儿童干眼的初步研究

目的探讨儿童干眼是否存在及有何临床特点。设计前瞻性病例观察系列。研究对象38例(76眼)可疑儿童干眼患者,38例(76眼)正常儿童。方法对符合成年人干眼诊断标准的38例(76眼)儿童作为可疑干眼的观察组,取年龄与之匹配的正常儿童38例(76眼)作为对照组分别做基础泪液分泌试验(Schirmer)、泪膜破裂时间检查(BUT)、角结膜荧光素(FL)染色检查,对观察组行药物治疗并追踪观察6个月,再行以上三项检查。对可疑儿童干眼患者的症状、病因进行分析。主要指标症状, Schirmer,BUT,FL染色检查。结果38例可疑儿童干眼中瞬目次数增加21例(55．26％),干涩15例(39．47％),畏光14例(36．84％),眼红14例(36．84％)。观察组比对照组Schirmer和BUT均有显著性降低(P均=0．0000)。观察组和对照组Schirmer和BUT左右眼明显相关。观察组和对照组Schirmer和BUT两种检查无相关性。观察组药物治疗6个月前后Schirmer比较差异无统计学意义(P=0．368),BUT和FL检查有显著性改善(P=0．049,P=O．001)。结论儿童干眼确实存在,症状中以瞬目次数增加为最多,儿童干眼并非一时的主观症状,患儿可能存在较长时间(至少>6个月)的影响泪液分泌的病理状态。     

超声乳化白内障吸除术后泪膜的变化

目的　了解超声乳化白内障吸除术对泪膜的影响。方法　随机抽取行超声乳化白内障吸除术的老年性白内障患者 6 8例 (79只眼 ) ,分别于术前 ,术后 1、2、7、14、30及 180d行泪膜破裂时间(breakuptime ,BUT)、基础泪液分泌试验 (SchirmerⅠtest,SⅠt)、角膜荧光素染色、干眼仪检查及下睑中央泪河高度检查。结果　与术前相比 ,术后 1及 2d ,BUT明显缩短 ,SⅠt、下睑中央泪河高度、角膜荧光素染色程度及干眼仪检查等级明显增高 (P <0 0 1) ;术后 7d时SⅠt,14d时下睑中央泪河高度 ,30d时BUT、角膜荧光素染色程度和干眼仪检查等级恢复至术前水平 ,与术前比较差异无显著意义(P >0 0 5 )。术后 30d ,19 3%的患眼泪膜未能恢复至术前水平 ;术前泪膜正常的患者中 1/9发生干眼。术后 1、7、14及 30d ,术前BUT <10s的术眼BUT <5s的发生率高于术前BUT≥ 10s的术眼(P <0 0 5 ) ;术后 14、30及 180d ,术前角膜荧光素染色评分 >2分的术眼术后角膜荧光素染色评分 >2分的发生率高于术前角膜荧光素染色评分≤ 2分的术眼 (P <0 0 5 ) ;术后 14d ,术前干眼仪检查等级≥Ⅲ级的术眼术后干眼仪检查等级≥Ⅲ级的发生率高于术前干眼仪检查等级 <Ⅲ级的术眼(P <0 0 5 )。结论　超声乳化白内障吸除术可影响泪膜的稳定性 ,使部分患     

两种干眼症状问卷评分与干眼临床检查的关联性研究

背景 目前常用的干眼症状评估问卷有两种,但二种问卷结果的关联性及问卷与临床检查的关联性研究尚未见到.如何有效地评估干眼症状,将患者的主观症状进行量化有助于临床上干眼的正确诊断. 目的 评价标准干眼症状评估(SPEED)问卷和眼表疾病指数(OSDI)问卷两种干眼问卷诊断干眼的一致性及其与干眼体征的相关性.方法 采用前瞻性队列研究设计.对66例干眼患者先依据SPEED问卷进行评分,并分为轻度症状组(＜10分)和重度症状组(≥10分);然后对同一批患者依据OSDI问卷进行评分,并分为轻度症状组(≤20分)、中度症状组(21～ 45分)和重度症状组(≥46分).所有患者行泪膜镜、泪膜破裂时间(BUT)、角膜荧光素染色、Schirmer Ⅰ试验等干眼临床检查,分析两种问卷与干眼临床检查结果之间的关系. 结果 SPEED问卷评分和OSDI问卷评分与BUT值均呈负相关(r=-0.390,P=0.001;r=-0.395,P=0.001),两种问卷评分与Schirmer Ⅰ试验结果间无明显相关性(r=-0.081,P=0.515;r=-0.080,P=0.525),与泪膜镜分级结果也均无明显相关(r=0.158,P=0.204;r=0.219,P=0.077).SPEED问卷轻度症状组BUT明显长于重度症状组,差异有统计学意义(t=2.339,P=0.022),而2个组间Schirmer Ⅰ试验和泪膜镜分级差异均无统计学意义(t=0.404,P=0.687;t=-0.947,P=0.347);2个组间荧光素染色阳性率的差异无统计学意义(x2=0.164,P=0.685).OSDI问卷评分轻度症状组、中度症状组、重度症状组间BUT值比较,差异有统计学意义(F=11.871,P=0.000),轻度症状组BUT明显长于中度症状组和重度症状组(P=0.000、0.000);3个组间Schirmer Ⅰ试验、泪膜镜分级差异均无统计学意义(F=1.432,P=0.246;F=2.799,P=0.068);3个组间荧光素染色阳性率的差异无统计学意义(x2=6.026,P=0.050).SPEED问卷评分值与OSDI问卷评分值间呈正相关( r=0.697,P=0.000).结论 SPEED问卷和OSDI问卷都是客观评估干眼症状的有效方法,与BUT有相关性,可作为临床诊断干眼的辅助手段;两种问卷可联合使用.     

泪液渗透压与干眼严重程度的关联性研究

背景 干眼的发病率逐渐增加,但目前尚无统一的诊断标准.近年的研究提示,泪液渗透压增高可导致眼表不适症状,2007年国际干眼工作小组(DEWS)将泪液渗透压作为伴随症状写入干眼定义中,因此研究泪液渗透压与干眼的关系有重要的临床意义. 目的 依据DEWS干眼严重程度分级标准,分析泪液渗透压与干眼严重程度的相关性.方法 采用描述性研究方法,收集在河南省眼科研究所经传统诊断方法诊断为干眼的患眼54例54眼,询问患者的眼部症状,裂隙灯显微镜下观察眼前节表现,同时行Schirmer试验Ⅰ(SⅠt)、泪膜破裂时间(BUT)试验、泪膜影像学检查、角膜荧光素染色以及泪液渗透压试验,参照和结合DEWS的标准对干眼表现进行评分,将干眼症状评分与泪液渗透压进行相关分析. 结果 男性发病与女性发病的比例为1:2.泪液渗透压与SⅠt、BUT均呈明显负相关(r=-0.456、-0.699,P＜0.01),与泪膜影像学检查值、角膜荧光素染色评分、结膜充血评分、干眼严重程度评分均呈显著正相关(r=0.545、0.686、0.691、0.803,P＜0.01),与年龄、性别相关(β1=141.138,P=0.000;β2=1.845,P=0.049). 结论 泪液渗透压检测可客观地反映干眼的严重程度,结合临床症状和体征可作为干眼严重程度分级的标准.     

干眼诊断的两种方法评价对比

目的 对比干眼仪方法与传统的Schirmer试验方法的检查结果,评价两种方法在干眼诊断中的作用.方法 选取在门诊就诊干眼患者30例(60只眼).其中男性2例(4只眼),女性28例(56只眼),年龄22～67岁,平均(38.23±10.54)岁.对30例患者依次询问症状,行干眼仪检查和Schirmer试验检查.应用SPSS12.0统计软件包,用相关回归分析干眼仪与Schirmer试验检查方法之间的相关性(双侧检验);P＜0.05为具有统计学意义.结果 在观察的病例中,Schirmer试验＜5mm/5min(阳性)的32只患眼中,有6只眼干眼仪测试分级为2级(阴性).Schirmer试验(滤纸条湿长)＞5mm/5min(阴性)的28只患眼中,23只眼干眼仪检查分级>2级(阳性);5只眼干眼仪测试分级为2级,但患者有明显的干眼症状.此外,相关回归性分析显示干眼患者的干眼仪检测等级越高,Schirmer试验滤纸条湿长越短,两者呈负相关(r=-0.307,P=0.017).结论 干眼仪和Schirmer试验从不同角度诊断干眼,并客观反映病情的严重程度.但是,两者都存在假阴性,所以为了避免漏诊与误诊,仍需要与传统的其他干眼诊断方法联合使用.     

飞秒激光制瓣LASIK术后泪膜变化及相关性分析

目的 观察飞秒激光制瓣准分子激光原位角膜磨镶术后泪膜的变化,BUT、泪液分泌试验和泪河高度的相关性.方法 临床病例系列研究.收集2013年8～9月长春爱尔眼科医院行飞秒激光制瓣LASIK术并随访3个月的患者120例(240只眼),观察术前、术后1周、1、2和3个月患者的荧光素检查的泪膜破裂时间(BUT)、Oculus角膜地形图仪检查的BUT、泪液分泌试验(S Ⅰ t)、Oculus角膜地形图仪检查的泪河高度(TMH)的变化,同时观察荧光素BUT和Oculus BUT、泪液分泌试验和Oculus泪河高度的相关性.结果 Oculus BUT:术后1周与术前相比有差异有统计学意义(P=0.00＜0.05),术后1、2、3个月与术前相比差异无统计学意义(P =0.556,0.663,0.087＞0.05).荧光素BUT:术前荧光素BUT与术后1周、l、2、3个月相比均差异有统计学意义(P =0.033,0.025,0.004,0.000＜ 0.05).Schirmer Ⅰ试验:术后1周、1个月与术前差异有统计学意义(P =0.000,0.002＜0.05),术后2、3个月与术前差异无统计学意义(P=0.776,0.753＞0.05).泪河高度:术后1周、1个月与术前相比差异有统计学意义(P =0.00＜0.05),术后2、3个月与术前相比差异无统计学意义(P =0.096,0.229＞0.05).Oculus BUT和荧光素BUT相关分析:相关关系为正相关.泪河高度和Schirmer Ⅰ相关分析:无相关关系.结论 飞秒激光制瓣准分子激光原位角膜磨镶术术后早期影响泪膜的稳定性;Oculus角膜地形图仪非侵入性BUT检查具有可靠性,重复性较好,可以作为临床干眼诊断的一个参考标准.     

儿童干眼的临床特点

目的 确定儿童是否存在与成人类似的干眼,并探讨儿童干眼的特点.方法 对2005年3月至2007年10月诊治的62例儿童干眼患者的资料,分析病史及症状、SchirmerTest(泪液分泌试验)、BUT(泪膜破裂时间)、FL(荧光素染色)、干眼仪检查及疗效.结果 54例有较明确的病史.主要症状表现为眼痒37例(26.1%),瞬目频繁21例(14.8%),干涩感15例(10.6%).畏光14例(9.9%),眼红14例(9.9%),以及对风、烟、空调敏感,异物感,分泌物增多,眼睑痉挛,烧灼感等.SchirmerTest:38例<10mm/5min,平均为55.mm/5min.BUT:62例全部<5s.FL:12例角膜上皮点状着染1～3象限.干眼仪检查:36例图像为3级以上.经人工泪液等药物治疗后观察4周,62例患者症状全部缓解,12例角膜点状着染者转阴,BUT有所增加,Schirmer无明显增加.结论 儿童存在与成人类似的干眼.     

OCT前节模块测量的上下泪河数值与干眼的相关性

背景 干眼是常见的眼表疾病,光学相干断层扫描（OCT）前节模块可实现对泪河进行直接和精确的检测. 目的 用OCT前节模块对上下泪河进行测量,并分析测量结果与干眼症状和体征的相关性.方法 采用回顾性系列病例观察方法,收集2010年9-10月在北京大学第一医院眼科就诊的符合眼表疾病指数问卷（OSDI）评分＞20分的干眼患者36例,使用OCT前节模块测量平视状态时上下泪河的高度（U/LTMH,μm）、深度（U/LTMD,μm）和泪三角面积（U/LMA,mm2）;对患者行泪膜干涉成像仪、泪膜破裂时间（BUT）、角膜荧光素钠（Fl）染色、结膜丽丝胺绿染色、Schirmer Ⅰ试验（SⅠt）检查.采用Spearman秩相关分析法评估OCT前节模块测量的泪河参数与患者干眼相关症状体征之间的相关性. 结果 本组患者平均UTMH为（232±56） μm,平均UTMD（156±53）μm,平均UMA为（0.021±0.008） mm2,LTMH平均为（222±72） μm,平均LTMD为（163±65） μm,平均LMA为（0.020±0.006） mm2,测量的上下泪河高度、深度接近,差异均无统计学意义（目河高度：t=0.530,P＞0.05;泪河深度：t=0.650,P＞0.05;泪河高度：t=1.010,P＞0.05）.泪河各参数与OSDI评分、泪膜干涉分析成像仪分析结果间无明显相关性;UTMH、UTMD、UMA与BUT均呈正相关（r=0.46,P=0.01;r=0.40,P=0.02;r=0.43,P=0.01）;LTMH、LTMD、LMA与BUT均呈正相关（r=0.61,P=0.00;r=0.64,P=0.00;r=0.64,P=0.00）,与SⅠt结果均呈正相关（r=0.54,P=0.02;r=0.46,P=0.01;r=0.55,P=0.01）,而与角膜荧光素染色评分均呈负相关（r=-0.37,P=0.04;r=-0.37,P=0.04;r=-0.41,P=0.05）,与结膜染色评分亦均呈负相关（r=-0.56,P=0.01;r=-0.37,P=0.04;r=-0.47,P=0.00）.结论 OCT前节模块可用于对上下泪河进行客观和非侵入性测量,其测量结果与BUT、角膜荧光素钠染色、结膜丽丝胺绿染色和SⅠt结果均有相关性,可作为干眼诊断的有效辅助工具.     

纯水雾剂治疗干眼的临床观察

目的 观察纯水雾剂治疗干眼的临床疗效。方法 2004年8月～2005年3月于我院门诊就诊的198例干眼患者，使用随机数字表法分为两组，A组82例，给予纯水雾剂治疗，每日4～6次；B组116例，给予0．1％透明质酸钠（0．1％爱丽滴眼液）治疗，每日3～4次。均治疗60天，治疗前后调查患者症状，行泪膜破裂时间（breakup time，BUT）、基础泪液分泌试验（Schirmer I test，SIt）及角膜荧光素染色检查。结果 与治疗前比较，A组患者症状明显好转，其中以眼红、干涩感、异物感、痒感及视疲劳改善明显；B组以干涩感、异物感及视疲劳改善明显。A组治疗后BUT较治疗前延长（P〈0．05），角膜荧光素染色评分较治疗前降低（P〉0．05），SIt较治疗前增加（P〉0．05）；B组治疗后BUT较治疗前延长（P〈0．05），角膜荧光素染色评分较治疗前降低（P〈0．05），SIt较治疗前增高（P〈0．05）。A组与B组比较，两组治疗后BUT差异无显著性（P〉0．05），角膜荧光素染色评分A组高于B组，SItA组低于B组，差异均有显著性（P〈0．05）。结论 伟博水雾可以提高干眼症患者泪膜稳定性，同时缓解患者眼部激惹症状，是一种新型有效的泪液补充品。     

睑缘炎患者睑板腺形态变化及其与干眼的关系

背景 睑缘炎是一种常见的眼表疾病,常累及睑板腺体,而睑板腺体所分泌的脂质是泪膜的重要组成成分之一.泪膜稳定性的破坏可导致干眼相关症状,可以说睑缘炎是干眼发病的因素之一,但二者之间的关系有待进一步研究. 目的 使用非接触式红外线睑板腺观察仪观察睑缘炎患者睑板腺腺体的形态,并与干眼相关检查进行相关性分析. 方法 采用病例观察的设计方法对睑缘炎患者睑板腺形态改变与干眼症的关系进行研究.选取2010年9月至2011年4月于河南省眼科研究所眼科门诊依据PPP标准诊断为睑缘炎的患者83例83眼,取得患者的知情同意后,在裂隙灯下行眼前节检查睑缘畸形评分、泪液分泌( Schirmer Ⅰ)试验、泪膜破裂时间(BUT)、角膜荧光素染色评分及结膜充血评分,采用泪膜干涉仪行泪膜形态分级,采用非接触式红外线睑板腺摄像仪行睑板腺腺体缺失分级,对睑缘炎睑板腺腺体缺失分级与上述检查结果的关系进行评估.结果 不同年龄组不同性别间睑缘炎的频数分布差异无统计学意义(x2=2.69,P=0.75).睑缘炎患者的睑板腺腺体缺失分级与年龄星弱的正相关(r=0.58,P=0.00),但与性别无明显相关性(r=-0.09,P=0.99);患者睑板腺体缺失与睑缘畸形评分及结膜充血评分均呈弱的正相关(r=0.64,P=0.00;r=0.50,P=0.00);与泪膜影像分级及角膜染色评分均呈弱的正相关(r=0.23,P=0.04;r=0.50,P=0.00),与BUT呈弱的负相关(r=-0.32,P=0.00),但与Schirmer Ⅰ试验结果无明显相关性(r=-0.05,P=0.69).不同年龄组男性和女性的睑板腺缺失分级评分差异无统计学意义(Z=-0.09,P=0.93).结论 睑缘炎可引起蒸发过强型干眼,且患者的睑板腺体随年龄的增长缺失程度加重.非接触式红外线睑板腺观察仪作为一种有效、快速、无刺激地观察睑板腺体形态的仪器,可作为一项常规检查来辅助诊断睑缘炎.     

Tear film lipid layer alterations in allergic conjunctivitis

PURPOSE: To assess the alterations of the tear film lipid layer and tear functions in patients with seasonal allergic conjunctivitis (SAC) and to compare the results with healthy control subjects. METHODS: Seventy-eight eyes of 39 consecutive patients diagnosed as SAC (mean age 32.6 years; 11 male, 28 female) as well as 20 eyes of 10 healthy control subjects (mean age 32.5 years; 6 male, 4 female) underwent slit-lamp examinations, tear film breakup time measurements (BUT), corneal fluorescein stain scoring, Schirmer test, and tear film lipid layer interferometry. The 2 groups were then compared for the examined parameters. RAST and serum IgE level evaluations were also carried out in the patients to confirm the diagnosis of allergy. RESULTS: The mean BUT was 3.4 +/- 1.5 seconds in patients with SAC compared with the mean value of 12.4 +/- 2.4 seconds in the controls (P < 0.05). There were no significant differences in relation to Schirmer test values between the 2 groups; 78% of the patients with SAC had grade 3 or above dry eye change in tear film lipid layer interferometry, whereas none of the controls had an interferometry grade greater than 3 (grade 1-2 normal; grade 3-4 dry eye; grade 5 severe dry eye). Eyes with SAC had significantly higher tear film lipid layer thickness ranges compared with the control eyes (P < 0.05). CONCLUSION: SAC was associated with advanced tear instability and thickening of the tear film lipid layer. Evaluation of the tear film lipid layer thickness might be useful in the assessment of the extent of dry eye disease and the treatment outcomes in patients with allergy.     

Ocular surface changes after excimer laser phototherapeutic keratectomy

PURPOSE: To study the ocular surface disorder in patients with Avellino, granular, and lattice dystrophy, band keratopathy, and corneal leukoma before and after excimer laser phototherapeutic keratectomy. DESIGN: A prospective case-controlled study. PARTICIPANTS: A total of 45 eyes of 33 patients with superficial corneal opacities seen at Kobe Kaisei Hospital, Department of Ophthalmology, and 40 eyes of 20 normal control subjects were studied. INTERVENTION: The subjects underwent routine ophthalmic examinations, corneal sensitivity measurements, tear film break up time (BUT), Schirmer test, tear film lipid layer interferometry, and conjunctival impression cytology. MAIN OUTCOME MEASURES: The patients and the control subjects were compared for prephototherapeutic keratectomy (PTK) tear function parameters, tear film lipid layer interferometry grade, goblet cell density, and conjunctival squamous metaplasia grade. Alterations of these parameters within 3 months after PTK were also looked for. RESULTS: The average pre-PTK corneal sensitivity and tear film break up time were lower in patients compared with control subjects before PTK. Tear film lipid layer interferometry grade and conjunctival squamous metaplasia grades were higher in the patients than the controls before PTK. All these parameters improved gradually and significantly after PTK. Goblet cell density was significantly lower in the patients compared with controls before PTK. Schirmer test results and goblet cell density did not show any significant alterations after PTK. CONCLUSIONS: Concurrent improvements in corneal sensitivity, tear film break up time, lipid layer interference grades, and conjunctival squamous metaplasia grades all point to the favorable effects of PTK on the ocular surface by improving the stability of the tear film and ocular surface health through attainment of a regular corneal surface and probably inducing qualitatively/quantitatively better mucin production by a healthier epithelium after PTK.     

中老年患者干眼症临床分析

目的探讨中老年患者干眼症的临床特点及诊治要点。方法通过问卷调查、泪膜破裂时间（BUT）、SchirmerⅠ试验、角膜荧光素染色以及DR-1泪膜干涉成像仪的检查，分析了60例（97只眼）中老年干眼症患者的临床资料。结果干眼症患者主要的眼部不适症状依次为眼疲劳（50．49％）、眼红（49．48％）、异物感（47．42％）、干涩感（39．18％）、分泌物（38．14％）、痒（29．90％）、水分过多感（21．65％）、烧灼感（9．28％）。SchirmerⅠ试验结果为（11．10±3．14）mm，BUT试验结果为（3．12±1．05）s，角膜荧光素染色评分结果为1．26±0．37。干眼仪的敏感度为63．75％，特异度为49．84％。泪液蒸发过强型、泪液分泌减少合并泪液蒸发过强型、单纯泪液分泌减少型所占比例依次为63．92％、30．93％、5．15％。60例患者中曾经误诊为其他眼病者43例（71．7％）。结论眼科医生应掌握中老年患者干眼症的临床特点，重视症状、病史的询问以及传统的三项检查（Schii-merⅠ试验、BUT试验、角膜荧光素染色），避免误诊误治。     

Successful tear lipid layer treatment for refractory dry eye in office workers by low-dose lipid application on the full-length eyelid margin

PURPOSE: To test tear lipid layer treatment by low-dose lipid application on the full-length eyelid margin for the treatment of office workers with dry eyes refractory to conventional treatments. DESIGN: Prospective interventional case series. METHODS: Thirty eyes of 30 office workers with dry eyes with dark tear interference images, which did not respond to conventional treatments, were included. To supply lipid using a commercially available nonpreserved topical medication having both polar and nonpolar lipid base, ofloxacin eye ointment (Santen Pharmaceutical, Osaka, Japan) was selected. Low-dose ofloxacin ointment application on the full-length eyelid margin was carried out three times a day for two weeks. The symptom of ocular dryness using a visual analog scale, tear interferometry to assess lipid layer thickness (LLT), corneal fluorescein staining, tear-film breakup time (BUT), and meibum expressibility gradings were compared. RESULTS: After the treatment, the symptom score of ocular dryness decreased from 91.4 +/- 11.9 to 33.6 +/- 21.0 (P < .0001), LLT increased from 39 +/- 4 nm to 161 +/- 91 nm (P < .0001), BUT was prolonged from 2.6 +/- 1.6 seconds to 4.8 +/- 2.1 seconds (P = .01), and meibum expressibility gradings decreased from 2.8 +/- 1.3 to 1.6 +/- 1.3 (P = .0005). CONCLUSION: For office workers with refractory dry eyes, tear lipid layer treatment by low-dose ointment applied on the full-length eyelid margin was shown to be an effective approach. The applied lipid formed a uniform lipid layer, which contributed to tear stability, leading to the improvement of the symptom.     

糖尿病2型患者眼表状态的改变

目的:探讨2型糖尿病患者眼表状态的改变。方法:107例(107眼)2型糖尿病患者(DM组)及100例100只正常眼(对照组),观察分析两组患者主观感觉,基础泪液分泌试验(schirmerI test,SIt),泪膜破裂时间(tear breaking up time,BUT)测定角膜荧光素染色及结膜印迹细胞学状态改变。结果:DM组患者发生干眼的几率(54.2%)较对照组(17.0%)明显增高,差异具有统计学意义。DM组基础泪液分泌试验(8.48±4.34mm)较对照组(13.73±4.79mm)降低,BUT(6.78±4.08s)较对照组(14.31±4.78s)明显缩短,角膜荧光素着色点(19.6%)较对照组(6.0%)明显增多,差异具有显著意义(P<0.05);结膜印迹细胞学检查DM组结膜杯状细胞密度平均值(80.03±40.38/mm2)较对照组(132.14±33.01/mm2)明显降低,结膜鳞状化生级别较对照组增高,两组差异有统计学意义(P<0.01)。结论:糖尿病可引起角膜、结膜状态的改变。对于糖尿病患者尤其是在各种手术时要充分考虑眼表的改变,给予恰当的治疗。     

Strip meniscometry: a new and simple method of tear meniscus evaluation

PURPOSE: To investigate the applicability and efficacy of a new and simple method of quantification of the volume of tear meniscus, termed "strip meniscometry," in the diagnosis of the dry eye syndromes in a prospective controlled study. METHODS: One hundred eyes of 50 patients with dry eye (19 males; 31 females) aged between 18 and 76 years (mean, 54.3 years), as well as 80 eyes of 40 normal subjects aged from 15 to 70 years (mean, 50.8 years; 12 males, 28 females) were recruited in this study. The patients and the control subjects underwent strip meniscometry for 5 seconds, tear film lipid layer interferometry, tear film break-up time measurement, and ocular surface vital staining with fluorescein and rose bengal dyes and the Schirmer-1 test. RESULTS: Strip meniscometry scores correlated with tear quantity and stability, ocular surface staining scores, and lipid layer interferometry grades and improved after 2 weeks of punctal plug occlusion. CONCLUSIONS: Strip meniscometry is a swift, noninvasive, promising new method that is expected to find application in the diagnosis and evaluation of the outcome of treatment of dry eye syndromes.     

高度近视患者白内障超声乳化术对泪膜的影响

目的:探讨高度近视患者超声乳化吸除术后早期泪膜的改变。方法:选择59例(70眼)行白内障超声乳化吸除术的高度近视患者(屈光度为-6.00D~-17.25D),观察分析其术前、术后1d、1wk、1,3mo的主观感觉,泪膜破裂时间(break-up time,BUT),基础泪液分泌试验(Schimer试验)和角膜荧光素试验结果。比较各项结果在术后不同时间与术前的差异。结果:与术前相比,患者术后1d,1wk,不适主诉增加,术眼BUT较术前缩短,差异具有显著性(P<0.05),术后3mo接近术前水平,差异无显著性。术后1d、1wk角膜荧光素着色点明显增多,差异具有显著性(P<0.05)。术后3mo接近术前水平,无显著差异。术后1d泪液分泌量增多,差异具有显著性(P<0.05)。术后1wk,1,3mo接近术前水平,差异无显著性。结论:高度近视患者超声乳化吸除术后早期即可出现泪膜异常改变,尤其表现为泪膜稳定性下降,因而,此类人群为干眼的易患人群。     

Ocular surface changes after dacryocystorhinostomy

PURPOSE: To observe changes in tear film lipid interference patterns on the ocular surface in patients with nasolacrimal duct (NLD) obstruction before and after dacryocystorhinostomy (DCR). METHODS: The tear film lipid layer on the ocular surface was observed with a specular reflection video recording system in 5 eyes of 4 patients with NLD obstruction before and after DCR. Precorneal tear lipid layer interference patterns at the central cornea, tear meniscus height (TMH), and the Shirmer I test were recorded. Observed patterns were classified into 5 grades. RESULTS: Three of four eyes with TMH values over 0.4 mm before DCR showed decreased TMH postoperatively. One eye with a TMH of 0.2 mm showed no change after DCR. Concerning the tear film lipid layer interference patterns, 4 eyes were classified as grade 1 or 2, and 1 eye was classified as grade 4 before DCR. After DCR, the 5 eyes were classified from grade 3 to grade 4. Epiphora was successfully resolved in all patients after DCR. CONCLUSION: Tear film lipid layers were classified as normal grades before DCR but most cases changed to high grades after DCR. We suggest that the eye after DCR should have a thicker lipid layer than before DCR.     

Efficacy of a new warm moist air device on tear functions of patients with simple meibomian gland dysfunction

PURPOSE: To evaluate the safety and efficacy of an original warm moist air device on tear functions and ocular surface of patients with simple meibomian gland dysfunction (MGD). METHODS: Fifteen patients with simple MGD and 20 healthy volunteers were recruited in an initial prospective interventional clinical trial to evaluate the safety and short-term effects of the warm moist air device. The device was applied to the eyes of the subjects for 10 minutes. Temperatures of the eye lids and corneas were measured with an infrared thermometer. Symptoms of ocular fatigue were scored using visual analog scales (VASs). Schirmer test, tear film break-up time (BUT), DR-1 tear film lipid layer interferometry, fluorescein staining, and rose bengal staining were also performed before and after the application of the eye steamer. After the initial study, another 2-week prospective clinical trial was carried out in 10 patients with MGD who received the warm moist air treatment. Ten other patients were also recruited and received warm compress treatment with hot towels for 2 weeks to evaluate the long-term effects of the warm moist air device and the warm compresses on tear film lipid layer thickness and ocular surface health. The warm moist air device and the warm compresses were applied for 10 minutes twice a day. The changes in VAS scores for symptoms, BUT values, fluorescein, and rose bengal staining scores were examined before and after each treatment during the second trial. RESULTS: VAS scores of ocular fatigue improved significantly with short- and long-term applications of the warm moist air device in both studies. The mean corneal surface and eye lid temperatures showed significant elevation within safe limits 10 minutes after the moist air application. The mean BUT prolonged significantly in the patients receiving warm moist air applications but did not change significantly in those treated with warm compresses. DR-1 tear film lipid layer interference showed evidence of lipid expression in the patients and controls, with thickening of the tear film lipid layer after 10 minutes of warm moist air device use. In the 2-week trial, tear film lipid layer thickness increased in both warm moist air device and warm compress groups, with a greater extent of increase in the warm moist air device group. CONCLUSION: Warm moist air device use provided symptomatic relief of ocular fatigue and improvement of tear stability in patients with MGD. The new warm moist air device seems to be a safe and promising alternative in the treatment of MGD.     

Increased Tear Evaporation in a Patient with Ectrodactyly–Ectodermal Dysplasia–Clefting Syndrome

Purpose To describe the tear function and ocular surface disorders in a patient with ectrodactyly–ectodermal dysplasia–clefting (EEC) syndrome.Methods Routine ophthalmic examinations were performed, including slit-lamp biomicroscopy, anterior segment photography including transillumination photos of the lids, Schirmer tests I and II, tear film break-up time (BUT) assessment, corneal fluorescein staining, DR-1 tear film lipid layer interferometry, and tear evaporation rate measurements.Results Slit-lamp examination revealed conjunctival hyperemia, superficial punctate keratopathy, and corneal leucoma with neovascularization. Although the Schirmer test values were within normal limits, the BUT value was 0s in both eyes. Transillumination of the lids showed the absence of meibomian glandular structures. DR-1 tear film lipid layer interferometry results were dry eye grade 5 with an irregular tear film, areas of corneal surface exposure, and several dry spots. The tear evaporation rate was elevated and was measured as 6.98 × 10^–7g/cm²per second (normal, 4.1 ± 1.4 × 10^–7g/cm² per second).Conclusion The ocular surface disorder and shortened BUT in EEC syndrome were attributed to the absence of meibomian glands, leading to lipid layer deficiency in the tear film with a concomitant increase in tear evaporation. Jpn J Ophthalmol 2004;48:372–375 © Japanese Ophthalmological Society 2004