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作者门诊同时遇到2例蛇毒直接致眼损伤,报告如下.例1,蔡×,男,12岁.观看杀蛇时,左眼被蝮蛇吐出白液溅入1小时,当时眼痛明显、异物感、视物模糊、畏光、流泪,来院前曾用清水冲洗.检查:视力右眼1.5,左眼0.03.左眼睑轻度肿胀,球结膜混合性充血,角膜上皮大片不规则状脱落,知觉反射消失,裂隙灯下见基质层水肿,后弹力层有皱褶.KP(一),房闪(一),虹膜纹理清,瞳孔圆,直径约3mm,对光反射消失.晶体透明,眼底窥不清.右眼无明显异常.给予3%硼酸反复冲洗患眼结膜囊,双眼同时点托吡卡胺眼液2次,20分钟后健眼瞳孔散大,患眼瞳孔未改变,予以患眼结膜下注射地塞米松1mg,阿托品0.2mg,1小时后,瞳孔散大,直径6mm.嘱口服南通蛇药,局部滴氯霉素眼液.第2天,左眼视力0.1,角膜上皮大部修复,水肿减轻,后弹力层仍有皱褶,瞳孔药物性散大.第3天,左眼视力0.3,角膜荧光素染色(一),水肿消退,后弹力层皱褶仍存.第5天,左眼视力1.2,角膜完全透明,房闪(一),晶体透明,眼底无异常.
The author also encountered two cases of snake venom at the same time direct eye injury, the report is as follows.Example 1, Cai ×, male, 12 years old.Watch the snake, the left eye was vomit spit out white liquid splash into 1 hour, when the eye pain was obvious, Foreign body sensation, blurred vision, photophobia, tearing, rinse with water before going to the hospital.Check: visual acuity 1.5, left eye 0.03.Lower left eyelid swelling, conjunctival mixed congestion, irregular corneal epithelial shedding, Sensory reflex disappeared, the stromal lamp see stromal edema, after the elastic layer of folds.KP (a), atrial flash (a), iris texture clear, pupil circle, diameter of about 3mm, the light reflection disappears. Crystal transparency, fundus Peeping unclear right eye no obvious abnormalities given 3% boric acid repeatedly flush eyes conjunctival sac, eyes at the same time point tropicamide eye drops 2 times, after 20 minutes healthy eye mydriasis, affected eye pupil did not change, to suffer Eye subconjunctival injection of dexamethasone 1mg, atropine 0.2mg, 1 hour later, mydriasis, diameter 6mm. Oral oral Nantong, oral chloramphenicol eye drops on the first two days, left eye vision 0.1, large corneal epithelium Department of repair, reduce edema, after the elastic layer is still pleated, pupil medicine scattered.3 Day 3, left eye vision 0.3, corneal fluorescein staining (a), edema subsided, Descemet folds still. On day 5, 1.2 visual acuity, completely transparent cornea, anterior chamber flare (a), crystal clear, no abnormal fundus.