Napoli Pietro Emanuele, Sanna Raffaele, Iovino Claudio, Fossarello Maurizio
Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy.
Clinica Oculistica, San Giovanni di Dio hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy.
Int Med Case Rep J. 2017 Jul 24;10:247-250. doi: 10.2147/IMCRJ.S138786. eCollection 2017.
To describe an unusual case of unilateral, chronic symptoms and signs of dry eye, and recurrent episodes of ocular irritation related to pinguecula, which were refractory to prior medical treatments, successfully treated with argon laser photocoagulation.
A 36-year-old man presented with an elevated yellowish mass on his conjunctiva in his left eye, which was associated with dry eye symptoms and general discomfort, such as "tightening sensation" and "stiffness". On clinical assessment, the left eye revealed a mild conjunctival injection, a fluorescein break-up time (FBUT) of 3.5 s, an abnormal fluorescein staining, and a Schirmer test of 5 mm. Optical coherence tomography (OCT) imaging evidenced a height at the most elevated point of the pinguecula of 740 µm. The patient underwent argon-laser photocoagulation.
After 2 weeks postoperatively, no residual of pinguecula or focal injection of the conjunctiva was detected by slit-lamp biomicroscopy and there was a significant improvement of clinical symptoms and signs: Schirmer test and FBUT increased to 12 mm and >10 s, respectively, and fluorescein staining was absent. OCT imaging revealed a smooth structure of conjunctival contour, with a height of 404 µm. According to an ex juvantibus line of reasoning, definitive diagnosis was pinguecula-related dry eye disease.
Based on the concept that tear film instability and inflammation are two key components of the pathogenesis of dry eye, we coined the term "pinguecula-related dry eye disease," which can be successfully treated by a complete, accurate removal of the lesion with argon laser photocoagulation.
描述一例罕见的单侧慢性干眼症状和体征，以及与睑裂斑相关的反复眼部刺激发作的病例，该病例先前的药物治疗无效，而氩激光光凝治疗取得成功。
一名36岁男性，左眼结膜出现一个隆起的黄色肿物，伴有干眼症状及“紧绷感”和“僵硬感”等一般不适。临床检查发现，左眼有轻度结膜充血，荧光素泪膜破裂时间（FBUT）为3.5秒，荧光素染色异常，泪液分泌试验为5毫米。光学相干断层扫描（OCT）成像显示睑裂斑最高点高度为740微米。该患者接受了氩激光光凝治疗。
术后2周，裂隙灯生物显微镜检查未发现睑裂斑残留或结膜局部充血，临床症状和体征有显著改善：泪液分泌试验和FBUT分别增至12毫米和>10秒，荧光素染色消失。OCT成像显示结膜轮廓结构光滑，高度为404微米。根据经验性推理，明确诊断为睑裂斑相关性干眼疾病。
基于泪膜不稳定和炎症是干眼发病机制的两个关键因素这一概念，我们提出了“睑裂斑相关性干眼疾病”这一术语，通过氩激光光凝完全、准确地清除病变可成功治疗该疾病。
