2018年 · 第54卷第02期

This issue focuses on the research of ocular surface diseases. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Liu Guoguo.

In 2017, the International Association of Tear Film and Ocular Surface published the latest edition of dry eye expert consensus (Dry Eye Workshop II, DEWS II). This consensus modifies the definition of dry eye, removing the specific signs for the diagnosis of dry eye, and emphasizing the homeostasis of the tear film. Homeostatic imbalance suggests that the body has lost its ability to maintain equilibrium, resulting in high osmolarity and instability of the tear film with corresponding consequences, such as inflammatory response, neuropathy, and decreased function (lubricating, moisturizing ability). The correct diagnosis is based on examination, and the examination of dry eye in DEWS II in 2017 is now interpreted.

In 2017, the International Tear Film & Ocular Surface society (TFOS) published the latest version of the Dry Eye Workshop II (DEWS II), in which the content on gender, sex hormones and Dry Eye was organized by Professor David A Sullivan of Harvard University as the first author. Professor David A Sullivan is a Senior Professor of Ophthalmology at Harvard University, the Founder and Former Chairman of TFOS. For nearly 35 years, he has been dedicated to basic and clinical research on the relationship between gender, sex hormones and ocular surface diseases, and has published 225 related articles and obtained 11 patents.

Meige syndrome is a disease first described by and named after French neurologist Henry Meige in 1910, with blepharospasm-oromandibular dystonia as the main symptom. In recent years, some scholars have suggested that this disease be named "segmental craniocervical dystonia"^[1]。 The average age of onset was 60 years, and the ratio of male to female sex was approximately 1:2. Although the overall incidence rate has not been reported at home and abroad, in recent years, it has been found that the number of patients with it has been increasing obviously, which has attracted great attention from ophthalmology and neurosurgery. In view of this, the Neuroophthalmology Group of Ophthalmology Branch of Chinese Medical Association put forward this consensus after collective discussion, in order to guide clinical diagnosis and treatment work and research.

The child was a male, 7 and a half years old. On August 10, 2015, I came to the Department of Ophthalmology of Eye, Otolaryngology Hospital affiliated to Fudan University because of the increase in serum ferritin for 2 years and blurred vision in both eyes for 1 year. On April 25, 2013, the parents found that the child's growth and development were retarded after the age of 5. Physical examination found that the serum ferritin was increased, which was 1,454 ng/ml, and on May 20, it was found to be 2,343.64 ng/ml. Later, he went to Shanghai Children's Medical Center of Shanghai Jiaotong University School of Medicine and reexamined the serum ferritin of 961.9 ng/ml. The child had no complaints of discomfort. General physical examination: height 120 cm, weight 20 kg, generally acceptable, no anemia, a few lymph nodes accessible to the neck, 0.50~0.75 cm in diameter, no tenderness, good mobility, no difference in heart and lung, no enlargement of liver and spleen, no rash. The laboratory test on June 13 found that white blood cells were 5.5×10⁹Neutrophils 51.5%, lymphocytes 39.7%, hemoglobin 133 g/L, platelets 2.1×10¹¹Liver/L, reticulocyte percentage 3.4%, liver and kidney function, lactate dehydrogenase, serum iron, serum total iron binding capacity (-), 25 hydroxyvitamin D₃(-), hepatitis B (-), hepatitis C (-), carcinoembryonic antigen (-). B-ultrasound examination showed bilateral cervical lymph node enlargement, 1.5 mm ×7.0 mm, no abnormalities in liver, gallbladder and pancreas, and abdominal lymph node enlargement of 1.3 mm ×0.6 mm. Bone marrow puncture smear: obvious lymphoid hyperplasia. CT scans of head and chest (-), long bones and pelvis of limbs (-). Summary Physical examination showed that serum ferritin was significantly increased, and laboratory examination showed no iron deficiency anemia and increased iron load, and there were no inflammatory indicators and signs of tumor.

The child was a 4-year-old female. He went to Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University with the main complaint of "2-year poor visual acuity in both eyes". Physical examination: visual acuity 0.2 in right eye, 0.1 in left eye, corrected visual acuity 0.3 in right and 0.25 in left eye. IOP was 16.8 mmHg (1 mmHg =0.133 kPa) in the right eye and 18.1 mmHg in the left eye. After dilating the pupils, the lenses of both eyes are clear, the lens of the right eye is displaced below the nose, and the left eye is displaced to the nasal side (Figure 1）。 No abnormalities were observed in the rest of the anterior segment and fundus. Auxiliary examination: color doppler imaging (CDI) of the eye showed that the axis of the eye was 22.68 mm in the right eye and 23.34 mm in the left eye, and no obvious abnormalities were found in both eyeballs. Systemic examination: Echocardiography revealed mild tricuspid insufficiency. No abnormalities were observed. Family history: The mother of the child has a history of lens subluxation in both eyes and high myopia in both eyes. Diagnosis: congenital lens subluxation in both eyes, refractive errors in both eyes, amblyopia in both eyes, suspected Marfon's syndrome.

The patient was a 36-year-old female. He was seen in Tianjin Eye Hospital because he found that the conjunctiva of his right eye had grown for 2 years. The patient had brown pigment in the conjunctiva of the right eye without obvious trigger 2 years ago and was not treated. There were no abnormalities in the whole body examination, and there was no melanin deposition in the trunk, limbs and face. Eye examination: visual acuity was 0.8 in the right eye and 0.9 in the left eye; The appearance of the right eye is normal, the eyelid is not red or swollen, and the conjunctiva is shownQuintessence Picture 1； Anterior segment and fundus examination of both eyes showed no abnormalities. Clinical diagnosis: conjunctival mass of the right eye. Excision of the conjunctival mass of the right eye was performed. Histopathological examination showed that the tumor was brown in gross appearance and had a volume of 15 mm x 3 mm x 1 mm; Under light microscope, the nevus cells were located under the conjunctival epithelium or at the junction of the epithelium. The cell volume was small, most of them were small round, and the size was relatively consistent. The nevus cells located in the superficial layer of the conjunctival epithelium contained a small amount of melanin, and there was no obvious atypia (Quintessence Picture 2）。 Pathological diagnosis: conjunctival composite nevus of the right eye.