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偽樹枝狀角膜症：一種罕見的軟性隱形眼鏡合併症－病例報告
Pseudodendritic Keratopathy: A Rare Complication of Soft Contact Lens-Case Report
摘要
隱形眼鏡合併症有逐年增加的趨勢，眼科醫師有必要了解這些合併症，以利早期正確診斷，迅速適當治療。本文報告1例罕見的軟性隱形眼鏡合併症－偽樹枝狀角膜症。病人是23歲女性，平日配戴軟性隱形眼鏡及使用化學消毒法消毒鏡片，因最近兩眼不適而來求治，眼部檢查可見兩眼中間角膜有環形角膜上皮下灰白色樹枝狀病變，其上之角膜上皮有一部分呈現點狀缺損可被螢光素染色。角膜於病人停戴隱形眼鏡後3個月，逐漸恢復至正常。此後病人改用熱消毒法配合不含防腐劑的生理食鹽液使用，繼續配戴原有的軟性隱形眼鏡，門診追踪半年，無復發現象。以0.1% thimerosal及1% chlorhexidine分別對病患施行皮膚過敏試驗，結果皆為陰性反應。偽樹枝狀角膜症其成因及機轉目前仍不確定，我們以為最可能的原因是隱形眼鏡附屬藥水之內含物所引發的眼睛毒性或過敏性反應。由於除單純疱疹病毒可出現典型的樹枝狀角膜病變外，帶狀疱疹病毒、癒合中的角膜上皮缺損、systemic tyrosinemia及Thygeson's disease亦皆可表現相似的病變，所以本症有時易被誤診。臨床正確診斷本症端賴詳細的詢問病史及仔細觀察、鑑別樹枝狀角膜病變的個別特徵。
關鍵字
無資料並列摘要
Complications associated with contact lens wear are being seen more frequently. These abnormalities may be categorized by the mechanisms that produce them-mechanical, hypoxic, toxic or hypersensitive, infectious and combinations of these. In turn, these mechanisms can lead to various clinical complications including corneal abrasion, corneal edema, corneal neovascularization, sterile corneal infiltrates, superior limbic keratoconjunctivitis, corneal ulcer and giant papillary conjunctivitis. We describe a patient with dendriform corneal lesions who had been using daily wear soft contact lenses and chemical disinfection with preserved lens-care solution. The dendriform corneal lesions appeared in the midperipheral cornea of the both eyes, did not have terminal bulbs and stained with fluorescein in punctate fashion. Lesions resolved after discontinuation of soft lens wear, then the patient converted to heat disinfection and preservative-free saline and has been wearing her soft contact lenses since without further difficulty. The dendriform corneal lesions (pseudodendritic keratopathy) is presumed to result from a toxic or hypersensitive reaction to components of lens care solutions. Pseudodendritic keratopathy is a rare corneal complication of soft contact lens and may be confused clinically with several diseases such as herpes simplex, herpes zoster, systemic tyrosinemia, Thygeson's disease, healing corneal epithelial erosion and timolol keratopathy. Differential diagnosis can be made by careful attention to the clinical history and the morphologic features of the dendritic corneal lesions in most cases. Recognition of pseudodendritic keratopathy of soft contact lens wearer will direct the practitioner to an appropriate diagnosis and treatment of this reversible corneal lesion.