Toxic Keratopathy Associated with Abuse of Multiple Eye Drops-A Case Report

目的：報告一病例在因為濫用多種眼藥所造成的毒性角膜病變，其臨床上的變化及其治療後的成效。方法：病例報告。結果：一位58歲男性高度近視病患，曾在17年前接受過放射狀角膜整型術，並且因在2年前被診斷出有兩眼開放性隅角青光眼而持續使用康舒目(Cosopt, dorzolamide 2% & Timolol 0.5 %, 5ml, MSD)治療，而且有過庖疹角膜炎及兩眼乾眼的病史。病患來到本院求助主訴在兩週前雙眼有疼痛及流淚現象，當時病患在大陸工作因而在當地醫院求診，大陸的醫生開給他多種藥物點予，其中包括抗生素，抗病毒藥物，青光眼眼藥，類固醇藥水及一些不知名的藥水如組織母細胞生長因子藥水及干擾素。經過眼科學的檢查後，發現在雙眼角膜下方均有聚集性的點狀角膜破皮合併基質水腫及細胞浸潤現象，診斷為毒性角膜病變，我們停止其所有之前的用藥並將其收住院，只給予其不含防腐劑的人工淚液及輕微類固醇使用將近三週後，病人的症狀逐漸改善，且視力有顯著進步。結論：毒性角膜病變的成因多歸於過度使用含有防腐劑的眼藥水，雖然本病例真正的致病因子難以確定，但停止其之前使用的所有藥物的確達到了治療的效果，因此正確且適量的使用眼藥水去治療病患的眼疾是相當重要的。

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並列摘要

Purpose: To report the clinical course of a case of toxic keratopathy associated with abuse of multiple topical eye medications. Method: Case report Results: A 58-year-old male visited our out-patient department with complaints of blurred vision, redness, tearing and photophobia of both eyes. He had radial keratotomy 17 years ago and was diagnosed with primary open-angle glaucoma and herpetic keratitis two years previously. Two weeks before evaluation in our clinic, he developed stinging pain and tearing after using multiple eye drops prescribed by a hospital in mainland China. These drops included topical antibiotics, antiviral agents, antiglaucomatous agents and other drugs, such as fibroblast-growth factor. Multiple superficial punctate keratopathy, stromal edema and cell infiltrations were observed in both corneas. With a working diagnosis of toxic keratopathy, all previous medications were discontinued, and he was admitted immediately. Topical, preservative-free lubricants and mild steroids were applied. The corneal defect healed very slowly, and the vision improved. Conclusion: Toxic keratopathy may result from abusing multiple eye drops. Though the definite cause in this case was difficult to identify, cessation of all medications is the first treatment step.

並列關鍵字

Toxic keratopathy ； corneal ulcer ； drug abuse ； superficial punctuate Keratopathy

國際替代計量

Toxic Keratopathy Associated with Abuse of Multiple Eye Drops-A Case Report

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