Chiou A G, Florakis G J, Kazim M
Edward S. Harkness Eye Institute, Columbia Presbyterian Medical Center, New York, New York 10032, USA.
Surv Ophthalmol. 1998 Jul-Aug;43(1):19-46. doi: 10.1016/s0039-6257(98)00005-8.
Physical or chemical injuries, infections, immunologic oculocutaneous disorders, drugs, and various systemic disorders may cause scarring of the conjunctiva and disturbances of the ocular surface. Trichiasis, lid margin malposition, and dry eye may result in persistent ocular irritation. The cornea may be primarily or secondarily involved. If severe, disturbances of the ocular surface may lead to significant visual impairment. Thorough evaluation of patients and of the underlying disease process is required for optimal management. Treatment may be challenging and should be comprehensive, combining medical measures and surgical correction of structural changes. Suppression of exogenous irritants, treatment of dry eye, antiinflammatory therapy, and immunosuppressants are paramount to control the underlying disease and allow optimal surgical results. Surgical correction of trichiasis and lid margin malposition, conjunctival grafting, mucous membrane transplantation, limbal stem cell transplantation, amniotic membrane transplantation, and penetrating keratoplasty help reestablish a physiologic ocular surface. Severe cases may require keratoprosthetics for visual rehabilitation. Corneal ulceration or perforation requires prompt attention to maintain ocular integrity. Special measures should be considered for patients who require cataract or glaucoma surgery.
物理或化学损伤、感染、免疫性眼皮肤疾病、药物以及各种全身性疾病都可能导致结膜瘢痕形成和眼表紊乱。倒睫、睑缘位置异常和干眼可能导致持续性眼部刺激。角膜可能原发性或继发性受累。如果情况严重，眼表紊乱可能导致严重的视力损害。为了实现最佳治疗，需要对患者和潜在疾病过程进行全面评估。治疗可能具有挑战性，应全面综合，将药物治疗措施与结构改变的手术矫正相结合。抑制外源性刺激物、治疗干眼、抗炎治疗和使用免疫抑制剂对于控制潜在疾病并获得最佳手术效果至关重要。倒睫和睑缘位置异常的手术矫正、结膜移植、黏膜移植、角膜缘干细胞移植、羊膜移植和穿透性角膜移植有助于重建生理性眼表。严重病例可能需要角膜假体进行视力康复。角膜溃疡或穿孔需要及时处理以维持眼球完整性。对于需要进行白内障或青光眼手术的患者，应考虑采取特殊措施。
