甲状腺相关眼病患者的眼表功能分析

目的 观察甲状腺相关眼病患者的眼表功能变化.方法 对68例(136只眼)甲状腺相关眼病患者和39例(78只眼)正常对照组,详细记录甲亢治疗、糖皮质激素治疗、眼球突出度、睑裂、眼球运动、眼表相关症状、体征、泪液分泌试验(基础Schirmer Ⅰ试验,SIt)、泪膜破裂时间(break up time,BUT)、角膜荧光素染色等项目检查,并作统计学分析.结果 (1)病例组BUT均值6.97/s,低于对照组9.77s,(P=0.006).(2)病例组SIt均值8.10mm/min,与对照组8.18mm/min,无明显差异(P=0.935).(3)病例组BUT与SIt存在正相关(P=0.034);与眼球突出度存在负相关(P=0.024)关系.(4)病例组SIt与睑裂高度(P=0.006)、眼球突出度(P=0.050)、上睑退缩程度(P=0.02)、下睑退缩程度(P=0.005)、上睑迟落程度(P=0.045)、眼睑闭合不全程度(P=0.002)、眼球上转受限程度(P=0.005)、眼球运动受限程度(P=0.002)、TAO的NOSPECS分级(P=0.004)存在正相关关系.结论 (1)甲状腺相关眼病继发蒸发过强型干眼.(2)甲状腺相关眼病患者基础泪液分泌降低,反射性泪液分泌增强.

Analysis of ocular surface functions in patients with thyroid associated ophthalmopathy

Objective To observe ocular surface changes in patients with thyroid associated ophthalmopathy (TAO). Methods Tear film break-up time (BUT), tear secretion test (Schirmer Ⅰ test, SIt) in 68 patients (136 eyes) with thyroid associated ophthalmopathy and 39 normal subjects (78 eyes, control group) without eye and systemic diseases who were selected randomly in same period were evaluated. Relevant parameters,such as age, gender, palpebral fissure width, degree of proptosis, ocular motility, concomitant diseases, previous treatment for Graves disease, symptoms and signs, severity scores of the disease, the methods of treatments were retrieved and analyzed. Corneal fluorescein staining (FL) in patients with TAO was also determined. Results Compared with the normal controls, patients with TAO showed statistically significant decrease in BUT (TAO 6.97s, controls 9.77s, P =0.006). The TAO group showed no significant difference in SIt with the control group (TAO 8.10mm/min, controls 8.18 mm/min, P =0.935). The BUT in TAO patients correlated positively with the SIt (P =0.034) and negatively with exophthalmus (P =0.024). The SIt in TAO patients correlated positively with palpebral fissure width (P =0.006), exophthalmus (P =0.050), superior eyelid retraction (P =0.02),inferior eyelid retraction (P =0.005), lid lag (P =0.045), lagophthalmus (P =0.002), restrictive motility (P =0.002) and TAO severity score (P =0.004). Conclusions Thyroid associated ophthalmopathy is complicated with evaporative dry eye secondly. Foundation tear secretion of patients with TAO may decrease, but reflexive tear secretion of patients of TAO may increase.