容易误诊的儿童隐匿性角膜异物临床报告
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摘要
目的探讨儿童隐匿性角膜异物的临床特点及误诊原因、防范措施。方法对曾误诊的儿童隐匿性角膜异物8例的临床资料进行回顾性分析。结果本组误诊率17.8%,年龄5个月~16岁,皆有反复眼红表现,均曾误诊为角膜炎,给予相应治疗效果不佳。误诊时间3 d~2个月。入我院后根据眼红反复发作、角膜刺激症状及详细裂隙灯检查并荧光素染色后确诊为隐匿性角膜异物,均行角膜异物取出术,术后恢复良好。门诊复查2个月,均未再出现眼红。结论隐匿性角膜异物易误诊。临床接诊眼红反复发作、畏光、流泪、异物感或眼科检查角膜炎症浸润、溃疡混浊、透明度局部下降且久治不愈者应警惕隐匿性角膜异物。
Objective To investigate clinical features,misdiagnosed causes and preventive measures of children with concealed corneal foreign body. Methods Clinical data for 8 misdiagnosed children with concealed corneal foreign body was retrospectively analyzed. Results The misdiagnosed rate was 17. 8% in this study,and patients' age range from 5 months to16 years old. All children had repeatedly red-eye,and had been misdiagnosed as having keratitis,but the effects were poor by corresponding treatments. Misdiagnosed time was 3 d-2 months. Concealed corneal foreign body was confirmed by red-eye recurrent attacks,corneal irritation,careful slit lamp examination and staining,and foreign body was removed. The children recovered well after the surgery without red-eye symptom during 2 months of review. Conclusion Concealed corneal foreign body is easy to be misdiagnosed. The patients should be highly suspected as having concealed corneal foreign body with symptoms of repeatedly red-eye symptom,photophobia,lacrimation,foreign body sensation or with corneal inflammatory infiltration,ulcer turbidity,local opacity in eye examinations and long-term incurability.
Objective To investigate clinical features,misdiagnosed causes and preventive measures of children with concealed corneal foreign body. Methods Clinical data for 8 misdiagnosed children with concealed corneal foreign body was retrospectively analyzed. Results The misdiagnosed rate was 17. 8% in this study,and patients' age range from 5 months to16 years old. All children had repeatedly red-eye,and had been misdiagnosed as having keratitis,but the effects were poor by corresponding treatments. Misdiagnosed time was 3 d-2 months. Concealed corneal foreign body was confirmed by red-eye recurrent attacks,corneal irritation,careful slit lamp examination and staining,and foreign body was removed. The children recovered well after the surgery without red-eye symptom during 2 months of review. Conclusion Concealed corneal foreign body is easy to be misdiagnosed. The patients should be highly suspected as having concealed corneal foreign body with symptoms of repeatedly red-eye symptom,photophobia,lacrimation,foreign body sensation or with corneal inflammatory infiltration,ulcer turbidity,local opacity in eye examinations and long-term incurability.
引文
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[14]赵培忠,王辉.裂隙灯下角膜异物取出治疗体会[J].中国保健营养,2016,26(23):119-120.
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[17]汤伟民,陈德钦,王涛,等.裂隙灯显微镜联合荧光素染色检查法在眼表隐匿性异物诊治中的应用[J].眼科新进展,2013,33(4):338-340.
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[19]王颖,马利波.眼球内磁性异物存留20年一例[J].中国实用眼科杂志,2012,30(10):1252,1254.DOI:10.3760/cma.j.issn.1006-4443.2012.10.033.
[20]陈放,朱俊,解正高.隐匿性球内异物致眼铁锈症三例[J].中国实用眼科杂志,2017,35(2):214-215.
[21]罗荣邦,吴志群,叶志平.学龄前儿童角膜异物36例临床误诊分析[J].临床误诊误治,2000,13(6):478.
[22]王晓通.显微无齿镊在门诊角膜异物取出中应用242例体会[J].浙江创伤外科,2016,21(4):685-686.
[23]张智敏.角膜异物伤448例临床分析[J].中华眼外伤职业眼病杂志,2013,35(8):591-593.
[24]华虹.隐匿性角膜异物诊治体会[J].医学信息,2015,28(4):135.
[25]孟繁萍.显微镜下深部角膜异物剔除术护理浅谈[J/CD].实用临床护理学电子杂志,2017,2(2):192-193.
[2]刘佳,濮清岚.角膜铁质异物125例临床分析[J].中国现代医生,2015,53(29):51-53,57.
[3]李年爽,黄盖,连福梅.旁侧挑切法取出角膜深层异物34例临床分析[J].临床军医杂志,2014,42(1):13.
[4]邓婷.角膜异物66例眼临床分析[J].中国临床医生,2014,42(1):71-72.
[5]李淑霞.易贝滴眼液治疗栗刺角膜异物临床观察[J].中国现代医生,2012,50(16):134-135.
[6]周芳红.角膜异物处理失误4例[J].眼外伤职业眼病杂志,2000,22(3):321.
[7]郑洪霞.贝复舒用于治疗角膜异物的时机观察[J].临床研究,2016,24(12):74-75.
[8]武建华.角膜异物剔除术后使用贝复舒眼压凝胶疗效观察[J].基层医学论坛,2013,17(26):3443-3444.
[9]林加藤,姜华静,姜丽平,等.山东半岛沿海渔业人员角膜异物临床分析[J].中华眼外伤职业眼病杂志,2016,38(3):192-195.
[10]黄慧,陈季生,陈良权,等.容易误漏诊的隐匿性眼睑结膜异物[J].临床误诊误治,2008,21(1):79.
[11]沈蕾,吴尚操,朱斌,等.超声生物显微镜在非金属巩膜异物诊断中的应用[J].国际眼科杂志,2013,13(4):804-806.
[12]叶玲.超声生物显微镜在巩膜栗刺异物诊断中的应用[J].中华眼外伤职业眼病杂志,2015,37(4):277-278.
[13]赵丽红,宋淑欣,李惠琴.透明角膜异物误漏诊分析[J].中国误诊学杂志,2005,5(7):1280-1281.
[14]赵培忠,王辉.裂隙灯下角膜异物取出治疗体会[J].中国保健营养,2016,26(23):119-120.
[15]雷波,耿小红.角膜异物长期误诊误治3例报告[J].医药前沿,2012,2(1):312.
[16]李巧云,赵广英.角膜异物长期误诊误治三例报告[J].眼外伤职业眼病杂志,2001,23(2):211.
[17]汤伟民,陈德钦,王涛,等.裂隙灯显微镜联合荧光素染色检查法在眼表隐匿性异物诊治中的应用[J].眼科新进展,2013,33(4):338-340.
[18]胡运韬,马志中,冯学峰,等.球内异物临床特征的回顾性分析[J].中华眼视光学和视觉科学杂志,2015,17(2):76-80.DOI:10.3760/cma.j.issn.1764-854X.2015.02.004.
[19]王颖,马利波.眼球内磁性异物存留20年一例[J].中国实用眼科杂志,2012,30(10):1252,1254.DOI:10.3760/cma.j.issn.1006-4443.2012.10.033.
[20]陈放,朱俊,解正高.隐匿性球内异物致眼铁锈症三例[J].中国实用眼科杂志,2017,35(2):214-215.
[21]罗荣邦,吴志群,叶志平.学龄前儿童角膜异物36例临床误诊分析[J].临床误诊误治,2000,13(6):478.
[22]王晓通.显微无齿镊在门诊角膜异物取出中应用242例体会[J].浙江创伤外科,2016,21(4):685-686.
[23]张智敏.角膜异物伤448例临床分析[J].中华眼外伤职业眼病杂志,2013,35(8):591-593.
[24]华虹.隐匿性角膜异物诊治体会[J].医学信息,2015,28(4):135.
[25]孟繁萍.显微镜下深部角膜异物剔除术护理浅谈[J/CD].实用临床护理学电子杂志,2017,2(2):192-193.