病例7　20岁男性，眼红、眼痒不适反复1年

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

见图1-10、图1-11。See Figs. 1-10 and 1-11.

鉴别诊断

Differential Diagnosis

◎ 春季角结膜炎：结膜乳头是本病的主要体征。本病在临床上分为三型：睑结膜型，乳头主要位于上睑结膜，呈铺路石样外观；角膜缘型，角膜缘Horner-Trantas结节；混合型，睑结膜和角膜缘均累及，严重者合并角膜盾形溃疡。

◎ 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.

◎ 巨乳头性结膜炎：患者常有角膜接触镜、眼部假体或缝线等刺激诱因，以直径>1mm的结膜乳头为主要临床特征。

◎ 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.

病史询问

Asking History

◎ 是否有过敏原，是否伴随过敏性鼻炎。

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

◎ 是否有角膜接触镜配戴史、手术或者外伤史。

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

检查

Examination

◎ 视力下降。

◎ Visual acuity is decreased.

◎ 裂隙灯显微镜检查见睑结膜充血水肿，伴局部分泌物，呈铺路石样的巨大乳头，角膜缘可有Horner-Trantas结节，角膜盾形溃疡（图1-10、图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).

实验室检查

Lab

◎ 结膜刮片或印迹细胞学检查，可见嗜酸性粒细胞。

◎ Conjunctiva scraping or conjunctiva impression cytology shows eosinophils.

◎ 泪液或血液IgE抗体检测，IgE抗体呈阳性。

◎ Tear or blood IgE antibody test is positive.

诊断

Diagnosis

春季角结膜炎。

Vernal keratoconjunctivitis.

治疗

Management

◎ 避免接触过敏原。

◎ Avoidance of allergen.

◎ 肥大细胞稳定剂和抗组胺药。

◎ Mast cell stabilizer and antihistamine drug.

◎ 局部糖皮质激素、非甾体抗炎药以及免疫抑制剂。

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

◎ 人工泪液。

◎ Artif icial tears.

患者教育和预后

Patient Education & Prognosis

◎ 应嘱患者脱离过敏原。

◎ Tell the patients to avoid allergen.

◎ 在过敏季节之前使用预防性药物，如抗组胺剂 / 肥大细胞稳定剂。

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

◎ 预后取决于病情严重程度。

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