Bilateral Corneal Perforation Caused by Ocular Rosacea-A Case Report

眼睛型玫瑰斑導致雙眼角膜穿孔－病例報告

鍾慧娟(Hui-Chuan Chung) ； 蔡宜倫(I-Lun Tsai) ； 林孝政(Hsiao-Cheng Lin) ； 郭麗琳(Li-Lin Kuo) ； 蔡景耀(Ching-Yao Tsai) ； 劉秀雯(Shiow-Wen Liou) ； 翁林仲(Lin-Chung Woung)

《中華民國眼科醫學會雜誌》 49卷3期 (2010/09) Pp. 397-402

https://doi.org/10.30048/ACTASOS.201009.0022

摘要

目的：報告一例年輕女性因眼睛型玫瑰斑(ocular rosacea)導致雙眼角膜穿孔。
方法：病例報告。
結果：一22歲女性因左眼瀕臨角膜穿孔轉介至本院。檢查發現雙眼眼瞼結膜炎，睫毛根部粘著皮屑，眼瞼結膜充血嚴重。左眼角膜有一直徑3.5mm的後彈力層膨出伴有虹膜鑲嵌。右眼有一直徑4mm的黏連性角膜白斑且中心角膜薄化。臉頰、鼻頭及下巴有似青春痘的丘疹及膿疱有反覆短暫性臉潮紅。根據病史及臨床症狀診斷為玫瑰斑眼睛併發症，會診皮膚科後服用Doxycycline治療。雙眼相繼接受角膜移植。術後矯正視力左眼20/30，右眼20/25。臉部及眼睛症狀於治療二個月後也明顯改善。
結論：玫瑰斑較少見於年輕人也易與青春痘混淆。若有慢性眼瞼結膜炎、瞼板腺功能異常、霰粒腫反覆盡作、角膜上皮病變且對一般治療效果不佳時，應將眼型玫瑰斑列入鑑別診斷。因為它可以經治療獲得良好控制。即早診斷並給予適當的治療可避免嚴重的併發症。

並列摘要

Purpose: To present a case of bilateral corneal perforation caused by ocular rosacea
Method: A case report.
Result: A 22-year-old female was referred to our hospital due to impending corneal perforation of her left eye. Upon examination, her eyes showed lid crusting, meibomitis, lid margin telangiectasia, and palpebral conjunctival hyperemia with papillary reaction (OS＞OD). The iris was incarcerated by a 3.5 × 3.5 mm descemetocele in the inferior portion of the left cornea. The right cornea had a 4 × 4 mm area of central thinning with iris adherence and an inferonasal pannus. Numerous erythematous papules and pustules were observed over the patient's cheeks, nose and chin and intermittent skin flushing was also noticed. Penetrating keratoplasties were performed in both eyes six months apart. Oral doxycycline (100 mg bid) was prescribed for the diagnosed acne rosacea. Post-operative best corrected visual acuity was 20/30 (OS) and 20/25 (OD). Both facial and ocular conditions improved markedly after treatment.
Conclusion: Ocular rosacea is rare in adolescents and young adults. Cutaneous manifestations are often misdiagnosed as acne vulgaris. Ophthalmologists should be alert to the possibility of ocular rosacea in young adults with meibomian gland disease, chronic blepharitis, recurrent chalazia and corneal epitheliopathy which do not respond to usual treatment. Such patients respond well to doxycycline or tetracycline. Early diagnosis and treatment can improve visual outcome and prevent serious complications.

並列關鍵字

ocular rosacea ； corneal perforation ； acne vulgaris