Khan Selina, Chak Melanie
Ophthalmology Department, Great Western Hospital, Swindon, UK.
Case Rep Ophthalmol Med. 2018 Feb 12;2018:4375354. doi: 10.1155/2018/4375354. eCollection 2018.
We report an unusual case of actinic keratosis (AK) of the tarsal conjunctiva in a 63-year-old man. Examination revealed a crusty, leukoplakic lesion prone to bleeding on the tarsal conjunctiva of the right upper eyelid. This was treated by surgical excisional biopsy. At 1-year follow-up, there was no evidence of recurrence and the surgical site was completely healed without conjunctival scarring. Current opinion cites excessive exposure to ultraviolet (UV) radiation, in particular UV-B in sunlight, as the causative agent in developing AK. In the case we present, the tarsal conjunctiva is an unusual place for actinic keratosis due to the lack of direct UV-light exposure. The key learning points are to evert the upper eyelid during examination especially if the lesion involves the eyelid margin and, secondly, to ensure risk factors are addressed during the history.
我们报告了一例63岁男性睑结膜光化性角化病（AK）的罕见病例。检查发现右上眼睑睑结膜有一个结痂、白斑样病变，容易出血。通过手术切除活检进行治疗。在1年的随访中，没有复发迹象，手术部位完全愈合，没有结膜瘢痕形成。目前的观点认为，过度暴露于紫外线（UV）辐射，尤其是阳光中的UV-B，是发生AK的致病因素。在我们呈现的病例中，睑结膜由于缺乏直接的紫外线暴露，是光化性角化病的一个不寻常部位。关键的学习要点是在检查时翻转上眼睑，特别是如果病变累及眼睑边缘，其次是在病史询问过程中确保考虑到危险因素。
