病例7　20歲男性，眼紅、眼癢不適反復1年

CASE 7　A 20-year-old male, with both eyes redness, itching and irritation for 1 year

見圖1-10、圖1-11。See Figs. 1-10 and 1-11.

鑒別診斷

Differential Diagnosis

◎ 春季角結(jié)膜炎：結(jié)膜乳頭是本病的主要體征。本病在臨床上分為三型：瞼結(jié)膜型，乳頭主要位于上瞼結(jié)膜，呈鋪路石樣外觀；角膜緣型，角膜緣Horner-Trantas結(jié)節(jié)；混合型，瞼結(jié)膜和角膜緣均累及，嚴重者合并角膜盾形潰瘍。

◎ Vernal keratoconjunctivitis (VKC): The hallmark of VKC is papillary hyperplasia. VKC can be classif ied into three variants. Palpebral variant: papillae are predominantly located in the upper tarsal conjunctiva with a cobblestone appearance. Limbal variant: Horner-Trantas dots in the superior limbus are characteristic feature. The mixed variant of VKC has clinical features of both limbal and palpebral VKC. Severe VKC may be associated with corneal “shield” ulcer.

◎ 巨乳頭性結(jié)膜炎：患者常有角膜接觸鏡、眼部假體或縫線等刺激誘因，以直徑>1mm的結(jié)膜乳頭為主要臨床特征。

◎ Giant papillary conjunctivitis (GPC): Giant papillary conjunctivitis is associated with continuous irritations from a foreign body such as an ocular prosthesis, exposed suture, or more commonly, contact lenses. The conjunctival giant papillary (>1mm) is clinical characteristic of GPC.

病史詢問

Asking History

◎ 是否有過敏原，是否伴隨過敏性鼻炎。

◎ Asking the disease associated with allergens, such as allergic rhinitis.

◎ 是否有角膜接觸鏡配戴史、手術或者外傷史。

◎ And the history about wearing contact lens, surgery or trauma.

檢查

Examination

◎ 視力下降。

◎ Visual acuity is decreased.

◎ 裂隙燈顯微鏡檢查見瞼結(jié)膜充血水腫，伴局部分泌物，呈鋪路石樣的巨大乳頭，角膜緣可有Horner-Trantas結(jié)節(jié)，角膜盾形潰瘍（圖1-10、圖1-11）。

◎ Slitlamp examination: VKC is characterized by the presence of conjunctival hyperemia, edema, discharge,“cobblestone” papillae, Horner-Trantas dots in the limbal,corneal shield ulcer (Fig.1-10, Fig. 1-11).

實驗室檢查

Lab

◎ 結(jié)膜刮片或印跡細胞學檢查，可見嗜酸性粒細胞。

◎ Conjunctiva scraping or conjunctiva impression cytology shows eosinophils.

◎ 淚液或血液IgE抗體檢測，IgE抗體呈陽性。

◎ Tear or blood IgE antibody test is positive.

診斷

Diagnosis

春季角結(jié)膜炎。

Vernal keratoconjunctivitis.

治療

Management

◎ 避免接觸過敏原。

◎ Avoidance of allergen.

◎ 肥大細胞穩(wěn)定劑和抗組胺藥。

◎ Mast cell stabilizer and antihistamine drug.

◎ 局部糖皮質(zhì)激素、非甾體抗炎藥以及免疫抑制劑。

◎ Topical glucocorticoid, non-steroid anti-inf lammatory drug and immunosuppressor.

◎ 人工淚液。

◎ Artif icial tears.

患者教育和預后

Patient Education & Prognosis

◎ 應囑患者脫離過敏原。

◎ Tell the patients to avoid allergen.

◎ 在過敏季節(jié)之前使用預防性藥物，如抗組胺劑 / 肥大細胞穩(wěn)定劑。

◎ Using antihistamine drug or mast cell stabilizer before seasons when allergy occurs.

◎ 預后取決于病情嚴重程度。

◎ The prognosis is depending on the severity of the condition.