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要約 58歳女性が右眼の結膜充血,眼脂,霧視を主訴として受診した。27歳のときに慢性関節リウマチと診断され,副腎皮質ステロイド薬を長期間使用していた。10週前に上顎洞炎と診断され,抗生物質の投与を受けていた。当科初診時に右眼に周辺部角膜の菲薄化,角膜穿孔と虹彩脱出があった。頭部MRI検査で,右上顎洞内の陰影と眼窩底の骨吸収があり,眼窩内への炎症の波及と,眼窩内容物の外側前方への圧排があった。抗生物質の追加投与,ステロイド点眼,治療用コンタクトレンズ装用を行い,耳鼻咽喉科手術後に表層角膜移植術を行った。本症例では,リウマチが基礎疾患としてあり,免疫学的機序による角膜の菲薄化に加え,上顎洞炎による眼窩内組織の感染と圧排などが角膜穿孔を起こしたと解釈される。
Abstract. A 58-year-old woman presented with hyperemia,discharge and blurred vision in her right eye. She had been diagnosed with chronic rheumatoid arthritis at the age of 27 years,and had been treated with systemic corticosteroid. She had been diagnosed with maxillary sinusitis and been given antibiotics since 10 weeks before. Her right eye showed peripheral thinning and corneal perforation with iris prolapse. Magnetic resonance imaging(MRI)showed inflammatory mass in the right maxillary sinus and defect in the orbital floor. Inflammatory process had extended to the intraorbital tissue. She was treated by additional systemic antibiotics,topical corticosteroid,and therapeutic contact lens. Lamellar keratoplasty was performed after surgery for maxillary sinusitis. Long-term presence of rheumatoid arthritis and maxillary sinusitis appear to have induced corneal perforation.
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