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要約 目的:一般的な角結膜化学腐蝕とは異なる臨床経過をたどったパラコート含有除草剤による化学外傷の1例について報告する。
症例:79歳,女性。除草剤が左眼に入り,充血を主訴に受診した。軽度の点状表層角膜炎を認めるのみであったが,4日後に増悪を訴え再診した。角膜全面の上皮欠損,全周性の強い結膜充血と瞼結膜の偽膜形成を認めたが,疼痛の訴えはほとんどなかった。洗浄や偽膜の除去,抗菌薬の点眼,ステロイドの点眼と内服による治療を行ったが,所見の改善はみられなかった。受傷9日目に除草剤がパラコート含有と判明し,抗酸化作用のあるレバミピド点眼を追加した。数日おきに洗浄と壊死組織の除去を行ったが,上皮欠損は縮小しなかった。受傷20日をすぎてから徐々に上皮化した。経過中,前房内炎症や眼圧上昇はなかった。受傷40日頃に上皮欠損は消失し,角膜の実質混濁や内皮異常,知覚低下を生じることなく治癒した。最終矯正視力は1.2であった。
結論:パラコートによる化学眼外傷では,受傷直後は軽微な所見にもかかわらず,数日後に急速に組織壊死と炎症が増悪する特異的な経過をたどる。報告例は少なく,成書にも記載が乏しいため,化学外傷の初療時には注意が必要である。
Abstract Purpose:Here, we report a case of chemical corneal injury caused by a paraquat-containing herbicide. In a patient whose clinical course differed from that observed in patients with injuries caused by other chemicals.
Case:A 79-year-old woman who accidentally splattered herbicide into her left eye presented with conjunctival hyperemia. An examination revealed mild punctate superficial keratitis. She returned 4 days later with worsening hyperemia but no ocular pain. The patient underwent irrigation and was treated with topical antibiotics, betamethasone, and oral prednisolone(20 mg), but no improvement in ophthalmological findings occured. On the 9th day after the injury, we discovered that the herbicide contained paraquat. And administered rebamipide(antioxidant)eye drops. The epithelial defect persisted for 20 days despite eye irrigation and the removal of necrotic tissue being repeated every few days. Epithelialization of the entire cornea without stromal opacity, endothelial abnormalities, or sensory disturbances of the cornea occurred on approximately the 40th day. The patient's final visual acuity was 1.2. Neither anterior chamber inflammation nor an intraocular pressure elevation was detected during the treatment course.
Conclusion:Paraquat-induced ocular surface injuries show a specific course with rapid worsening of tissue necrosis and inflammation a few days after the injury. Despite minor findings immediately after the injury. Only a few previous studies and a few textbooks have described this injury;therefore, we should carefully provide the initial treatment of chemical injuries.
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