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儿童青少年睑缘炎相关角结膜病的诊疗进展综述
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Abstract:
儿童青少年睑缘炎相关角结膜病(Pediatric Blepharokeratoconjunctivitis, PBKC)是一种以慢性、反复发作为特征的眼表炎症性疾病，主要累及眼睑边缘、结膜及角膜，是导致儿童角膜瘢痕、不规则散光及弱视的重要原因之一。PBKC的发生发展与多种因素密切相关，包括睑缘细菌定植、蠕形螨感染、免疫反应失调以及睑板腺功能障碍等，多种机制相互作用导致持续性眼表炎症和角膜损伤。由于临床表现多样且缺乏特异性，PBKC易被误诊或延误诊断，部分患儿在出现明显角膜并发症时方被发现。近年来，PBKC的诊断标准、活动度与损伤度分级逐步规范，为疾病的早期识别和个体化治疗提供了依据。在治疗方面，PBKC以长期、综合管理为原则，强调眼睑卫生、抗感染与抗炎治疗、免疫调节、改善睑板腺功能及眼表微环境，必要时联合全身治疗。本文系统综述了PBKC的流行病学特征、发病机制、临床表现、诊断标准及治疗策略的研究进展，旨在提高临床医师对该疾病的认识，促进早期诊断和规范化治疗，减少角膜并发症和视功能损害。
Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic and recurrent inflammatory ocular surface disease predominantly affecting the eyelid margin, conjunctiva, and cornea in children and adolescents. It represents an important cause of corneal scarring, irregular astigmatism, and amblyopia in the pediatric population. The development and progression of PBKC are closely associated with multiple factors, including eyelid bacterial colonization, Demodex infestation, immune dysregulation, and meibomian gland dysfunction. The interaction of these mechanisms leads to persistent ocular surface inflammation and corneal damage. Owing to its heterogeneous and nonspecific clinical manifestations, PBKC is frequently misdiagnosed or diagnosed late, with some patients only being identified after significant corneal complications have developed. In recent years, the establishment of standardized diagnostic criteria and grading systems for disease activity and damage has facilitated earlier recognition and individualized management of PBKC. Current therapeutic strategies emphasize long-term, comprehensive management, including eyelid hygiene, anti-infective and anti-inflammatory therapy, immunomodulation, improvement of meibomian gland function, and restoration of the ocular surface microenvironment, with systemic treatment applied when necessary. This review systematically summarizes recent advances in the epidemiology, pathogenesis, clinical manifestations, diagnostic criteria, and treatment strategies of PBKC, aiming to enhance clinicians’ awareness of this condition, promote early diagnosis and standardized management, and ultimately reduce corneal complications and visual impairment in affected children.
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