病例11 34岁女性，双眼反复红、疼痛、畏光数年
CASE 11 A 34-year-old female, with recurrent bilateral redness, pain and photophobia for many years
见图1-16。See Fig. 1-16.
图1-16 双眼角膜上皮及上皮下散在均匀点状混浊，略隆起表面，边界清，混浊间角膜正常，荧光素染色阳性Fig. 1-16 There are several rough bilateral punctate intraepithelial and subepithelial opacities, correlated with slightly elevated the epithelium. The boundary of lesions is clear and the cornea between lesions is transparent. The lesions are stained with f luorescein.
鉴别诊断
Differential Diagnosis
◎ Thygeson浅层点状角膜炎：Thygeson浅层点状角膜炎是一种自发性、暂时性、双眼性疾病，表现为粗糙的角膜上皮混浊但无基质浸润。
◎ 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.
◎ 流行性角结膜炎：流行性角结膜炎有明显的结膜充血水肿，睑结膜多量滤泡增生，结膜囊大量水样分泌物，可有伪膜形成；角膜病变表现为上皮下的点状浸润，荧光素一般不着色。
◎ 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.
病史询问
Asking History
◎ 疾病是否反复发作。
◎ Asking the history of recurrent attack.
◎ 疾病发作前是否有病毒感染史。
◎ Asking the history of infection by virus.
检查
Examination
◎ 视力正常或者轻度下降。
◎ Visual acuity is normal or mild decreased.
◎ 裂隙灯检查：检查睑板腺功能，角膜上皮及上皮下散在均匀点状混浊，略隆起表面，边界清，混浊间角膜正常。
◎ 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.
◎ 角膜活体共聚焦显微镜检查：角膜上皮层可见高密度区，前弹力层大量朗格汉斯细胞。
◎ Laser confocal microscopy: Clusters of highly reflective dots are revealed in the epithelium. There are lots of Langerhans cells under the epithelium.
诊断
Diagnosis
Thygeson浅层点状角膜炎。
Thygeson superf icial punctate keratitis.
治疗
Management
◎ 局部人工泪液或者凝胶可用于轻度患者。
◎ Artif icial tear eye-drops or ointments may be a suitable treatment for mild cases.
◎ 局部低浓度糖皮质激素。
◎ Low-dosage steroidal eye-drops.
◎ 局部应用环孢素 / 他克莫司。
◎ Ciclosporin/Tacrolimus.
患者教育和预后
Patient Education & Prognosis
◎ 该病为慢性疾病，病程较长（从几个月到几年不等），可以反复发作，可能加重或缓解；最终恢复可不遗留瘢痕。
◎ TSPK is a chronic disease of recurrent and long duration(from months to years) with exacerbations or remissions;eventual healing without scars.