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患者,男,19岁。右眼打入铁屑急诊入院。检查:视力右眼前手动,左1.5。结膜充血重,角膜1时位2mm大小不规则全层穿通创口,周边角膜灰白色环形混浊,前房浅,瞳孔不圆,晶体混浊,眼压T_(-1)。全身检查未见异常。X线异物定位示右眼玻璃体内有金属异物。局麻下摘出1×1.5×2mm右左磁性异物,并缝合角膜创口。术后静点抗菌素等。翌日角膜环形混浊加重,有脓样物,急做3次结膜囊涂片检查有大量革兰氏阳性枯草芽胞杆菌,改静滴足量的氨(?)青霉素,地塞米松治疗,2周后炎症得到控制,但视力丧失,眼球凹陷,眼压T_(-2),趋于萎缩。细菌培养证实为枯草芽胞杆菌感染。讨论枯草芽胞杆菌属结膜囊存在的常住菌群。正常结膜因泪液的冲洗和溶菌酶的溶菌作用,枯草杆菌数量很少,一旦经创口或某种原因进入眼内可致严重感染,在结膜囊内大量繁殖。枯草菌致炎的发病特点
Patient, male, 19 years old. The right eye into the scrapie emergency admission. Check: manual right eye, left 1.5. Conjunctival hyperemia, corneal position 1mm 2mm size irregular full-thickness wound, peripheral corneal gray turbidity, anterior chamber shallow, pupil is not round, crystal opacity, intraocular pressure T _ (- 1). No abnormalities in the whole body examination. X-ray foreign body positioning shows the presence of metallic foreign body in the vitreous. Local anesthesia was removed 1 × 1.5 × 2mm right and left magnetic foreign body, and sutured the corneal wound. Postoperative antibiotics and so on. The next day the cornea ring turbidity aggravated, there are pus-like material, urgent 3 conjunctival sac smear a large number of Gram-positive Bacillus subtilis, intravenous infusion of sufficient amount of ammonia (?) Penicillin, dexamethasone treatment, 2 weeks later Inflammation was controlled, but the loss of vision, eyeball depression, intraocular pressure T _ (- 2), tends to atrophy. Bacterial culture confirmed Bacillus subtilis infection. Bacillus subtilis conjunctival sac to discuss the presence of resident bacteria. Normal conjunctiva due to lacrimal fluid washing and lysozyme lysozyme, Bacillus subtilis a small number, once the wound or some reason into the eye can cause serious infections, large numbers of conjunctival sac multiplication. Bacillus subtilis inflammation of the incidence characteristics