眼睑炎的诊断思路（一）

翟羽佳

眼睑炎的诊断思路

眼睑炎初期表现：colour change red/ swollen ,pain(irritation), abnormal appearance.

        颜色变红/肿胀，疼痛（刺激），外观异常。

症状：Blepharitis ,inflammation of the eyelids ,is seen relatively commonly in general practice but is not always immediately diagnosed as such. Patient are more commonly dogs than cats and the condition is more frequently bilateral than unilateral. Owners report that the dog is irritated by its eyes with frequent attempts at rubbing. Some mucoid or mucopurulent discharge is likely and the owner is also likely to mention that the eyes look red. This can be due to a combination conjunctival hyperaemia ,eyelid hyperaemia and eyelid erosions or areas of ulceration. The condition is most likely to be insidious and gradually progressive in onset, although occasionally acute presentations do occur. Although focal forms, such as chalazia and styes, do occur ,we will concentrate on the diffuse cases since the former are typically straightforward to diagnose and treat.

眼睑炎，眼睑发炎，是一种较为常见的临床病例，但是通常不能被立刻确诊。犬一般比猫常发病，而且双侧同时发病的几率大于单侧。主诉通常是犬表现的很烦躁，总频繁地企图去摩擦它的眼睛。有一些粘液性或者黏脓性的分泌物，主人可能会提及眼睛突然看起来红了。这可能是因为混合了结膜充血，眼睑充血，眼睑糜烂或者局部溃疡等原因。通常眼睑炎的病情会被忽视，而且这种病的病情是逐步发展的，仅偶尔可见急性病例。虽然有局灶性形式病例的存在，如霾粒肿和麦粒肿，我们仍然主要关注弥散性眼睑炎的情况，因为前者的诊断和治疗比较简单。

4.1一只五岁的柯利牧羊犬，内侧眼角患有溃疡性睑缘炎。双侧发生并且在唇连合处有相似症状。皮肤活检确诊为免疫介导性疾病。

4.2一只两岁大的有睑板腺炎的拉布拉多-注意沿睑缘结膜多发性的小型凸起肿胀。

4.3一只六岁大有严重眼睑炎的公犬。注意眼睑肿胀，充血和渗出，但是明显没有更多眼部损伤。这是因为葡萄球菌感染，全身使用氨苄效果较好。

A young Labrador retriever might present seasonally with itchy eyes and foot-chewing associated with atopy. A dog which has recently travelled to Mediterranean countries could present with uveitis, and Leishmania would be strongly suspected in such an example. In these instances the definitive diagnosis can be reached from the history and clinical examination ,with perhaps response to treatment ,or just a single diagnostic test to confirm the diagnosis. However, other, often more chronic presentations are less straightforward, perhaps with a several week history of bilateral swelling and redness with intermittent rubbing, or simply a change in appearance of the periorbital area. Clearly further workup is required in these cases.

一个年轻的拉布拉多猎犬可能出现季节性的眼睛发痒和眼睑下缘损伤，这些症状与特异性免疫反应相关。一只曾经去做地中海国家的狗出现了葡萄膜炎的症状，这个病例强烈怀疑为利士曼原虫病。这些情况可以根据病史和临床检查做出明确的诊断，或者通过治疗的应答，仅需要单个的诊断测试就可以确诊。然而其他的慢性炎症过程，或者间接的问题，也许已经有几个星期的间断性摩擦引起的发红肿胀病史，或者在眶周区域出现外观的简单变化。在这些情况下，通常还需要后续的进一步处理。

Clinical examination 临床检查

Since many forms of blepharitis are part of a generalized dermatological condition, careful general clinical examination with specific concentration on the skin is required. The causes of blepharitis can be as varied as those for generalized dermatitis and sometimes the general involvement. Secondary bacterial infection is common and can mask the underlying aetiology. Careful examination of the feet , external ear canals and all mucocutaneous junctions is advised.

因为很多形式上的眼睑炎是全身皮肤病学的一个部分，所以必须要仔细做皮肤学的相关检查。眼睑炎的原因很有可能是这些全身皮炎或者有事是全身性的复杂病例。经常会继续细菌性的感染，有时会掩盖潜在的病因。要仔细检查脚垫、外耳道、所有皮肤黏膜结合处。

Ophthalmic examination will reveal eyelid swelling and hyperaemia ,possibly with crusting or exudative erosions close to the eyelid margins(4.1). Some lesions are erosive and a serosanguinous discharge can be present(4.2). Periorbital hyperaemia or alopecia could be signs of self-trauma. Close examination of eyelids themselves might reveal multiple swellings along the lid margin in the location of the meibomian glands-suggestive of a meibomiantis (4.3). Schirmer tear test readings should be checked in all cases.

眼科检查会发现眼睑肿胀及充血，可能在靠近眼睑边缘位置有结痂或者渗出性糜烂(4.1)。有些病灶可能有糜烂或者有血性浆液性物质流出(4.2)。眼眶充血或者睫毛脱落可能出现是自损的现象。仔细检查眼睑，沿眼睑缘的睑板腺位置有多个肿大部位，可能提示睑板腺炎(4.3)。在所有的情况下都需要做泪液试验进行检查。

Conjunctival hyperaemia will accompany most cases of eyelid inflammation and can be incorrectly assumed to be the primary problem. Sometimes the eyelid swelling can distort the palpebral fissure ,resulting in such secondary problems as entropion, ectropion and trichiasis. Corneal ulceration can also develop which will further exacerbate the blepharospasm and a vicious cycle can be established. Normally there is no intraocular involvement with cases of blepharitis, but if any uveitis, for example, is present it might suggest either an immunological condition such as uveodermatological syndrome, or a protozoal infection such as Leishmania.

绝大多数眼睑炎都有结膜充血的症状，而且不能够确定为主要的症状。有时眼睑肿胀会使眼睑裂发生扭曲，造成激发问题，内翻、外翻或者倒睫。还可能进一步形成角膜溃疡，角膜溃疡将进一步加重眼睑痉挛，形成一个恶性循环。通常结膜炎没有眼内炎症的参与，但是任何一种葡萄膜炎出现时，可能预示着有免疫的问题、如葡萄膜皮肤症候群（小柳原田），或者是感染原虫病、如利什曼原虫。

李增洋

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胡璠

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