面部红斑痤疮患者眼部损害的表现及其治疗

Clinical characteristics and treatment effect in patients with facial rosacea combined ocular damage

目的探讨面部红斑痤疮患者眼部损害的特征及治疗方法。设计回顾性病例系列。研究对象2010年1月--2012年12月在沈阳军区总医院眼科就诊的伴有眼部损害的面部红斑痤疮患者16例，年龄16～56岁。方法除肉眼观察外，以裂隙灯显微镜检查眼部，并用其弥散光线扫描观察面部皮肤的细微改变，特别是血管的异常。对12例眼干涩的患者进行泪液分泌试验及泪膜破裂时间测定。对面部及鼻部皮肤进行螨虫检查。对睑缘进行微生物学镜检及培养。患者口服盐酸米诺环素50mg，2次／日，维持3~6个月；联合氯替泼诺混悬滴眼液点眼3次／日，左氧氟沙星眼液点眼3次／日，直到眼部体征改善后2周。随访12个月。主要指标皮肤改变，眼部改变，泪液分泌试验及泪膜破裂时间。结果面部皮肤红斑血管扩张16例（100．0％），结膜充血及球结膜血管扩张变形或增生16例（100．0％），睑缘结膜炎14例（87．5％），干眼12例（75．O％），下方角膜舌状、树状血管翳4例（25．0％），面部肥大性酒渣鼻6例（37．5％），角膜溃疡4例（25．0％），表层巩膜炎4例（25．0％），虹膜睫状体炎2例（12．5％）。治疗后，皮肤及眼部病变均明显改善，面部及鼻部皮肤红斑消退，角膜血管翳消退、角膜浸润灶消失，结膜充血消失。结论面部红斑痤疮患者眼部损害表现常不典型、难于辨认，血管改变是基本依据，常需结合面部血管改变明确诊断。全身应用盐酸米诺环素联合局部皮质类固醇对伴有眼部损害的面部红斑痤疮患者效果显著。（眼科，2014，23：121．J25）

Objective To investigate the clinical characteristics and treatment of facial rosacea with ocular damage. Design Retro- spective case series. Participants Sixteen cases of facial rosacea with ocular damagewere enrolled from January 2010 to December 2012. The age range at presentation was between 16 and 56 years. Methods 16 cases of medical records were followed up for 12 months. In addition to gross inspecting rosacea lesions of the eyes and face, slitlamp and microscope were used to detect the subtle changes in the face and eyes, particular vascular abnormalities. Tests of tear production and tear breakup time （BUT） were performed in 12 patients with ocular dry sensation. Mites were checked on face and nasal skin, and microbiological examination and culture were performed on the palpebrals. Minocycline hydrochloride was used orally 50 mg, twice one day for 3 to 6 months. Topical corticosteroids （loteprednol suspension eye drop） and antibiotic （levofloxacin） were used 3 times one day until two weeks after ocular changes were negative. Main Outcome Measures Skin changes, ocular changes, Schirmer test and tear film BUT. Results Clinical features： common signs of facial skin showed erythema vasodilation hyperplasia in 16 patients （100%）, conjunctival hyperemia and conjunctival vasodila- tion deformation or hyperplasia in 16 patients（100%）, 14 cases （87.5%） of blepharoconjunctivitis and 12 cases （75%） of dry eye. Less common signs were including 4 cases （25%） of inferior corneal tongue and tree-like pannus, 6 cases （37.5%） of facial rhinophyma, 4 cases （25%） of corneal ulcers, 4 cases （25%） of episcleritis and two cases （12.5%） of iridocyclitis. After the medication treatment, skin and eye lesions of all the participants were significantly improved （100%）. It showed that erythema of facial and nasal skin, and corneal pannus was subsided, corneal infiltrates and conjunctival hyperemia disappeared. Conclusion Atypical ocular clinical manifestations were often difficult to identify, vascular changes was the basis sign, facial vascular changes were often combined for diagnosis. And it was very effective to use minocycline hydrochloride combined with corticosteroid for facial rosacea with ocular damage.