- 中英对照眼科临床病例荟萃
- 李筱荣 林海江主编
- 1361字
- 2025-05-08 15:31:28
病例10 72岁女性,右眼红痛20天。患者既往类风湿性关节炎病史
CASE 10 A 72-year-old female, with right eye redness and pain for 20 days. The patient has the history of rheumatoid arthritis
见图1-15。See Fig. 1-15.

图1-15 结膜充血水肿,角膜缘全周溃疡,下方较重,变薄Fig. 1-15 Conjunctival congestion and edema. The 360 degrees of limbus ulcer and more severe and thinner in the inferior
鉴别诊断
Differential Diagnosis
◎ 边缘性角膜溃疡:是指近角膜缘处角膜基质的半月形炎症性病变,伴随角膜上皮缺损以及基质炎症浸润。多伴有全身免疫性疾病。
◎ Peripheral ulcerative keratitis (PUK): PUK is a type of crescent-shaped inf lammatory damage that occurs in the cornea limbus, always combined with an epithelial defect and the destruction of the peripheral corneal stroma. PUK may have a connection with systemic immune disease.
◎ 蚕食性角膜溃疡:是一种慢性疼痛性周边角膜溃疡性疾病,原因不明。溃疡起始于角膜缘,向周边及中央区进展,呈潜掘状。最后大部分角膜被血管化混浊的组织替代,残余角膜中央岛。
◎ Mooren ulcer: Mooren ulcer is characterized by painful peripheral corneal ulceration of unknown etiology. The ulcer extends circumferentially and centrally with a leading undermined edge. Cornea is replaced by a vascularized,opaque thinned tissue leaving behind a central island of cornea.
◎ Terrien角膜边缘变性:是一种少见的特发性的角膜周边变薄,通常双眼发病。
◎ Terrien marginal degeneration: Terrien marginal degeneration is a rare idiopathic peripheral corneal thinning that usually occurs in both eyes.
◎ 泡性角结膜炎:为眼部的非感染性疾病,是微生物抗原引起的免疫反应,引起角膜和结膜的结节样病变。
◎ Phlyctenular keratoconjunctivitis: It is an immune respond to microbial antigens to cause the corneal and conjunctival nodular lesions.
◎ 透明边缘性角膜变性:是一种非炎症性的扩张性角膜疾病,表现为周边角膜窄带样变薄,与角膜缘间隔1~2mm,是一种罕见的角膜疾病。
◎ Pellucid marginal degeneration: Pellucid marginal degeneration (PMD) is a non-inf lammatory ectatic corneal disease characterized by a narrow band of corneal thinning separated from the limbus by a relatively uninvolved area 1 to 2 mm in width. It is a rare corneal disorder.
病史询问
Asking History
◎ 询问是否有类风湿性关节炎、Wegener肉芽肿、复发性多软骨炎等全身免疫相关疾病。
◎ Asking the history of systemic diseases such as rheu ma toid arthritis, Wegener’s granuloma and recurrent polychondritis.
检查
Examination
◎ 视力下降。
◎ Visual acuity is decreased.
◎ 裂隙灯检查:角膜缘处角膜基质的新月形炎性浸润,伴随角膜上皮缺损和基质变薄。
◎ Slit-lamp examination: crescent-shaped inf la mmatory inf iltration that occurs in the limbal region of the cornea,combined with an epithelial defect and thinning of the peripheral corneal stroma.
实验室检查
Lab
◎ 全身自身免疫性疾病检查包括:全血细胞计数(CBC)、尿液镜检、抗核抗体(ANA)、抗中性粒细胞胞浆抗体(ANCA)、类风湿因子(RF)、抗环瓜氨酸肽(anti-CCP)、快速血浆反应素试验(RPR)、荧光密螺旋体抗体(FTAAbs)、胸部X线、结核菌素纯蛋白衍化物实验(PPD)、骶髂关节X线、鼻窦CAT扫描、乙肝及丙肝病毒检查。
◎ Systemic evaluation for underlying autoimmune dise ases may include: Complete blood count (CBC), urinalysis with microscopic analysis (UAµ), antinuclear antibody (ANA), anti-neutrophil cytopl asm ic antibody(ANCA), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), rapid plas ma reagin (RPR), f luorescent treponemal ant ibody (FTA-Abs), chest X-ray, tuberculin purif ied protein derivative (PPD), sacroiliac joint X-ray,CAT scan of sinuses, hepatitis B virus, hepatitis C virus.
◎ 角膜微生物培养。
◎ Corneal microbial culture.
诊断
Diagnosis
边缘性角膜溃疡。
Peripheral ulcerative keratitis.
治疗
Management
◎ 无防腐剂的人工泪液,泪点塞或者泪点烧灼,角膜绷带镜可用于治疗干眼,促进角膜上皮化。
◎ Preservative free artif icial tears, closure of puncta with plugs or cautery, and bandage soft contact lens are used to treat associated dry eye and promote epithelialization of the ulcer.
◎ 氰基丙烯酸盐黏合剂可用于有穿孔风险的角膜溃疡。
◎ Cyanoacrylate adhesive may be applied to the ulcer bed to limit ulceration in cases of impending perforation.
◎ 局部抗生素用于预防细菌感染。
◎ Topical antibiotics are used to prevent bacterial sup erinfection.
◎ 局部使用免疫抑制剂和胶原酶抑制剂。
◎ Local immunosuppression, collagenase inhibitors.
◎ 全身免疫抑制剂。
◎ Systemic immunosuppression.
◎ 其他抗代谢药物:T细胞抑制剂,烷基化药物以及生物制剂。
◎ Steroid sparing agents include antimetabolites T cell inhibitors, alkylating agents and biologic agents.
◎ 手术治疗:适用于角膜穿孔,或者有穿孔风险的角膜溃疡。手术方式包括板层或穿透性角膜移植术、角膜 - 巩膜移植术。
◎ Surgery: Indications for surgical intervention include corneal perforation or excessive corneal thinning with impending perforation. Surgical options include lamellar keratoplasty, penetrating keratoplasty, as well as possible cornea-scleral keratoplasty.
患者教育和预后
Patient Education & Prognosis
◎ 边缘性角膜溃疡通常是全身疾病未得到控制的表现,需要全身免疫抑制治疗。
◎ Peripheral ulcerative keratitis is often a sign of an unco n t r o lled systemic disease requiring systemic immunosuppr e s s ion.
◎ 对于全身疾病未控制和反复发作的患者,预后差。有角膜穿孔风险的患者通常需要手术干预。
◎ The visual prognoses in patients with uncontrolled systemic disease and repeated attacked is poor. Surgical management for PUK is required in cases of impending corneal perforation.