幼児のマイボーム腺炎角結膜上皮症の3例

Three cases of meibomitis-related keratoconjunctivitis in children

要約　目的：幼児のマイボーム腺炎角結膜上皮症（MRKC）では，詳細な前眼部診察が困難で診断に苦慮する場合がある。今回，MRKCの幼児3症例を経験したので臨床的特徴を含め報告する。

症例：［症例1］患者は5歳，女児。4歳時に左眼角膜潰瘍の治療歴があった。内斜視，両眼視力不良のため，5歳時に広島赤十字・原爆病院（当院）に紹介され受診した。初診時，視力は右（0.6），左（0.3）で，両眼のマイボーム腺のpluggingと結膜の充血が認められ，両眼角膜中央部に混濁があった。MRKCを疑い，抗菌薬内服・点眼治療を行った。約2年の経過観察中に再発と寛解を繰り返したが，右視力は（1.0）に改善した。

［症例2］患者は2歳，女児。右上斜視疑いで当院に紹介され受診した。初診時，両眼ともに下方の結膜の充血が認められ，角膜下方に混濁と血管侵入があった。顎引き頭位が顕著であった。MRKCを疑い，抗菌薬内服・点眼治療を行った。治療後に頭位異常は改善した。

［症例3］患者は5歳，男児。右上睫毛内反症，弱視の加療目的で当院に紹介され受診した。視力は右（0.6），左（1.2）。右眼は眼瞼縁の発赤，腫脹，collarette付着と点状表層角膜症があった。MRKCを疑い抗菌薬内服・点眼治療を行い，右視力は（1.2）に改善した。

結論：幼児では，結膜充血を伴う頭位異常や弱視の原因としてMRKCを想定して診療を行う必要がある。

Abstract　Purpose：To report about three children who had meibomitis-related keratoconjunctivitis（MRKC）.

Cases：Case 1 was a 5-year-old girl who had a history of recurrent corneal ulcers in the left eye. She was referred to our hospital for esotropia and amblyopia. During the first visit, her corrected visual acuity was 0.6 in the right eye and 0.3 in the left eye. Slit-lamp examination revealed plugging of the meibomian gland, conjunctival hyperemia, and opacities at the center part of the cornea in both eyes. We diagnosed MRKC. After treatment, ocular surface inflammation and meibomitis were alleviated, and her corrected visual acuity was 1.0 in the right eye. Case 2 was a 2-year-old girl who was referred to our hospital for hypotropia in the right eye. During the first visit, a slit-lamp examination revealed hyperemia of the meibomian gland, conjunctival hyperemia, and vessel invasion to the corneal lower part in both eyes. In addition, the patient's chin-down head posture was remarkable. We diagnosed MRKC. Her abnormal head position improved after treatment. Case 3 was a 5-year-old boy who was referred to us for palpebral entropion and amblyopia. During the first visit, his corrected visual acuity was 0.6 in the right eye and 1.2 in the left eye. Slit-lamp examination revealed plugging of the meibomian gland, collarette, and superficial punctate keratitis in the right eye. We diagnosed MRKC, and his corrected visual acuity was 1.0 in the right eye after treatment.

Conclusion：The present cases illustrate that abnormal head posture or amblyopia with conjunctiva hyperemia may be symptoms of MRKC in children.