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尖峰眼科课程分享之wills手册春季结膜炎或特应性结膜炎

尖峰眼科 2019-01-10 06:28:14

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Vernal/AtopicConjunctivitis

Symptoms

Itching, thick, ropy discharge, seasonal (spring/summer) recurrences, history of atopy. Usually seen in young patients,especially boys.

春季结膜炎或特应性结膜炎

症状:

痒、黏稠分泌物,季节性发作,春夏季多见,好复发,有特应性病史。通常见于年轻患者,尤其是男孩。

Signs

Critical. Large conjunctival papillae seen under theupper eyelid or along the limbus (limbal vernal). See Figure 5.1.6.

主要体征:

巨大的结膜乳头,见于上眼睑下或角结膜缘处(角膜缘型春季结膜炎)。参见图5.1.6。

Other. Superior corneal “shield” ulcer (a well-delineated, sterile, gray–whiteinfiltrate), limbal raised white dots (Horner–Trantasdots) of degenerated eosinophils (see Figure 5.1.7), superficial punctatekeratopathy (SPK).

其他体征:

上方角膜“盾牌状”溃疡,呈边界清晰的无菌性灰白色浸润;眼睑或角膜缘可见由变性的嗜酸性粒细胞构成的白色斑点(Horner-Trantas斑,参见图5.1.7),浅层点状角膜病变。

shieldulcer的图片

Shield ulcer in VKC.

A, Large papilla visible justbelow the upper lid margin. The border of an epithelial defect of the cornea isseen just inferior to the papilla.

 B, Slit lamp view of the epithelial defect.

 C, The same defect with progressive ulcerationof the stroma.



Treat as for allergic except prophylactically use a mast cell stabilizer (e.g., lodoxamide 0.1% q.i.d. or pemirolast 0.1% q.i.d.), or a mast cell stabilizer and/or antihistamine (e.g., nedocromil 2% b.i.d., olopatadine 0.1% b.i.d., ketotifen 0.025%, or azelastine 0.05%) for 2 to 3 weeks before the season starts.

治疗:

1.治疗同过敏性结膜炎,并在发病季节开始前预防性用药,持续使用2-3周。选用以下一种方式:

(1)使用肥大细胞稳定剂,如0.1%洛度沙胺,日4次,或0.1%吡嘧司特钾,日4次。

(2)使用肥大细胞稳定剂和/或抗组胺药,如2%奈多罗米,日2次,0.1%奥洛他定,日4次,0.025酮替芬,或0.05%氮卓斯汀。

2   If a shield ulcer is present, add:

       —Topical steroid(e.g., loteprednol 0.5% or prednisolone 1% drops, dexamethasone 0.1% ointment)four to six times per day.

       —Topicalantibiotic (e.g., erythromycin ointment q.i.d., bacitracin ointment q.i.d.,polymixin/bacitracin q.i.d.).

       —Cycloplegicagent (e.g., scopolamine 0.25% t.i.d.).

       —Add antiallergy drops as for allergic conjunctivitis if not alreadyusing.

2.如果出现“盾牌状”角膜溃疡,需加用:

(1)局部用类固醇,如0.5%氯替泼诺(露达舒),或1%泼尼松龙滴眼液,0.1%地塞米松眼膏,日4-6次。

(2)局部用抗生素,如红霉素眼膏,日4次,杆菌肽眼膏,日4次,多粘菌素/杆菌肽,日4次。

(3)睫状肌麻痹剂,如0.25%东莨菪碱,日4次。

(4)家用抗过敏滴眼液治疗过敏性结膜炎。

3   Cool compresses q.i.d.

    4   Considercyclosporine 0.05% (e.g., Restasis) b.i.d. if not responding to the precedingtreatment. Maximal effect not seen for several weeks.

    5   If associated with atopic dermatitis ofeyelids, consider tacrolimus (e.g., Protopic) 0.03% to 0.1% q.h.s. or b.i.d.(preferred), topical steroid ophthalmic ointment (e.g., fluorometholone 0.1%q.i.d.), or pimecrolimus 1% (e.g., Elidel) b.i.d. to the affected skin.

3.冷敷,日4次。

4.如上述治疗无效,考虑使用0.05%环保霉素A(如Restasis)滴眼,日2次。数周后才能达到最大疗效。

5.如伴发特应性眼睑皮肤炎,需采用以下药物涂抹患处皮肤:0.03%-0.1%他克莫司(如Protopic),每晚睡前滴用或日2次(推荐用法);类固醇眼膏,如0.1%氟米龙,日4次,或1%吡美莫司(如Elidel),日2次。

Note

Shield ulcers may need to be scraped to removesuperficial plaque-like material before reepithelialization will occur.

注:

应刮除角膜的“盾牌状”溃疡,去除角膜浅表的盘状物质,以利于上皮的再生。

Follow-Up

Every 1 to 3 days in the presence of a shield ulcer;otherwise, every few weeks. Topical medications are tapered slowly asimprovement is noted. Antiallergy drops are maintained for the duration of theseason and are often reinitiated a few weeks before the next spring. Patientson topical steroids should be monitored regularly, including IOP monitoring,even if used only on the skin.

随访:

1.如有角膜“盾牌状”溃疡,每1-3d复查1次,如无溃疡可数周1次。

2.如症状改善,局部用药可缓慢减量。

3.整个发病季节都需用抗过敏药物点眼,并且在下个春季来临之前数周重新开始用药。

4.如局部应用类固醇,应定期复查,包括检查眼压。即使只在皮肤用药,也应定期复查。


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