隐匿性眼表异物致眼部损伤的临床特点分析

Clinical analysis of ocular injury caused by hidden ocular surface foreign bodies

目的分析隐匿性眼表异物致眼部损伤的临床特点。方法回顾性病例研究。收集华中科技大学同济医学院附属同济医院眼科2019年1月至2020年10月接诊的隐匿性眼表异物致眼部损伤的24例(24眼)临床资料,分析其临床表现、体征及诊断方法中的共同特点。结果本研究中,男性11例(11眼),女性13例(13眼),年龄4~71(42.29±19.37)岁,病程7~245(53.21±62.03)d。所有患者在就诊时均未述外伤史,且均有≥2次就诊经历。患者主诉主要包括异物感(16例)、眼痛(5例)、流泪(4例)、视力下降(4例)、分泌物增多(1例)。体征主要包括结膜充血(13例)、眼睑痉挛(3例)、角膜溃疡(5例)、结膜肉芽肿(2例)。行角膜荧光素染色后,20例(83.33%,20/24)患者角膜荧光素染色阳性,3例(12.50%,3/24)患者结膜荧光素染色阳性。在溃疡或角膜荧光素染色阳性对应部位发现异物。睫毛(45.83%,11/24)是发现最多的隐匿性眼表异物,而上睑结膜/上穹隆(45.83%,11/24)是隐匿性异物最常见的位置。5例角膜溃疡,结膜囊内取出谷壳的患者结膜囊分泌物及角膜溃疡刮片培养出金黄色葡萄球菌,另4例角膜溃疡刮片细菌、真菌培养均为阴性。所有患者经异物摘出后,症状均明显好转,1周后复查角膜荧光素染色均呈阴性。结论隐匿性眼表异物致眼部损伤患者多无明确外伤史,临床表现以异物感居多,部分伴眼红、流泪或分泌物增多,角膜溃疡者可伴眼睑痉挛和视力下降,病程长者可出现结膜肉芽肿。角膜荧光素染色检查有助于明确诊断。取出异物后,患者结果良好。

Objective To analyze the clinical traits of ocular injury brought on by hidden foreign body on the ocular surface.Methods This was a retrospective case series study.The clinical data of 24 eyes of 24 patients with ocular suface injury induced by hidden foreign body treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Jan.2019 to Oct.2020 were included.The common characteristics of clinical manifestations,signs and diagnosis methods were analyzed.Results In this study,there were 11 eyes of 11 males and 13 eyes of 13 females,aged from 4 to 71 years,with an average of(42.29±19.37)years.The disease course was from 7 to 245 days,with an average of(53.21±62.03)days.All patients had at least twice visits with no declaration of trauma history on their appointments.The main complaints of the patients included foreign body sensation in 16 cases,pain in 5 cases,tearing in 4 cases,decreased vision in 4 cases,and increased discharge in 1 case.The main signs included conjunctival hyperemia in 13 cases,blepharospasm in 3 cases,corneal ulcer in 5 cases,conjunctival granuloma in 2 cases.Twenty patients(83.33%,20/24)were positive for corneal fluorescein sodium staining,and 3 patients(12.50%,3/24)were positive for conjunctival fluorescein staining.Foreign bodies were found in areas corresponding to corneal ulcers or positive corneal fluorescein staining.Eyelashes(45.83%,11/24)were the most commonly found hidden foreign bodies on the ocular surface,while conjunctival/superior fornix of the upper eyelid(45.83%,11/24)was the most common location for hidden foreign bodies.Among 5 patients with corneal ulcer,Staphylococcus aureus was cultured from conjunctiva sac secretions and corneal scraping in 1 patient with rice husk removed from his conjunctiva sac,while bacteria and fungi cultures from corneal scrapings were negative in the other 4 patients.After the removal of foreign bodies,the symptoms of all patients were significantly released,and the corneal fluorescein staining was negative 1 week later.Conclusion Patients with ocular surface injury caused by hidden foreign bodies almost have no history of trauma.The clinical manifestations are mostly foreign body sensation,some with tears,congestion or increased secretions,blepharospasm and decreased vision in patients with corneal ulcers,and conjunctival granuloma in patients with long course.Corneal fluorescein staining is helpful for diagnosis.The results are good after removal of the foreign bodies.