巩膜炎的临床表现和诊断
- Authors
- John H Stone, MD, MPH
John H Stone, MD, MPH
- Professor of Medicine
- Harvard Medical School
- Director of Clinical Rheumatology
- Massachusetts General Hospital
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
- Section Editor
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
- Deputy Editor
- Paul L Romain, MD
Paul L Romain, MD
- Deputy Editor — Rheumatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
- Translators
- 罗肇文, 主任医师，教授
罗肇文, 主任医师，教授
- 大连医科大学附属第一医院眼科
引言
巩膜炎性疾病包括表层巩膜炎和巩膜炎。表层巩膜炎通常具有自限性，或对局部治疗反应迅速。相反，巩膜炎是一种疼痛性、破坏性，且可能致盲的疾病，还可能累及角膜、邻近的表层巩膜及下层的葡萄膜。巩膜炎具有明显的、高度症状性的临床表现(图片 1)。
巩膜炎有时为单发疾病，不伴其他器官的炎症证据。然而，在多达50%的患者中，巩膜炎伴有基础性全身疾病，如类风湿关节炎(rheumatoid arthritis, RA)或肉芽肿性血管炎(Wegener肉芽肿)[1]。2/3的巩膜炎患者需要使用大剂量的糖皮质激素或大剂量糖皮质激素联合另一种免疫抑制剂来控制疾病[2]。
本专题将总结巩膜炎的临床表现和诊断。巩膜炎的治疗及眼部其他炎症性疾病相关问题见其他专题。 (参见“巩膜炎的治疗”和“表层巩膜炎”和“葡萄膜炎：病因、临床表现和诊断”和“类风湿关节炎的眼部表现”和“全身性疾病和感染相关的视网膜血管炎”)
解剖
巩膜位于结膜和表层巩膜下，脉络膜之上(图 1)。不透明的巩膜组织由胶原纤维构成，胶原纤维精确的交织排列方式提高了巩膜的硬度和稳定性。虽然巩膜自身不含血管，但该组织可通过富含血管的表层巩膜和脉络膜弥散来满足其代谢需求。
巩膜占眼外层的90%。巩膜组织起自角膜缘(角膜的外缘)，在后方止于视神经管。在眼球后极，巩膜与视神经的硬脑膜和蛛网膜鞘融合。这些解剖关系解释了为何视神经水肿和视力受损是后部巩膜炎的常见并发症(图片 2)。 (参见下文‘后部巩膜炎’)
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-04-07.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Okhravi N, Odufuwa B, McCluskey P, Lightman S. Scleritis. Surv Ophthalmol 2005; 50:351.
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