睑缘炎相关性角结膜病变1例

doi:10.3877/cma.j.issn.2095-2007.2024.03.007

患者，男性，19岁。2024年3月患者诉因左眼结膜充血，眼部磨痛2周，伴畏光、眼部白色分泌物增多，无其他不适症状，曾就诊于当地医院，诊断为"左眼结膜炎"。给予"左氧氟沙星滴眼液和氧氟沙星眼膏抗炎治疗"，未见明显好转，遂就诊于北部战区总医院眼科，以"左眼角膜结膜病变"收入院。患者既往有阿莫西林过敏史；慢性泪囊炎病史2年，平素间断抗炎治疗，否认高血压和糖尿病等全身疾病史，否认手术史和外伤史。右眼裸眼视力1.0，左眼裸眼视力0.25，矫正视力不提高。双眼第一眼正位，眼球各方向运动无明显受限。经SL－D701型裂隙灯显微镜(日本TOPCON株式会社生产)检查，可见双眼上下睑无内外翻及倒睫，泪小点位正，挤压右眼泪囊区无溢脓，挤压左眼泪囊区有少量溢脓。见图1A。双眼上下睑睑缘肥厚变形呈毛刷状，可见黄白色脂栓堵塞，左眼较右眼重，左眼睑缘可见新生血管。见图1B。右眼结膜轻度充血，无水肿，角膜上皮粗糙，角膜后沉积物(－)，前房深度正常，前房闪辉(－)，虹膜纹理清，瞳孔圆，直径约3 mm，光反射(＋)，晶状体透明，玻璃体透明，视盘边界清晰，颜色正常，杯盘比0.3，视网膜血管走形大致正常，动静脉管径比约为1：3，视网膜未见出血及渗出，黄斑中心凹反光(＋)。左眼结膜混合充血(＋＋)，角膜上皮粗糙且欠透明，角膜后沉积物(－)，前房深度正常，前房闪辉(－)，虹膜纹理清，瞳孔圆，直径约3 mm，对光反射(＋)，晶状体透明，玻璃体透明，视盘边界清晰，颜色正常，杯盘比0.3，视网膜血管走形大致正常，动静脉管径比约为1：3，视网膜未见出血及渗出，黄斑中心凹反光(＋)。角膜荧光素钠染色显示双眼荧光素钠染色(＋)，右眼点状着染，左眼点片状着染。见图2。右眼眼压19 mmHg(1 mmHg＝0.133 kPa)，左眼眼压20 mmHg。经眼表睫毛螨虫相关检查，在76TV型电子显微镜(江西新怡光学仪器有限公司生产)下可见螨虫外观，螨虫啃食毛囊导致毛囊结构破坏。见图3。右眼泪膜首次破裂时间0.27 s，左眼为0.12 s；右眼泪膜平均破裂时间5.3 s，左眼为2.8 s；右眼睑板腺腺体缺失<1/3(Ⅰ级)，左眼腺体缺失>1/3且<2/3(Ⅱ级)。免疫相关检验检查结果显示，抗核抗体系列、红细胞沉降率、人白细胞抗原B27及类风湿3项等均为阴性。根据患者的症状、体征及辅助检查结果，诊断为双眼睑缘炎相关性角结膜病变(blepharo kerato conjunctieitis，BKC)；左眼慢性泪囊炎。局部使用左氧氟沙星滴眼液(日本参天制药株式会社生产)点左眼，4次/d; 0.1%氟米龙滴眼液(日本参天制药株式会社生产)点双眼，3次/d；复方硫酸锌滴眼液(沈阳兴齐眼药股份有限公司生产)点双眼，4次/d;玻璃酸钠滴眼液(德国URSAPHARM Arzneimittel GmbH生产)点双眼，3次/d；睑缘涂妥布霉素地塞米松眼膏(齐鲁制药有限公司生产)0.1 g，涂左眼，1次/晚；全身给予米诺环素(海正辉瑞制药有限公司生产)50 mg，口服，2次/d；辅助配戴角膜绷带镜，每日清洁睑缘，隔日一次睑板腺按摩，雾化熏蒸。治疗2周后复诊，患者双眼上下睑缘较前光滑，右眼结膜无充血和水肿，左眼结膜轻度充血，无水肿，双眼角膜光滑透明，荧光素钠染色均未见着染，视力恢复良好。见图4。

图1　睑缘炎相关性角结膜病变患者入院时裂隙灯显微镜下双眼眼前节彩色照相(×16)　图1A示右眼，图1B示左眼，红色箭头处提示左眼睑缘可见新生血管　图2　睑缘炎相关性角结膜病变患者入院时裂隙灯显微镜下左眼荧光素钠染色照相(×16)　可见点片状着染　图3　睑缘炎相关性角结膜病变患者在电子显微镜下的睫毛彩色照相(×100)　可见蠕形螨啃食睫毛毛囊，致毛囊结构破坏　图4　睑缘炎相关性角结膜病变患者经2周治疗后裂隙灯显微镜下双眼荧光素钠染色眼前节彩色照相(×16)　图4A和图4C示右眼，图4B和图4D示左眼，可见双眼上下睑缘较前光滑，右眼结膜无充血和水肿，左眼结膜轻度充血，无水肿，双眼角膜光滑透明，荧光素钠染色均未见着染

[14]	Suzuki T, Teramukai S, Kinoshita S. Meibomian glands and ocular surface inflammation[J]. Ocul Surf, 2015, 13(2): 133－149.
[15]	Haque RM, Torkildsen GL, Brubaker K, et al. Multicenter open－label study evaluating the efficacy of azithromycin ophthalmic solution 1% on the signs and symptoms of subjects with blepharitis[J]. Cornea, 2010, 29(8): 871－877.
[16]	Geerling G, Tauber J, Baudouin C, et al. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction[J]. Invest Ophthalmol Vis Sci, 2011, 52(4): 2050－2064.
[17]	金子群. 睑缘炎相关角结膜病变临床特征及影响因素分析[D]. 济南：山东中医药大学，2023.
[18]	Banteka M, O′Gallagher M, Bunce C, et al. Systemic treatment for blepharokeratoconjunctivitis in children[J]. Cochrane Database Syst Rev, 2016, 5: CD011750.
[19]	Choi DS, DjalilianA. Oral azithromycin combined with topical anti－inflammatory agents in the treatment of blepharokerato－conjunctivitis in children[J].J AAPOS, 2013, 17(1): 112－113.
[20]	Rousta ST. Pediatric blepharokeratoconjunctivitis: is there a′right′ treatment[J]. Curr Opin Ophthalmol, 2017, 28(5): 449－453.
[21]	Hammersmith KM, Cohen EJ, Blake TD, et al. Blepharokerato－conjunctivitis in children[J]. Arch Ophthalmol, 2005, 123(12): 1667－1670.
[22]	O′Gallagher M, Bunce C, Hingorani M, et al. A Topical treatments for blepharokeratoconjunctivitis in children[J].Cochrane Database Syst Rev, 2017, 2: CD011965.
[23]	Viswalingam M, Rauz S, Morlet N, et al. Blepharo－keratoconjunctivitis in children: diagnosis and treatment[J]. Br J Ophthalmol, 2005, 89(4): 400－403.
[24]	Hamda S, Khan I, Denniston AK, et al. Childhood blepharo－keratoconjunctivitis: characterising a severe phenotype in white adolescents[J]. Br J Ophthalmol, 2012, 96(7): 949－955.
[25]	Rodríguez－García A, Gonzlez－Godínez S, López－Rubio S. Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome[J]. Eye, 2016, 30(3): 438－446.
[26]	Bondalapati S, Cabrera MT. Subtenon triamcinolone acetonide injections for topical medication intolerance in chronic blepharokeratoconjunctivitis[J]. Cornea, 2014, 33(9): 999－1001.
[27]	Gupta N, Dhawan A, Beri S, et al. Clinical spectrum of pediatric blepharokeratoconjunctivitis[J]. J AAPOS, 2010, 14(6): 527－529.
[28]	Teo L, Mehta JS, Htoon HM, et al. Severity of pediatric blepharokeratoconjunctivitis in Asian eyes[J]. Am J Ophthalmol, 2012, 153(3): 564－570.
[29]	Rubin M, Rao SN. Effcacy of topicalcyclosporin 0. 05% in the treatment of posterior blepharitis[J]. J Ocul Pharmacol Ther, 2006, 22(1): 4－53.
[30]	Ismail AS, Taharin R, Embong Z. Topicalcyclosporin as an alternative treatment for vision threatening blepharokerato－conjunctivitis: a case report[J]. Int Med Case Rep J, 2012, 5(5): 33－37.
[31]	Jones SM, Weinstein JM, Cumberland P, et al. Visual outcome and corneal changes in children with chronic blephar－okeratoconjunctivitis[J]. Ophthalmology, 2007, 114(12): 2271－2280.
[32]	Sheppard JD, Singh R, McClellan AJ, et al. Long－term supplementation with n－6 and n－3 PUFAs improves moderate to severe keratoconjunctivitis sicca: a randomized double－blind clinical trial[J]. Cornea, 2013, 32(10): 1297－1304.
[33]	Sullivan BD, Cermak JM, Sullivan RM, et al. Correlations between nutrient intakeand the polar lipid profiles of meibomian gland secretions in women with Sjögren′s syndrome[J]. Adv Exp Med Biol, 2002, 506(Pt A): 441－447.
[34]	Erdinest N, Shmueli O, Grossman Y, et al. Anti－inflammatory effects of alphalinolenic acid on human corneal epithelial cells[J]. Invest Ophthalmol Vis Sci, 2012, 53(8): 4396－4406.
[35]	Szymczak M, Murray M, Petrovic N. Modulation of angiogenesis by omega－3 polyunsaturated fatty acids is mediated by cyclooxygenases[J]. Blood, 2008, 111(7): 3514－3521.
[36]	Fenton JI, Hord NG, Ghosh S, et al. Immunomodulation by dietary long chain omega－3 fatty acids and the potential for adverse health outcomes[J]. Prostaglandins Leukot Essent Fatty Acids, 2013, 89(6): 379－390.
[37]	王晓虹，丁琳．睑板腺功能障碍治疗进展[J].国际眼科纵览，2016，40(2)：126－131.
[38]	杨帆，曾庆延. 睑板腺功能障碍治疗进展[J].眼科新进展，2016，36(10)：996－1000.
[39]	Thode AR, Latkany RA. Current and emering therapeutic strategies for the treatment of meibomian gland dysfunction[J]. Drugs, 2015, 75(11): 1177－1185.
[40]	史伟云，王婷．谈羊膜移植在角膜和眼表疾病应用中的问题[J].中华实验科验杂志，2014，32(9)：769－772.
[41]	柯兰，杨燕宁. 多层羊膜移植治疗重度睑缘相关角结膜病变的临床观察[J]. 临床眼科杂志，2017，25(4)：359－361.
[42]	Utine CA, Stern M, Akpek EK. Clinical review: topical ophthalmic use of cyclosporin A[J]. Ocular Immumnol Inflamm, 2010, 18(5): 352－361.
[43]	Viswalingam M, Rauz S, Morlet N, et al. Blepharokerato－conjunctivitis in children: diagnosis and treatment [J]. Curr Opin Ophthalmol, 2015, 26(4): 301－305.
[1]	Lemp MA, Nichols KK. Blepharitis in the United States 2009：a survey－based perspective on prevalence and treatment [J]. Ocul Surf, 2009, 7(2): 1－14.
[2]	Lindsley K, Matsu mura S, Hatef E, et al. Interventions for chronic blepharitis[J]. Cochrane Database Syst Rev, 2012, PMID: 22592706.
[3]	张晓玉，王智群，张阳，等. 睑缘炎相关角结膜病变172例的临床分析[J]. 中华眼科杂志，2016，52(3)：174－179.
[4]	孙旭光，周玉梅，姜超，等. 438例睑缘炎患者的临床分析[J]. 中华眼科杂志，2013，49(10)：878－883.
[5]	刘又言，徐小凤，王宁，等. 睑缘炎相关角结膜病变的诊断和治疗研究进展[J]. 国际眼科杂志，2018，18(6)：1043－1046.
[6]	Jackson WB. Blepharitis: current strategies for diagnosis and management[J]. Can J Ophthalmol, 2008, 43: 170－179.
[7]	Farpour B, Mcclellan KA. Diagnosis and management of chronic blepharokeratoconjunctivitis in children[J]. J Pediatr Ophthalmol Strabismus, 2001, 38(4): 207－212.
[8]	刘艳红，王婷，史伟云，等. 药物源性角膜病变临床特征和治疗回顾分析[J]. 中华实验眼科杂志，2014，32(3)：246－250.
[9]	胡建民，林玲，高莹莹，等. 类风湿性关节炎患者眼表损害临床分析[J]. 临床眼科杂志，2004，12(3)：212－215.
[10]	肖启国，刘祖国，张梅，等. 过敏性结膜炎的临床特点[J]. 眼科新进展，2002，22(3)：197－199.
[11]	梁凌毅. Terrien′s角膜边缘变性[J]. 中国实用眼科杂志，2001，19(9)：649－652.
[12]	Daniel MC, O′Gallagher M, Hingorani M, et al. Challenges in the management of pediatric blepharokeratoconjunctivis ocular rosacea[J]. Expert Rev Ophthalmol, 2016, 11(4): 299－309.
[13]	Ismail AS, Taharin R, Embong Z. Topical cyclosporin as an alternative treatment for vision threatening blepharokerato－conjunctivitis: a case report[J]. Int Med Case Rep, J, 2012(5): 33－37.

No related articles found!

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

One case of blepharitis related corneal and conjunctival lesions

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

One case of blepharitis related corneal and conjunctival lesions