病例11　34歲女性，雙眼反復紅、疼痛、畏光數年

CASE 11　A 34-year-old female, with recurrent bilateral redness, pain and photophobia for many years

見圖1-16。See Fig. 1-16.

鑒別診斷

Differential Diagnosis

◎ Thygeson淺層點狀角膜炎：Thygeson淺層點狀角膜炎是一種自發性、暫時性、雙眼性疾病，表現為粗糙的角膜上皮混濁但無基質浸潤。

◎ Thygeson superf icial punctate keratitis (TSPK): TSPK is an idiopathy, transient, bilateral disease, having coarse and punctuate corneal epithelial lesions and no associated stromal involvement.

◎ 流行性角結膜炎：流行性角結膜炎有明顯的結膜充血水腫，瞼結膜多量濾泡增生，結膜囊大量水樣分泌物，可有偽膜形成；角膜病變表現為上皮下的點狀浸潤，熒光素一般不著色。

◎ Epidemic keratoconjunctivitis (EKC): EKC is chara cte rized by obviously conjunctival congestion and edema.A large amount of follicle present in the palpebral con j unctiva and watery discharge in the conjunctival sac. There may be pseudomembrane. The focal subepithelial inf iltr a ti on may not stain with f luorescein dye.

病史詢問

Asking History

◎ 疾病是否反復發作。

◎ Asking the history of recurrent attack.

◎ 疾病發作前是否有病毒感染史。

◎ Asking the history of infection by virus.

檢查

Examination

◎ 視力正常或者輕度下降。

◎ Visual acuity is normal or mild decreased.

◎ 裂隙燈檢查：檢查瞼板腺功能，角膜上皮及上皮下散在均勻點狀混濁，略隆起表面，邊界清，混濁間角膜正常。

◎ Slit-lamp examination: to check the meibomian gland function. Rough bilateral punctate intrae p i t h e l ial and subepithelial opacities, which are usually sli g ht ly elevated the epithelium. The boundary of lesions is clear and the cornea between lesions is clear.

◎ 角膜活體共聚焦顯微鏡檢查：角膜上皮層可見高密度區，前彈力層大量朗格漢斯細胞。

◎ Laser confocal microscopy: Clusters of highly reflective dots are revealed in the epithelium. There are lots of Langerhans cells under the epithelium.

診斷

Diagnosis

Thygeson淺層點狀角膜炎。

Thygeson superf icial punctate keratitis.

治療

Management

◎ 局部人工淚液或者凝膠可用于輕度患者。

◎ Artif icial tear eye-drops or ointments may be a suitable treatment for mild cases.

◎ 局部低濃度糖皮質激素。

◎ Low-dosage steroidal eye-drops.

◎ 局部應用環孢素 / 他克莫司。

◎ Ciclosporin/Tacrolimus.

患者教育和預后

Patient Education & Prognosis

◎ 該病為慢性疾病，病程較長（從幾個月到幾年不等），可以反復發作，可能加重或緩解；最終恢復可不遺留瘢痕。

◎ TSPK is a chronic disease of recurrent and long duration(from months to years) with exacerbations or remissions;eventual healing without scars.