双眼木样结膜炎1例  

A case of binocular ligneous conjunctivitis

作　　者：殷悦 王艳 YIN Yue;WANG Yan(Department of Ophthalmology,Eye&ENT Hospital,Fudan university,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第S01期53-56,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：35岁女性,因双眼下睑眼袋整复术后出现反复红痒1年就诊,体检可见双眼下睑黄白色假膜增生,假膜较厚伴少量分泌物,余眼内结构未见明显异常。患者的分泌物细菌培养阴性,假膜病理送检提示HE染色下组织背景为大量嗜伊红均质纤维间质,内有炎症细胞浸润,浆细胞为主。患者的临床表现及病理结果均符合木样结膜炎的表现。予以患者先后共2次双眼下睑假膜切除、术后抗生素滴眼液及抗炎滴眼液局部治疗,患者症状缓解,但偶有假膜反复形成,患者常自行擦除清理。后进行基因学检测,发现患者存在与先天性纤溶酶原缺乏症相关的PLG基因变异。讨论体会:典型体征及病理结果可以对木样结膜炎患者进行诊断,目前认为木样结膜炎与患者纤维蛋白溶酶原的缺乏相关,在炎症及创伤后可诱发。此外,特殊用药以及IgG4的升高也可能与之相关。对木样结膜炎的反复发作,治疗上目前仍存在一定困难。A 35-year-old woman suffered recurrent redness and itchiness of both eyes after binocular eyelid blepharoplasty for one year.Physical exam showed binocular ligneous pseudomembranes with secretion in patient’s lower eyelids.No significant abnormalities of the rest of eyeballs were observed.The bacterial culture of secretion was negative.The pathology of the pseudomembranes showed massive fibrous hyperplasia with collagen denaturation,with infiltration of inflammatory cells especially plasmacytes.The clinical signs and pathological results accorded with the diagnosis of ligneous conjunctivitis.The excisions of binocular pseudomembranes were proformed twice.Antibiotic eye drops and anti-inflammatory eye drops were used after the excision.Patients symptoms relieved and the frequency of pseudomembrane relapse was decreased afterwards.Typical clinical signs and pathological results can help to diagnose ligneous conjunctivitis.Ligneous conjunctivitis currently considered to be related with plasminogen deficiency,and it is possibly be induced by inflammation or trauma.Besides,specific medication and elevated IgG4 are possibly associated.There is still huge difficulty in preventing relaspse.

关 键 词：木样结膜炎 假膜 纤维蛋白溶酶原 

分 类 号：R777.31[医药卫生—眼科]