患者,女,农民,59岁,左眼被名为Scotinophara菌的黑色谷物昆虫蜇伤后疼痛肿胀1wk,表现为急性进行性视物模糊。左眼检查发现有明显的眼球突出、眶周肿胀和上睑下垂,眼球各个方向运动均受到限制。角膜浑浊伴上皮大片缺损。眼底检查发现视网膜中央动、静脉闭塞,视盘水肿和黄斑区缺血等特征。CT扫描和脑与眼眶MRI检查发现眼眶软组织炎症。患者诊断为左眼眶蜂窝织炎、角膜炎(角膜葡萄肿)和和视网膜中央动静脉闭塞。全身和局部抗菌素治疗后,眼眶周围肿胀,眼球突出明显改善。但是视力仍为无光感,此外,仍存在持续性眼球运动障碍。Scotinophara菌产生了严重的和长久的潜在眼部刺激。Scotinophara菌所致可觉察的轻微人眼伤害尤其在易发部位应该及时给予滴眼液治疗。

A 59-year-old female farmer presented with left painful swollen eye for 1 week after being stung by a rice black bug (Scotinophara sp.).It was associated with acute progressive blurring of vision.On examination of the left eye,there was a marked periorbital swelling with proptosis and complete ptosis.The extraocular movements were restricted in all the directions.The cornea was hazy with large epithelial defect.Fundoscopy showed combined features of both central retinal vein and artery occlusions with swollen optic disc and ischaemia of the macular area.CT scan and MRI of orbit and brain showed evidence of orbital soft tissue inflammation.Patient was diagnosed with left orbital cellulitis,keratouveitis and central retinal vein and artery occlusions.The periorbital swelling and proptosis were improved after treatment with systemic and topical antibiotics.However,the vision remained no perception of light(NPL)and limitation of ocular movements persisted.The potential ophthalmic insults by Scotinophara sp.can be severe and permanent.Awareness of the debilitating insults by Scotinophara sp.to human eye should be instilled timely especially in its prone areas.

R779.1