윗눈꺼풀성형술 후 발생한 상윤부각결막염 양상을 보이는 결막 림프관종 1예
A Case of Conjunctival Lymphangioma With Clinical Manifestations of Superior Limbic Keratoconjunctivitis After Upper Lid Blepharoplasty
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목적: 윗눈꺼풀성형술 후 발생한 상윤부각결막염 임상양상을 보이는 결막림프관종 1예에 대해 보고하고자 한다. 증례요약: 1년 전 윗눈꺼풀성형술을 받은 55세 여자 환자로 2일 전부터 시작된 우안의 통증, 충혈, 시력저하를 주소로 내원하였다. 세극등 검사상 우안 상부 안구결막에 중앙부 미란을 동반한 융기되고 경계가 불분명한 종괴가 관찰되었고 각막 위쪽에 광범위한 각막미란, 각막 부종이 관찰되었다. 각막 미란에 대한 치료로 인공누액제, 항생점안액과 보호용 렌즈를 처방하였다. 경과관찰 중 우안 전방내 염증소견 보여 스테로이드 점안액을 추가하였으나 증상이 호전되지 않았다. 개안기를 이용하여 윗눈꺼풀을 외전시킨 후 관찰한결과 윗눈꺼풀성형수술받은 부위에 압흔을 보이는 병변이 관찰되었으나 노출된 봉합사는 관찰되지 않았다. 진단과 치료를 위해 안구결막 융기부와 미란부에 절제술 및 조직검사, 눈꺼풀판하 결막내스테로이드주입술을 시행하였다. 절제된 결막부의 병리조직검사 결과상 결막 림프관종으로 진단되었다. 결론: 윗눈꺼풀성형수술 후 눈꺼풀의 압력과 마찰로서 결막림프관종이 발생할 수 있다.
Abstract
Purpose: To report a case of conjunctival lymphangioma with clinical manifestations of superior limbic keratoconjunctivitis after upper lid blepharoplasty. Case summary: A 55-year-old woman who had upper lid blepharoplasty performed 1 year before complained of pain, injection,and blurred vision in her right eye, which lasted for 2 days. The slit lamp examination revealed a poorly demarcated hypertrophic lesion with central erosion on the superior bulbar conjunctiva and a diffuse corneal erosion and edema in the area of the superior limbus. Tenderness of the superior bulbar conjunctiva and corneal erosion were treated with artificial tears, antibiotic eye drops, and a therapeutic contact lens. Slight anterior chamber reaction was found and treated by steroid eye drops; however, there was no improvement. After eversion of the right upper eyelid with a Desmarres retractor, a hypertrophic lesion with central dimpling was found. However, no exposed sutures were observed. Resection and biopsy of the superior bulbar conjunctiva and a subtarsal triamcinolone injection were performed for diagnosis and treatment. A conjunctival biopsy specimen showed conjunctival lymphangioma. Conclusions: Conjunctival lymphangioma can occur due to pressure and friction of an eyelid lesion after upper lid blepharoplasty.
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