Contact Lens-Related Superior Limbic Keratoconjunctivitis

隱形眼鏡相關之上輪部角結膜炎

林耕國(Ken-Kuo Lin) ； 梁有松(Yu-Sung Liang) ； 徐紅娜(Hon-No Shyi) ； 楊和洲(Ho-Chou Yang) ； 李建興(Jiahn-Shing Lee)

《中華民國眼科醫學會雜誌》 33卷1期 (1994/03) Pp. 13-18

https://doi.org/10.30048/ACTASOS.199403.0003

摘要

本文分析報告11個隱形眼鏡相關之上輪部角結膜炎病例。這些病例包括1個男性，10個女性，年齡自21歲到37歲，平均為25歲，過去都無全身或眼睛局部疾病。所有病例皆是在成功的使用軟性隱形眼鏡一段時間（5個月到3年半）後，病人漸覺在配戴隱形眼鏡幾個小時後會出現眼睛有異物感、畏光、流淚及眼紅現象，嚴重的會出現視力降低。眼部症狀包括①上部球結膜充血②上輪部周圍的球結膜及角膜上皮呈現不規則及增厚變化③上部角膜下混濁④上輪部及上部角膜表現點狀角膜炎(punctate keratitis)，而會被螢光素染色。有2個病例因點狀角膜炎嚴重侵犯視軸區域而引起視力降低至20/200以下。所有病例的結膜抹片檢查顯示中度中性白血球反應，中度上皮細胞角化，並無嗜伊紅性血球。而結膜微生物培養皆呈現陰性結果。11個病例皆是使用冷消毒法(cold disinfection)保養隱形眼鏡，而其中有8例是使用含有thimerosal做為防腐劑的保養藥水，另3例的則不含。所有病例在停戴隱形眼鏡後幾個月（最長是1年），症狀完全消失，視力恢復到20/25以上。有5個病人選擇放棄隱形眼鏡配戴。其餘6個病人最後成功的恢復使用隱形眼鏡，而這6個病人最後都是改用不含有thimerosal的保養藥水或熱消毒法。其中1個是改戴一般硬片，3個改用高透氧硬片，2個繼續使用軟性隱形眼鏡。在3個最終成功使用高透氧硬片的病人中，有2例曾被嚐試繼續裝配使用軟性隱形眼鏡，但眼部症狀分別在1及3星期時復發，後來皆改配戴高透氧硬片，病人成功使用，追踪半年，並無復發。為了解thimerosal和本症的相關性，我們對部分病例施行了thimerosal過敏試驗。由於眼睛症狀恢復緩慢，我們並沒有施行眼部的過敏試驗，而在6個願意接受皮膚thimerosal過敏試驗的病人中，僅有2個(33%)呈現陽性反應。雖然皮膚試驗並不是一種十分敏感的試驗，但事實上有3例病人是使用不含thimerosal的保養藥水，故我們認為除thimerosal外，本症應尚有其它其因，目前這些原因仍不詳。本文亦深入分析本症與Theodore上輪部角結膜炎的差異點。

並列摘要

Eleven patients with daily wear, cosmetic soft contact lenses presented with syndrome of contact lens-related superior limbic keratoconjunctivitis were reported in this paper. These patients were successful soft contact lenses wear for months or years, then presented with complaints of irritation and redness of the eyes after several hours of contact lenses wear. Ocular signs included superior bulbar conjunctival injection, superior perilimbal epithelium irregularity and thickening, superior corneal subepithelial opacity, punctate fluorescein staining of the limbal and corneal epithelium over the involved area of punctate keratitis. Routine cultures were negative, scrapings from the superior bulbar conjunctiva showed a neutrophilic inflammatory cell response with prekeratinized epithelium and no eosinophils. Eight of the eleven patients used thimerosal-preserved solutions for lens care. Positive skin sensitivity reactions to thimerosal were present in one-third (2/6) of patients tested. Upon discontinuation of lens wear, all the eleven patients experienced gradual resolution of symptoms and signs over a period of many weeks to several months and none developed any permanent sequelae. Six patients were subsequently able to resume lens wear. Although thimerosal may be one of the causative factors, the etiology of contact lens-related superior limbic keratoconjunctivitis remains uncertain.

並列關鍵字

Contact lens-related superior limbic keratoconjunctivitis ； Thimerosal ； Hypersensitivity ； Skin occlusive patch test