Some standard content:
1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ35—2002
Diagnostic Criteria of Occupational Cataract
Diagnostic Criteria of Occupational CataractPublished on April 8, 2002
Implemented on June 1, 2002
Ministry of Health of the People's Republic of China
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. From the date of implementation of this standard, if the original standard GB11502-1989 is inconsistent with this standard, this standard shall prevail. Occupational cataract is a disease caused by occupational chemical, physical and other harmful factors, mainly characterized by opacity of the eye lens, which can cause varying degrees of visual impairment in the contact person. This standard is formulated to enable early diagnosis and correct treatment to protect the health of the operator.
Appendix A of this standard is an informative appendix, and Appendix B, C, and D are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Hospital of Peking University, and the Institute of Occupational Health and Poison Control of the Chinese Center for Disease Control and Prevention participated in the drafting.
This standard is interpreted by the Ministry of Health of the People's Republic of China Occupational Cataract Diagnostic Standard
GBZ35-2002
Occupational cataract is a disease caused by occupational chemical, physical and other harmful factors, with the main feature of lens opacity. It may not be parallel to systemic diseases.
1 Scope
This standard specifies the diagnostic standards and treatment principles for occupational cataract. This standard applies to the diagnosis and treatment of occupational cataract. 2 Diagnostic Principles
There is a clear history of exposure to occupational harmful factors such as chemical and physical factors, with lens opacity as the main clinical manifestation, and reference to the work environment survey and the measurement of chemical concentrations in the air and radiation doses. Comprehensive analysis, excluding other non-occupational factors that cause changes in the lens, can be diagnosed. 3 Observation subjects
Through irradiation examination, there are dot-shaped shadows in the periphery or posterior pole of the lens: a)
Through irradiation examination, there are dot-shaped opacities in the periphery or posterior pole of the lens, and the cortex is still transparent; or b)
b ...
4.2 Second stage cataract
There are varying degrees of visual impairment and one of the following manifestations: a) The maximum width of the peripheral annular opacity exceeds 1/3 of the lens radius, but is less than 2/3. Sometimes annular opacity may also appear in the central part, and its range is equivalent to the size of the pupil diameter; b) The posterior subcapsular cortex is honeycomb-shaped opacity, and the anterior subcapsular cortex opacity is aggravated. 4.3 Third stage cataract
The peripheral opacity of the lens exceeds 2/3 of the lens radius; or there are dense dot-shaped or disc-shaped opacities in the central part; or the entire lens is opaque, with obvious visual dysfunction. Treatment principles
5.1 Treatment principles
Treat according to routine cataract treatment. If the lens is completely opaque, cataract extraction can be performed, and corrective glasses can be worn after the operation as appropriate. If conditions permit, artificial lens transplantation can be performed. Other treatments
Occupational cataract lens opacity is an irreversible damage and can affect visual function (central vision, visual field). Anyone who has a definite impact on vision should be separated from contact. 5.2.1 Those who already have lens opacity but no obvious optic nerve damage should also be transferred to other jobs as appropriate. 5.2.2 If the lens is opaque and the vision or visual field is obviously impaired, appropriate rest should be arranged, or light work should be performed. 6
Instructions for the correct use of this standard
See Appendix A (Informative Appendix), Appendix B, C, and D (Normative Appendix). Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 The pathogenic factors of occupational cataract are mainly chemical and physical factors. The common clinical manifestations are opacities of different degrees, different parts, and different forms of the eye lens. The common clinical types and main causes of occupational cataracts are as follows: a. Toxic cataracts, see Appendix C (normative appendix); b. Non-ionizing radiation cataracts, mainly microwave cataracts, infrared cataracts and ultraviolet cataracts. Microwave cataracts refer to damage to the eye lens caused by radiation in the frequency range of 300MHz~300GHz or 1m~1mm wavelength in electromagnetic waves; infrared cataracts are thermal radiation in a high-temperature working environment, that is, infrared radiation with a wavelength shorter than 3×10m causes lens damage; exposure to ultraviolet rays can also cause cataracts. c Ionizing radiation cataracts are divided into radioactive cataracts and electric shock cataracts. Electric shock cataracts mainly refer to the opacity of the eye lens caused by electric shock after repairing live circuits and electrical appliances, or leakage current caused by reduced insulation performance of electrical appliances and other currents contacting the body surface.
A.2 The diagnosis of occupational cataracts is mainly based on the judgment of the morphology, characteristics, distribution and occupational factors of the opacity of the eye lens. In terms of occupational exposure history, for cataracts caused by chemical factors, attention should be paid to the concentration of toxic substances in the working environment; for cataracts caused by physical factors, attention should be paid to the radiation doses of various radiation factors, and simulated on-site measurements should be carried out when necessary. A.3 Currently the most common cataract is trinitrotoluene poisoning cataract. It is characterized by the presence of a large number of gray-yellow tiny punctate opacities of varying sizes in the anterior and posterior cortices of the lens. In severe cases, an annular or disc-shaped opacity equal to the diameter of the pupil appears in the central part. When examined by thorough illumination, an annular shadow formed by a large number of wedge-shaped opacities can be seen in the peripheral part of the lens. A.4 Cataracts caused by ionizing radiation have their own particularities in protection, diagnosis and treatment, and separate diagnostic standards are established. A.5 The problem of cataracts caused by non-ionizing radiation needs further experience summary. Appendix B
(Normative Appendix)
Requirements for ophthalmological examination and clinical observation
B.1 Thoracic examination: Under the condition of excluding glaucoma, perform a direct ophthalmoscope after fully dilating the pupil with 5% phenylephrine or compound tropicamide. Focus on observing the lens, and pay attention to vitreous and fundus lesions. B.2 Slit lamp examination: After the thoracic examination, use a slit lamp microscope to observe and record the changes in the lens in detail (diffused light and optical section examination), and mark the location and range of the lesions in the following format. Right eye
Illumination
Light section of the lens
B.3 General requirements for ophthalmology: Detailed medical history, routine external eye examination. Visual acuity examination includes distance and near vision and corrected vision.
B.4 Peripheral opacity of the lens (taking trinitrotoluene cataract as an example). B.4.1 The annular shadow in the peripheral part of the lens is formed by the connection of many wedge-shaped opacities, with the base of the wedge pointing to the periphery and the tip pointing to the center. There is a transparent zone between the peripheral part and the annular shadow. Slit lamp examination shows that the peripheral opacities are located in the anterior and posterior cortex and the adult nucleus. B.4.2 The central annular opacities and discoid opacities are fine gray-yellow granular opacities in the anterior cortex of the lens, located in the pupil area, and their diameter may be equal to the size of the pupil.
B.4.3 As the opacities in the peripheral part of the lens become more severe, the transparency of the lens cortex may decrease. B.5 Opacities in the posterior subcapsular cortex of the lens (taking radiation cataract as an example). B.5.1 The opacities in the posterior subcapsular cortex of the lens are fine dot-shaped opacities, arranged in a ring and gradually forming a disc shape. It can also extend to the deep layer of the cortex to form a pagoda-shaped appearance. In severe cases, it presents a honeycomb-shaped opacity. B.5.2 Irregular stripe-shaped opacities may appear around the discoid opacities, extending to the equator. Anterior and posterior subcapsular cortical opacities are often accompanied by vacuoles.
Visual impairment
Opacity in the peripheral part of the lens generally has no obvious effect on vision. B.6.1
Anterior central ring or disc-shaped opacity in the lens, disc-shaped opacity or honeycomb opacity in the posterior pole, with the increase of opacity density and the expansion of range, can lead to different degrees of visual impairment Appendix C
(Normative Appendix)
Toxic cataract
Occupational toxic cataract is mainly caused by long-term exposure to trinitrotoluene, naphthalene, thallium, dinitrophenol, etc. C.1
Eye disease with changes in the lens opacity as the main manifestation. Trinitrotoluene cataract is the most common. The degree of lens opacity is related to the contact time and contact amount. 2 The morphology and distribution of lens opacity caused by trinitrotoluene toxicity cataract have obvious characteristics. Refer to 4.1.a, 2
4.2.a, 4.3 and Appendix B (Normative Appendix). Appendix D
(Normative Appendix)
Ionizing radiation cataractwwW.bzxz.Net
Ionizing radiation cataract includes radiation cataract and electric shock cataract. Radiation cataract is ionizing radiation damage to the lens of the eyes or eyes caused by exposure to X-rays (such as medical X-rays), Y-rays, neutron rays, etc. Its diagnostic criteria and treatment principles refer to GBZ95.
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