Keratoconjunctivitis sicca due to sarcoidosis.
Keratoconjunctivitis sicca due to sarcoidosis.
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DOI：
10.1136/bjo.41.3.153
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发表时间：
1957-03-01
期刊：
影响因子：
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通讯作者：
STEVENSON, C J
中科院分区：
文献类型：
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作者：
JONES, B R;STEVENSON, C J
结节病被公认为泪腺肿胀的原因之一，并被纳入该区域肿瘤的鉴别诊断（Duke-Elder，1952）。在某些情况下，这种结膜炎之后可能会出现干燥性角结膜炎（Ainslie和James，1956; Gruber，1956）。系统性结节病与干燥性角结膜炎在泪腺无肿胀的情况下的相关性也有报道（Ainslie和James，1956; James，1956; Ramage和Kinnear，1956），但在这些病例中，未获得眼部病变的组织学检查结果;但推测它们属于相同的病理学。在将要描述的病例中，一名因结膜刺激症状在眼科诊所接受治疗3年的患者，在胸部集体X线摄影中发现具有结节病的典型放射学特征。鉴于这一发现，在通过肝活检获得系统性结节病的证据后，患者被转诊，以调查其眼部状况。患者的眼睛缺乏公认的眼部结节病特征，即泪腺肿胀、黄色结膜滤泡（Crick、Hoyle和Mather，1955; Crick，1956）或慢性葡萄膜炎，但表现出干燥性角结膜炎的临床特征。此外，她还抱怨鼻子和喉咙干燥。泪腺和结膜的活组织检查，然而，发现眼部疾病实际上是由于结节病。病例报告一个已婚妇女，42岁，被收住伦敦医院调查于1956年1月。3年来，她一直抱怨，夜间眼睛里会形成粘粘的线。这些与刺痛感和不适有关，白天减轻，晚上加重。她因慢性结膜炎接受了3年的治疗，包括青霉素和可的松在内的各种滴剂，但没有缓解，并因一个疗程的镀银而恶化。她还注意到她的鼻子和喉咙干燥，醒来时咽部刺激和干燥，通过咳出一团粘稠的粘液缓解。
SARCOIDOSIS is well recognized as a cause of swelling of the lacrimal glands and enters into the differential diagnosis of tumours of this region (Duke-Elder, 1952). Such swellings may be followed, in some cases, by a form of keratoconjunctivitis sicca (Ainslie and James, 1956; Gruber, 1956). The association of systemic sarcoidosis with keratoconjunctivitis sicca in the absence of swelling of the lacrimal glands has also been described (Ainslie and James, 1956; James, 1956; Ramage and Kinnear, 1956), but in these cases the histology of the ocular lesions was not obtained; it was presumed, however, that they were of the same pathology. In the case to be described, a patient, who had been treated in an ophthalmic clinic for 3 years for symptoms of conjunctival irritation, was found on mass radiography of the chest to have the typical radiological features of sarcoidosis. In view of this finding the patient was referred, after proof of systemic sarcoidosis had been obtained by liver biopsy, for investigation of her ocular condition. The patient's eyes lacked the generally accepted features of ocular sarcoidosis, namely swelling of the lacrimal glands, yellowish conjunctival follicles (Crick, Hoyle, and Mather, 1955; Crick, 1956), or chronic uveitis, but presented the clinical features of kerato-conjunctivitis sicca. In addition she had complained of dryness of the nose and throat. Biopsy of lacrimal gland and conjunctiva, however, revealed that the ocular disorders were in fact due to sarcoidosis.Case Report A married woman aged 42, was admitted to The London Hospital for investigation in January, 1956. For 3 years she had complained of, sticky threads forming in her eyes during the night. Thesewere associated with a pricking sensation and discomfort which lessened during the day but worsened in the evening. For 3 years she had been treated for chronic conjunctivitis with a variety of drops, including penicillin and cortisone, without relief, and had been worsened by a course of silvering. She also noticed dryness of her nose and throat and would awaken with pharyngeal irritation and dryness, relieved by coughing up a tenacious plug of mucus.