经久不愈的丝状角膜炎1例

A case of intractable filamentary keratitis

45岁男性,因"右眼上睑抬不起来,刺痛、畏光、流泪1年余"来我院就诊。既往体健,否认全身疾病史及特殊用药史,否认手术史。5年前有车祸史。查体:双眼裸眼视力均为1.0。右眼上睑轻度下垂,上方球结膜局限性充血,上方角膜见丝状物及多个不规则浅基质层灰白色混浊灶,前房及眼后节未见异常。SchirmerⅠ试验:右眼24 mm/5 min,左眼25 mm/5 min。眼眶磁共振成像(MRI)示:双侧眼球和眼眶未见明显病变征象。初诊为右眼丝状角膜炎、后天性上睑下垂。予局部麻醉下行右眼探查发现,右眼上穹隆结膜深处有一异物,部分刺破结膜暴露于穹隆部,予以取出。术后第1天患者右眼眼部不适症状缓解,角膜丝状物消失,角膜上皮无着染。讨论体会:丝状角膜炎病因多样,需要积极寻找疾病背后真正的病因。对于病程较长,疗效不佳的病例,临床医师应该多与患者交流,善于倾听,多了解病史中的一些细节,以便找出一些蛛丝马迹。临床诊疗过程中,必须重视基本的体格检查。

A 45-year-old man presented with photophobia,pain,and ptosis in the right eye for more than one year.Previously healthy,denied history of systemic diseases,history of special medication,and history of surgery.There was a car accident history 5 years ago.Slit-lamp examination of his right eye revealed epithelial filaments and multiple gray-white opacity lesions in one-third of the upper cornea.The results of SchirmerⅠtest were 24 mm/5 min and 25 mm/5 min in the right and left eye respectively.Orbital MRI report showed no remarkable lesions.His right eye was diagnosed as filamentary keratitis and acquired ptosis.An exploratory surgery was performed under local anesthesia,and a foreign body was taken out from the superior fornix of conjunctiva of the right eye.On the first postoperative day,his filamentary keratitis resolved.Filamentous keratitis has various causes,and it is necessary to actively search for the real cause behind the disease.For cases with a long course of disease and poor efficacy,clinicians should communicate with patients more,be good at listening,and learn more about some details in the medical history in order to find some clues.In the process of clinical diagnosis and treatment,basic physical examination must be emphasized.