【摘 要】
：
患者男,34岁.因"右眼红2周,加重伴视物模糊、眼痛5天"入院.发现血压高2年,最高达160/90 mmHg(1 mmHg=0.133 kPa),未监测血压.入院血压200/180 mmHg,全身体格检查未见明显异常.VOD 0.15,矫正视力1.0(-6.25DS),VOS 1.0,右眼颞侧眼球触痛明显,颞侧结膜充血、水肿,下方巩膜表面血管充血、扩张,上方结膜下点片状出血,右眼眼底视盘边界清,色
【机 构】
：
510630 广州,南方医科大学第三附属医院眼科
【出 处】
：
2014年中国眼底病论坛暨全国眼底病专题学术研讨会
论文部分内容阅读
患者男,34岁.因"右眼红2周,加重伴视物模糊、眼痛5天"入院.发现血压高2年,最高达160/90 mmHg(1 mmHg=0.133 kPa),未监测血压.入院血压200/180 mmHg,全身体格检查未见明显异常.VOD 0.15,矫正视力1.0(-6.25DS),VOS 1.0,右眼颞侧眼球触痛明显,颞侧结膜充血、水肿,下方巩膜表面血管充血、扩张,上方结膜下点片状出血,右眼眼底视盘边界清,色淡红,C/D=0.5,A/V=1:2,动静脉压迫征(+),视网膜见散在点片状出血灶及黄白色片状渗出,黄斑周围视网膜见放射状皱褶,中心凹反光(-),周边7点位视网膜可见一干性小裂孔,未见网脱,颞侧视网膜大片灰白色隆起,其中可见一团块状暗红色隆起;左眼前节正常,眼底视盘边界清,色淡红,C/D≈0.5,A/V≈1:2,动静脉压迫征(+),视网膜见散在点片状出血灶及黄白色片状渗出,中心凹反光(-).眼压:右眼25.8 mmHg,左眼28.7 mmHg.诊断:1.右眼表层巩膜炎2.右眼视网膜裂孔3.右眼球壁内肿物?4.双眼高血压性视网膜病变5.右眼屈光不正6.高血压病7.双眼青光眼.予以右眼局部抗炎、降低眼压、改善循环等对症治疗(双氯芬酸钠滴眼液,典必殊滴眼液,布林佐胺滴眼液,灯盏花注射液),完善相关检查以明确肿物性质.眼眶MR:右侧眼球外侧壁似见略增厚,信号较对侧略增高,T2序列见眼球壁内侧点状低信号,大小约2 mm×2mm,黑色素瘤待排.眼球彩超:右眼球壁低回声团块.FFA检查:右眼颞侧弱荧光,双眼高血压性眼底改变,视网膜局部散在脱色素.因肿物位于赤道前,OCT无法探及.甲状腺彩超:甲状腺右侧叶实性团块伴钙化.胸片、肝胆胰脾彩超及血液癌性指标未见明显异常.24h尿香草苦杏仁酸正常.心内科会诊,行相关检查,暂不支持继发性高血压.普外科会诊不排除甲状腺右叶结节恶性可能.经上述抗炎等对症治疗15天后,患者右眼颞侧眼球无明显触痛,颞侧巩膜表面血管充血明显减轻,VOD 0.6,矫正视力1.0(-1.50DS),右眼眼底见颞侧视网膜灰白色隆起不明显,范围较前缩小,其中暗红色团块隆起较前缩小.患者于外院行甲状腺手术,病理提示结节性甲状腺肿.1月后复诊,右眼眼底见原似肿物隆起处变平.故最后诊断:右眼脉络膜出血.
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