病例8　45歲女性，雙眼異物感3個月

CASE 8　A 45-year-old female patient, with both eyes foreign body sensation for three months

見圖1-12。See Fig. 1-12.

鑒別診斷

Differential Diagnosis

◎ 絲狀角膜炎：原因不明，干眼是其主要的病因。角膜上皮的異常生長代謝和黏液的聚集是其病理基礎(chǔ)，角膜表面形成黏絲樣贅生物，患者伴有不同程度異物感、眼疼、畏光流淚等癥狀。

◎ Filamentary keratitis: The pathogeny of filamentary keratitis is still unknown and dry eye is the main possible cause. The abnormal growth and metabolism of corneal epithelium and the accu m ulation of mucus are its pathological basis. The corneal surface forms mucinous f ilamentous exc res cence. The patients frequently complain of different degrees of foreign body sensation, eye pain,photophobia and tearing.

◎ 角膜上皮剝脫：通常與外傷和眼部原有疾病（如角膜上皮基底膜營養(yǎng)不良）有關(guān)，癥狀與絲狀角膜炎類似，但更為強烈。

◎ Corneal epithelial exfoliation: Corneal epithelial ex f oliation is usually related to trauma or the original diseases of the eye (such as corneal epithelial bas e ment membrane dystrophy). The symptoms are simi lar to but more severe than f ilamentary keratitis.

◎ 角膜異物：多有異物進眼史，裂隙燈檢查可發(fā)現(xiàn)角膜上附著異物。

◎ Corneal foreign body: Mostly it has a history of injury that lead to some foreign bodies into eyes, which can be checked by the slit lamp.

病史詢問

Asking History

◎ 疾病何時發(fā)生，是否反復(fù)。

◎ Asking the duration of disease, the history of recurrence.

◎ 是否患有其他眼部疾病，如病毒性角結(jié)膜炎、干眼等，是否有眼部手術(shù)史或長期配戴接觸鏡史。

◎ The history of other eye diseases (such as viral ke ratoconjunctivitis, dry eye, the history of eye surgery or longterm contact lens wearing).

◎ 是否有全身慢性疾病史和自身免疫病史，如類風(fēng)濕性關(guān)節(jié)炎或干燥綜合征，以及是否接受過放療化療。

◎ The history of systemic chronic diseases and autoimmunity(such as rheumatoid arthritis or Sj?gren’s syndrome),chemotherapy and irridiation therapy for cancer patients.

檢查

Examination

◎ 裂隙燈檢查見角膜上單個或數(shù)個卷曲狀的絲狀物，長短不一，一端附著于角膜，另一端游離，并隨瞬目運動彎曲移動，孟加拉紅染色陽性。絲狀物與角膜黏附牢固，用力眨眼后可能自行脫落，對應(yīng)區(qū)域角膜上皮缺損，常合并角膜點狀上皮糜爛或表層點狀角膜炎（圖1-12）。

◎ Slit lamp examination: Single or multiple curly f ilaments of different lengths can be seen on the cornea. One end of the f ilaments is attached to the cornea, the other end is free,bending and moving with the blink movement. Bengal red staining positive. Filaments adhere f irmly to the cornea.When blinking hard it may fall offand corneal epithelial defects in the corresponding area. It is often combined with corneal punctate epithelial erosion or superf icial punctate keratitis (Fig. 1-12).

實驗室檢查

Lab

◎ 紅細胞沉降率（血沉）、類風(fēng)濕因子、抗核抗體、抗SS-A抗體及抗SS-B抗體等排查患者是否有自身免疫系統(tǒng)疾病。

◎ Erythrocyte sedimentation rate (ESR), Rheumatoid factor(RF), antinuclear antibody, anti-SS-A antibody, anti-SS-B antibody, etc., are used to check whether patients have autoimmune diseases.

診斷

Diagnosis

絲狀角膜炎。

Filamentary keratitis.

治療

Treatment

◎ 去除誘因，積極治療原發(fā)病；

◎ Remove the inducement and treat the primary disease actively.

◎ 在表面麻醉下擦除或剔除絲狀物；

◎ Wipe or remove the f ilaments with topical anesthetic.

◎ 抗生素眼藥水或眼藥膏預(yù)防感染；

◎ Antibiotic eye drops or ointment.

◎ 人工淚液或自體血清減輕癥狀促進愈合；

◎ Artif icial tears or serum.

◎ 乙酰半胱氨酸減少絲狀物黏性；

◎ Acetylcysteine.

◎ 角膜繃帶鏡減輕癥狀，減少復(fù)發(fā)。

◎ Bandage contact lens.

患者教育和預(yù)后

Patient Education & Prognosis

◎ 病因眾多且不明確，需要積極尋找可能的原因，并積極予以治療。

◎ The etiology is numerous and unclear. It is necessary to actively look for possible causes and actively treat them.

◎ 如果潛在病因持續(xù)存在，如干燥綜合征或全身慢性疾病等，治療困難且易復(fù)發(fā)。

◎ If the underlying etiology persists, such as Sj?gren’s syndrome or chronic systemic diseases, it is difficult to treat and easy to relapse.

◎ 部分輕度患者可自愈，絲狀物不可自行刮除，以免感染。

◎ Some mild cases can recovery with no treatment. But to avoid infection, it is important to advise the patients not to scrape the f ilaments themselves.