay we thay dim cho chau sang mit pi = Chbilé kbd, léxuft ign thi nto. nding of ab = Cité lu bt tug king Tt 32 Tgp th io gp bénhrhin d8 cu nt. ‘Béah abd vin wé ~ O6tdn cin cha dg te 5 hing? ibe 1 Gotdandfhige dav ate ndthng? «AN SA-Bleg tn west f° Uh mate mt C6 df hig Mi mt kom king? Yeu edu bab akin . Corsi morse et : Shaler sano in tay di kém khong? in trai dé i bea - Ghtedifindieicsoh sg, 8852 NOT eng sin ch 66s Gstngibing? eee ma i i es be sak Noss thin malt diém xudt hign chin thug’ han ey chi thuong 1 sata cS, 9, tay sung dang eB hay saya 4 feng Sim chy rate yg sin tfong mit c6 may yg 1 thong phan phy thuge - 1116 da0, xuong hdc Ne it wf ban dau a3 te te snr wen ; 2 vie [oti akong hg ch én bing a ea ae iC fi nh Ss a ae an thy 13. ue thf higa 48 xée eng cob cha ci cli ng thi thi lve Snellen noe en nbd hat may. hn ngéi céch bang thy aiantnt rdge duge toan BO cfc chit 1h3.D). Soeteg J dustin 00° ng ht doe bang hike ben oid ae tua mat dang do chinh 1a tr s6 » BIN carn nfm bab nbn doe saab cfe ci ci trong hang pint th lye v0 96 Khim mat, so 46 béah nhan chuyén ming che sg mit phd va-xéc dinh thj lye mét ining oy nbu tren. ‘32 Trang hap thi lye ‘duéi 10/10 Bénh aban van tip tyc miéng che mat éibéa Ditkinh 1 eve mét dang thi th Ive Yéu du bénh aban nhin qua 1 nhé ‘tinh gida 4 doc nhitng hang chit ahd ‘bon bén dudi. ‘Hedin hang chit nh nhit ma bénh *Hin do dng tit cA cdc chit cdi trong big. tii tj sé thi lve sau khi mang kinh 0 sé khém mit wi ee yi” J artrén xudng cde chit cdi ink ay 1 2 3 4 5 6 7 a 9 10 1. Bang thi thi luc Snellen chm migng che mt che nit 48 chit taj lye mt phi ite H ANG KHOA COBAN 33.Truting hop benk nhin khong doc Auge hing chit to nbittrén bang thi Ive Xéc din vj tri xa mht ma béoh nahin hin thdy va dém duge nhitng ngén tay. Ghi lai vi ui may bang mét vi du nh 46m ng6n tay Im, dém ngén tay 0.5m ‘Trading hgp bénh nhin khong thé dém ge ngon tay th ghi nin xem bénb nin 6 nhdn thy béng ban tay khOng (thi Ie dutge ghi 1 béng ban tay (+)) hay chi nba thdy duge nh sing (thi lye uge ghi nhgn 12 sing t6i (2) kde nay dn kiém tra thém tit cd 4 hudng chiéu den vio mt nur tén, dui, trong, ngoai). ‘Trudng hop cubi cing a khong con kha nding nhdn thay anh séng th thi Ive (uige ghi nhn 1a sing ti am tinh, Can ahi 6 bling chiA “Gm tinh” khong éuge~ ashi du () nh trding hyp dong tin va cdn ghi nhin thém dc diém cia phan xg nh sing tnfc tip va gidn tiép. + Tim phin xq inh sing tye tiép bling céch che m&t d0i bén lai ri xem suf thay dGi kich thudc déng ti Khi chiéu dén pin vao mét dang kham. Néu kich thude déng tir khong thay 46i khi chiéu séng thi ghi nbgn 18 PXAS tryc tiép am tinh. Néu kich thuée c6 thay Adi th ghi nhén 1a PXAS trv tiép (+). 283 KY NANG Y KHOA COBAN 42.10 ohn 6p Ning nin gaye a a wep — 4 Tam phn xa Gh sing. Bie nh nhin Wem tren pig . Tom hin ani ethan nea i ON aes i ‘ch tnt Nb 1 Biot thule 16 (Tete ye ae yg mt VA in ‘ben sbi xem oy thay 6 ‘yao ch hai mt bénh nag gee fi noe {ig 8 of dang NEES Maer AFiaanerie dn ae, tide ding tt kidng thay 661 oetoee cect! ED sing AM gh aha 12 PXAS oe a a wisn tig Am tinh, Néu Kh tO Say aye (06 thay 6% thi ghi obi 12 PAS soins — gid tiép (4). 4. XAC DINHNHAN AP 4.1. Ue taggin ip Bing 8 2 dng bi Kn dng ohn 6 KE ‘Maclakov do gic mac dang viem 1064, clin thug rch gide mae, ben shan ‘kh6ng md mét (Hinh 4.1). inh 42. Bénh nhin rn tn gu anes tage ‘va nh thus ts = Ngwi Khim sit wing gi | Maclakov va nhudm mye duet wong tan fan nay (Hin 43), Ses \ Beimtl atid Z vendic Hinh 4.1. Vigm loétgide mac khéng do duge j ee nan ap = ~ Yéu cdu bénh ohn nhin xuéng dé STM hoc nhin xudng chin cla bénh nhiin, -& - Ngubi khém ding hai ng6n tay trd an & he nh’ng qua mf tén cba bénh nin y € wdc lugng 4p luc bén trong niin chu. - Ghi lai cm giée wéc lung vio sé khém bénh nh nhin cfu cing ettng, ohin clu hoi cing, nhiin edu tinh thuing, nbin cu qué mém, 284 an nin gid mOt ngon tay oa chu ee dt va Dn nbfin pha yao du ngén tay trd nay, en jgurqud cin thing ding vag igo mac cla bénh nhan trong . acne clnra Hinh 44), oh 44. Dat qua can théng ding vao ‘gti gfe mac cle bénh nhan iim dp cOn that méng vao noi cin jptisf ahdn dp va in phan myc cén lai ténddu qué cfin vao ndi nay. Bo detng Kinh trong cita vong muc dé ade ih tj sO nhain Ap theo thuéc do Mov. stivo{ummtu PHAN ONG THE MI ajc cho bénh nhiin myc dich cba ‘ing fc Khim bénh a@ bEnh nhan hiéu Veh td et, a cdu bénh nbn nhin xu6ng dat feats chin cia bénh nhin = ‘him ding ng6n tay, tré ‘fn nhe 4 mf tn cla bénh nha, thi nbn cm giée dau o hai “abénb nbn (inh 5.1). 7 KHAM MAT Hinh 51. céch ng i 5.4. Cac tim dé nigy phan tng thé mi Néu bénh aban da (+), nu én wt ‘ing thé mi am 6.80 DUNG DEN pr (Hinh 6.1) w th phan Ging thé mi in khOng dau thi phin — Kum Mat Hinh 6.1, St dung dn pin dé khém mat benh nhan 6.1. Dan gid mi mit ~ Ghi abjin binh dang mi mit bao gm bi ‘cong mi trén va mi dui, géc trong va _g6c ngodi xem o6 bat thudng gi Khong. Ghi nbn dic diém da mi mit va vong xung quanh mi mft xem c6 tn thong khong. énh gid tinh chit cia cd si Long mi trén va mf dui xem e6 cham vao bE mat nhdin cau khong 285, NANG V KHOA COBAN, —— cae “a Ghi in sem gm 06 duc khu tri hog mh, sng tht xm I ig, 7 yi," 4 6,2. Dan gi ket mae ‘yen céu bénh akin 0 it 6 dénh gig miu sfc va ‘mach md cl et mae shin clu (Hinh 6.2). ane. hivaaung nist ntl Ct Kone mi di o€ quan st két mac ae Ce Mngt hin cng 3 diva et ge mi di tutngkinh gion — Lat mi én blng ofch yéu cfu bénb shin ein nun, ogi kim ding hai bi nn vem 6 mash a eg vo ving apie mc ln | ngén tay adm ang da mi be v8o BO 4 trén son mi trén va lft mi trén 48 quan Fe sétkétmac mf ten (Hinh 63). V B eet ae R Hinh 6. 1. SOI BAY ‘TRYCTIEP - + Gif tich mec = ‘nfs bénk ahi Hin 65. Mang mdu ngage") ~ Béah ahin ngs fed ‘bon ngu kin. Catto fie pie) ain v8 dng ds anghibm php bong ri. gi kai, 63, Duh gi phic me PM peak nn aka hdng aes, |” NP Rémi dp. Sarde ea ieee kes eth ki ding dain i soi cing ben Witaivgctapicees tht dang beg sab 8597 Nadi ty ~ Ding thude do dung Kinh ngang ci song song voi mit piles EF hig, den dé xoay cé sidcmae ng cla Gh ah vt 49 neta fh and phia nso vi 6 ign DEt bE rOng ming we pin 1 titn phdng xep, ‘a e sng ran im qué. Yb 7 gv én phdng Th nog, ng rtm oh hig dui aw gt en ping bi 0 ng of bong on th si. 5 gas iat ‘ gon dang ba thy tin Pe say sh to hay V9. tan Tt i ° ma vic ela tly Sh tid a se ham ding mt vg tay cm pie aes 19 BEn vei mét dy inh Khim we Ovi : Oi ch tbh akin tem apa ‘ebém quan sét nh dng ta dah sing ‘mau cam di dn soi vio diy mdi ya Fangodi qua l6 déng ut (Hinh 72), voipiy MAT BANG DEN SOT were Gatch mye dich cba vige Kiim dy kt ténh nhin bidu va hop téc tt ‘eh chin ngBi thing Img hoi thip ‘itp kgm. Yeu cdu bénh hin Hin 7.2. Ani dng tt eb mu cam thao hinh NovE hung di tai cing bén cia dang ding tt hen sraimiic. WN thm sit dung mit va = Sau 46 di chuyén dén soi theo hutng apinesoviot Yui cae ben, cae i on cca bah dng tt vio sit nd bab obin foi sing 98 | a voi, ‘a hi as Gl ccéch Khoding Lem (Hin 73). Dig chiah inhg bgt ae ce se aE On Ki lng og ty tain seat oy céc tu Ki dibu sng Ddongram ee | Matta dan inky rd nt ga thi, ngch ft, von vb sbng wit i soi Fin 7.1. ‘mac va hong diém (Hinh 7.4) = 8. KHAM LE 8A. Khém phat itn te guy g | quang trén giée mac fn % = Bénh nbn ngdi phia tase Khém 50cm, wii thich :% ey the | an tim va hdp tie tt hy = Nei khém ding dén thing vio mt Bésh shag bbgnh nbn nhin thing vo gah ga Quan sét vj ti cla chm sg aang ‘én gid mac. a + Néu chim séng nm n gidc mac: bénh hn they ign 6 (nh 8.1 ti), + N€a chim séng nm ich vig raf ofa tim dng 1 nigh ‘ngoai (Hinh 8.1 gia). : + Néu chifm séng nim lech vé thai dviomg: mat bi 1¢ tore ia 8.1 phi). 82. Dénh gid mite 46 host ding cis eo van nhiin ‘Bénh nhan ng6i cdch gui khim Se, gidi thich r6 @ bénh nan an tin hap téc tt. inh 7.4. Banh gi ga th, mach mau, ving mae va hong diém | 2 ; inh bén phai: Anh phan quang ngay hai tam gide mi ait Hinh 8 hinh gia: ich vé phfa mi & mt tél, hinh bén phi Kgch v8 phia thal ddr 288 anh 8.2. 9 hubng ni .y bah oban abin in ‘gui Khim ghi at hai mt trong 9 Tong 6 bg cia od tt von ra ngoai, oF Ue di (juti ra agoai, o¢ chéo trong, xu6ng dui, oo chéc trong lén rn, oo tre ng’ hin ra ngoai, co tree tr shin vao trong (Hinh 8.2). 9. RA QUYET DINE TRU BENH MAT THUONG GAI 9.4. Trung hyp 43 mit dén = Tinkiéim cdc dau higu gi bonh + Bénh sit DS mét dot dau nhife, khong m3 1 + C6 thé thay nhiéu bc da trong tring hdp (Finh 9.1). yeuck ‘pong: i cia | yeuclu bénb nbfin nbin Hin 1ugt theo 9 judng. New®i Kham ghi nbn d9 cin 6; cla bai mét trong 9 hudng nay. ‘rong 46 hung cla o6 trye trén li Ten tren ra ngoai, co tryc duéi 1a xudng difi ra ngodi, co chéo tén 2 vio trong, xudng dui, od chéo dudi la vio trong Jén trén, oo trye ngodi LA hung ain ra ngoai, o6 trye trong 18 huting ain vao trong (Hinh 82). 9. RA QUYET BINH TRUGC NHUNG BENH MAT THUONG GAP 941. Trung hop 46 mit don thuain + Timkiém céc dtu hifu giip chiin dodn benk + Bénh sit: BS mt dén thudn, khong du nde, khong mi mat. + C6 thé thay nhidu bong nuéc ngodi a trong trating hgp nhiém Herpes (inh 9.1). ‘tang nin rong dm hot dg ea tng co 2S an Hinh 9.1, Néibong nude da mt va trén, enh mii + C6 thé khém thiy simg dau hach tide tai Khi nbiém adenovirus + Khdm thy sung huyét két mac todn bp (Hinh 9.2). 289 Hin 9.2. Két mac nh + inh 9.3. Gid mge & két mac mitrén an cd ouang W Va PE Cnt tit trong ho ghen ho#e gid ‘mac (Hinh 9:3). _ ‘Tinm cdc dtu hidu dm tinh gidp Logi trit cde bonh kde ciing gay dd mat 20 ‘Thi lve va nhdn fp binh thug. Phin itng thé mi Am tinh Gite mac trong, thi nghigm fluorescein amin. ‘Tién phong sach, hign twong Tyndall ‘im toh. (Cli xt nghiém cin tim sang + + Soi tuoi v8 48 gh pret nu nk thy 6 prs wg kétmge wy Xét nghiém méu tim Hy , da qua ming do Fe KG ing ra quyé dink + Néu 4 mét don thud, y, khong dau, khong me mgy ey trong su6t, thir nghitm fy, fon tn, REL mae a na mae mi va cing & ta, phit hop abit 8 viem két mye NEu cht tet 6 dang aa ogc gid mac th) huGng te nahdn gay bénb 18 vi ting 3, hop chat ti€t trong suét aby mnt td hung de nts, vid thuting gap nbétla Adenon, Néu bénh nhan 06 kém vim in. dng thoi thi chén doén pti nhét 1 viém hong, viém kéi =, do Adenovirus. 9.2. Trading hgp 43 mit Kem mi vide hie mit ~ Tim kiém cdc déiu hiéu giip chindis benh i: Khai théc bénh sit v8 8 mit hie va mo mit. Do nhan 4p c& hai mit. Khém da mi va ving xune mf xem 06 dau higu viem 88 nue nut trong tring MP herpes khOng (Hinh 9). —— pigu phn tng thé mi, + ' Neon ( e Se ves i bien thy "Bhiém fhuore se Bi su 1 aa be lla tds bas Bide mae Gn cir i

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