Pham-Vang Sandy, Hardten David R
Minnesota Eye Consultants PA, Minneapolis, Minnesota, USA.
Optometry. 2008 Sep;79(9):505-11. doi: 10.1016/j.optm.2007.11.012.
Any etiology of epithelial defect can lead to severe bacterial keratitis. Patients with recurrent corneal erosions suffer repeated corneal epithelial defects without significant trauma and therefore are at risk of infectious keratitis more frequently than someone without recurrent erosions. A stromal infiltrate with an overlying area of epithelial defect can be challenging to differentiate between infectious and noninfectious inflammatory conditions. It is important for clinicians to appreciate the clinical findings in these cases and initiate aggressive treatment promptly.
A 32-year-old woman presented with a history of anterior basement membrane dystrophy and recurrent corneal erosions. She had symptoms of redness, pain, foreign body sensation, photophobia, epiphora, and burning in her left eye that started 2 days before the visit to our office. Examination showed a large epithelial defect with dense stromal infiltrate inferiorly on the cornea that appeared white and milky with diffuse cellular infiltrate as well as 3+ cells in the anterior chamber.
Laboratory results were positive for bacterial keratitis (Staphylococcus aureus). Infectious presentation should be considered visually threatening and treated immediately and aggressively. Early intervention is important to help avoid severe complications.
上皮缺损的任何病因都可导致严重的细菌性角膜炎。复发性角膜糜烂患者在无明显外伤的情况下反复出现角膜上皮缺损，因此比无复发性糜烂的患者更频繁地有感染性角膜炎的风险。伴有上皮缺损覆盖区域的基质浸润可能难以区分感染性和非感染性炎症情况。临床医生了解这些病例的临床表现并及时启动积极治疗非常重要。
一名32岁女性，有前弹力层营养不良和复发性角膜糜烂病史。在前来我们诊所就诊前2天，她左眼出现眼红、疼痛、异物感、畏光、流泪和烧灼感等症状。检查发现角膜下方有一个大的上皮缺损，伴有致密的基质浸润，呈白色乳状，有弥漫性细胞浸润，前房有3+细胞。
细菌性角膜炎（金黄色葡萄球菌）的实验室检查结果呈阳性。感染性表现应被视为有视力威胁，需立即进行积极治疗。早期干预对于避免严重并发症很重要。
