维生素A缺乏干眼症模型兔泪液分泌及泪膜稳定性的改变

目的观察维生素A缺乏干眼症模型兔眼表及泪膜的变化,评价其对泪液分泌及泪膜稳定性的影响。方法健康兔9只以维生素A完全缺乏饲料喂养,于实验前和实验后2个月、3个月、4个月、5个月、6个月行Schirmer试验、泪膜破裂时间及虎红染色检测。对照组9只兔喂以正常饲料。6个月后处死所有动物,取泪腺、角膜及结膜行病理学观察。结果实验组4个月起Schirmer试验滤纸浸湿长度为(17.8±2.7)mm,6个月后滤纸浸湿长度为(8.3±1.6)mm,明显短于对照组(25.6±4.2)mm,差异有显著性,并且随观察时间延长差异更加明显。实验组4个月后泪膜破裂时间为(14±7)s,6个月后泪膜破裂时间为(6±3)s,明显短于对照组(26±9)s,差异有显著性,并且随观察时间延长差异更加明显。虎红染色实验组呈阳性,对照组呈阴性。病理学观察,实验兔泪腺见多数萎缩的腺细胞,腺泡腔内分泌粘液明显减少,角膜上皮层次增加,排列紊乱,结膜杯状细胞几乎不见。结论维生素A缺乏兔泪腺上皮细胞萎缩,角膜上皮角化,结膜杯状细胞减少,导致泪液分泌的质和量改变及泪膜稳定性降低而发生干眼症。     

NFκBp65、NOS2在去势雄兔角膜、结膜和泪腺中的表达及意义

基于免疫的炎症反应是各种类型干眼症发病的共同机制,本研究通过制作去势雄兔的干眼症模型,检测NFκBp65、NOS2在其角膜、结膜、泪腺组织的表达和意义,探讨干眼症组织破坏的发生机制。1材料与方法1.1实验动物健康成年雄性新西兰大白兔12只,体重(2.5±0.3)kg,随机分为去势雄兔组和对照组,每组6只。1.2方法通过切除睾丸及附睾制作去势雄兔干眼症模型,3个月后观察各组的SchirmerⅠ实验、泪膜破裂时间和角膜荧光素染色。然后两组兔均以空气栓塞法处死后取双眼角膜、结膜、泪腺组织,制成石蜡切片。用免疫组织化学SP法检测NFκBp65、NOS2不…     

高原环境对兔泪液指标及相关解剖结构的影响

目的：探讨高原低压缺氧环境对兔泪液指标及相关解剖结构的影响。

方法：选取18只健康新西兰兔,随机分为高原组和对照组,每组9只18眼。高原组饲养于西北特殊环境人工实验舱,模拟海拔6 000 m低压缺氧环境; 对照组饲养于常压常氧的清洁动物房。分别于干预前、干预3、7 d,2、4 wk采用RHCT-1角膜地形图仪干眼综合分析系统检测泪河高度、泪膜破裂时间,并采用泪液分泌试验测量泪液分泌量,同时利用拉曼光谱分析高原环境干预前后泪液成分的变化。干预4 wk采用苏木素-伊红(HE)染色观察下睑结膜、角膜、泪腺、哈氏腺的组织病理学变化,采用免疫组织化学法检测结膜组织中黏蛋白5AC(MUC5AC)的表达。

结果：与对照组相比,高原组兔泪液分泌量、泪河高度、首次及平均泪膜破裂时间自干预3 d开始明显下降,且随观察时间的延长有显著差异(P<0.05); 干预2 wk开始上述各指标增加。干预4 wk,高原组兔泪液成分中蛋白质、脂质含量较干预前增多,核酸含量较干预前减少,且与对照组相比,高原组兔角膜基质水肿增厚,结膜杯状细胞数量增多,MUC5AC表达水平升高,泪腺上皮细胞胞浆萎缩扁平,腺腔扩大,哈氏腺无明显破坏性改变。

结论：急性高原环境可破坏兔眼表稳态,使泪液分泌量下降,泪膜稳定性降低,但在一定时间内随着对低压缺氧环境的习服,机体发生代偿,可在一定程度上增加泪液分泌量,恢复泪膜稳定性。     

局部滴用阿托品建立兔干眼模型的评价

目的评价滴用阿托品建立兔干眼模型的优劣。方法新西兰大白兔16只,随机选1眼滴用1%硫酸阿托品滴眼液,对侧眼作对照。用药前及用药后不同时间点对实验组及对照组行Schirmer试验、结膜角膜虎红染色、角膜荧光素染色、结膜印迹细胞检查。第35d取结膜、角膜及泪腺组织行光学显微镜检查,泪腺组织同时行电镜检查并采用酶标仪检测其中的乙酰胆碱浓度。结果滴用阿托品后第1d,实验组Schirmer试验值下降,荧光素染色及虎红染色积分上升(P<0·05),至用药后第1周表现最明显,之后逐渐减轻。用药前后杯状细胞密度未出现差异(P>0·05)。滴药后第35d,实验组结膜、角膜、泪腺组织光镜及电镜检查未见异常,泪腺中乙酰胆碱浓度[(18·99±9·79)μmol/mg]比对照组明显增高[(13·10±7·34)μmol/mg](P=0·0318)。结论滴用阿托品可以使兔很快出现干眼,但随时间延长而减轻,因而这种干眼模型不够理想。     

雌雄激素对去卵巢雌鼠泪液分泌及泪腺凋亡基因表达的影响

目的探讨雌雄激素对去卵巢雌鼠泪液分泌和泪腺凋亡基因表达的影响。方法雌性性成熟Wistar大鼠64只,随机分为正常对照组8只、假手术组8只、实验组48只。假手术组仅打开腹腔,切除部分脂肪,实验组行双侧卵巢切除术（OVX）。分别于术前及术后1、2、3、4、5个月,行泪液分泌量（SchirmerⅠtest,SⅠt）、泪膜破裂时间（BUT）、角膜荧光素染色检查。于OVX术后5个月将实验组随机分为3组,分别全身及局部给予玉米油、苯甲酸雌二醇、丙酸睾丸酮,观察给药6周后SⅠt、BUT、角膜荧光素染色结果,并处死动物,取其泪腺行组织病理学检查及免疫组织化学法检测凋亡基因bax和bcl-2的表达。结果OVX术后5个月大鼠血清雌二醇及睾酮质量浓度均降低（P〈0.05）。OVX术后1个月BUT缩短（P〈0.01）;OVX术后3个月SⅠt较OVX术前缩短50%（P〈0.01）;OVX术后4个月角膜染色阳性（＋）,5个月时加重（＋＋）。全身给予雌激素治疗6周后BUT缩短（P〈0.01）;SⅠt缩短（P〈0.05）;角膜荧光素染色加重（＋＋＋）。全身给予雄激素治疗6周后BUT延长（P〈0.05）;SⅠt延长（P〈0.05）;角膜荧光素染色减轻（＋）。全身雌激素治疗6周后泪腺上皮细胞bax表达增加,bcl-2表达减少。全身雄激素治疗6周后泪腺上皮细胞bax表达减少,bcl-2表达增加。结论推测去卵巢雌鼠泪液分泌减少及泪膜稳定性下降与血清睾丸酮水平下降有关,雄激素改善泪液分泌及泪膜稳定性,而雌激素作用与之相反,且泪腺上皮细胞凋亡可能是其作用机制之一。     

泪腺肿物切除术后干眼症分析

目的探讨泪腺肿物切除术后患者术眼干眼症状及相关指标变化。方法 37例(37只眼)泪腺肿物患者行泪腺肿物切除手术,分别观察术前、术后2周干眼症状,包括干涩感、异物感、烧灼感等,并行相关角膜荧光素染色检查、泪液分泌检查及泪膜破裂时间测定。结果泪腺肿物切除术后2周,小部分患者出现干眼症状(16%),反射性泪液分泌减少,与术前相比差异有显著意义(P<0.05);术后2周角膜荧光素染色、基础泪液分泌和泪膜破裂时间与术前相比差异无显著意义(P>0.05)。结论泪腺肿物切除术后,小部分患者术眼出现干眼症状,程度较轻。     

放射科技师泪膜功能的研究

目的探讨放射科技师泪膜功能。方法前瞻性研究，放射科技师及对照组各34例，分别行干眼症状询问、泪膜破裂时间测定（BUT）、角膜荧光素染色（FIS）、基础泪液分泌实验（SIt）、睑板腺功能检查。结果病例组泪膜破裂时间、基础泪液分泌试验的结果及其异常的比率与对照组比较，差异有统计学意义（P〈0．05），病例组出现干眼症状的比率高于对照组（P〈0．05），角膜荧光素染色阳性、睑板腺功能障碍的比率与对照组比较，差异无统计学意义（P〉0．05），专业工作年限与眼干症状、泪膜破裂时间、角膜荧光素染色、睑板腺功能障碍、基础泪液分泌试验之间无相关性。结论放射科技师易发生泪膜功能及泪腺分泌异常，易出现干眼症状。     

兔泪液分泌腺体组织学

眼干燥症在眼科中较常见,临床治疗多用点滴人工泪液或封闭泪小管,它的发病与泪液分泌腺体的异常有关。本文观察泪腺和Harder腺的组织切片及结膜印迹片,探讨泪液分泌腺体与眼干燥症形成的关系。1 材料与方法1.1 动物:新西兰兔6只,体重1 5kg左右。实验前检查两眼无病变,购自中国药品生物制品鉴定所。1.2 标本制备兔空气栓塞处死后,取出泪腺及Harder腺,福尔马林固定、切片,HE染色。用硝酸纤维膜制作结膜印迹片,使用混合固定液固定,PAS染色。2 结果泪腺:泪腺由腺泡、结缔组织和少量的淋巴细胞组成,结缔组织中有腺导管及血管(图1)。Harder…     

结膜修补物的历史回顾

广义上，结膜和角膜的表层及泪膜共同构成了眼表。结膜的疾病迁延势必影响角膜。另外，结膜杯状细胞分泌的粘液和副泪腺分泌的水性泪液是泪膜的重要成分，结膜异常可能会导致泪膜异常。因此，结膜的疾病不容忽视。在临床上也经常会遇到一些棘手的结膜异常问题，如：眼化学伤、热烧伤、复发性翼状胬肉、结膜肿瘤、类天疱疮及史-约（Stevens-Johnson）综合征等。     

去卵巢对大鼠泪腺中IL-17A等炎症因子表达的影响

目的 建立去卵巢大鼠模型,观察性激素水平改变对泪腺中IL-17A以及IL-1β、IL-6、TNF-α等炎症因子表达的影响.方法 实验研究.健康雌性SD大鼠20只随机分为2组,实验组(10只)摘除大鼠双侧卵巢,对照组(10只)为未摘除卵巢的模拟手术组.术前及术后第1个月、第2个月、第3个月时2组均行泪液分泌试验(SIT)、角膜荧光染色检查进行眼表评估.于第3个月时放射免疫分析法分别检测2组大鼠血清雌二醇、睾酮含量,HE染色观察泪腺上皮细胞形态,免疫组化染色法、Western Blot法检测2组泪腺中IL-17A、IL-1β、IL-6、TNF-α的表达.2组性激素质量浓度比较、炎症因子A值表达比较均应用独立样本t检验.2组各时间点的SIT结果比较采用重复测量资料两因素方差分析.结果 实验组大鼠去卵巢后第3个月时,体内雌二醇浓度低于对照组(t=-35.37,P＜0.01),睾酮浓度低于对照组(t=-12.13,P＜0.01).2组各时期SIT检查未见泪液分泌减少、均未见角膜荧光染色.HE染色见实验组泪腺腺泡萎缩,排列紊乱,胞质内酶原颗粒明显减少.泪腺IL-17A表达量2组比较实验组高于对照组(免疫组化法:t=7.56,P＜0.01;Western Blot法:t=20.90,P＜0.01).余各因子表达量实验组也均高于对照组(免疫组化法:IL-1β:t=13.71,P＜0.01;IL-6:t=13.92,P＜0.01;TNF-α:t=6.11,P＜0.01.Western Blot法:IL-1β:t=16.93,P＜0.01;IL-6:t=12.46,P＜0.01;TNF-α:t=14.47,P＜0.01).结论 大鼠去卵巢3个月时性激素水平降低,未见明显眼表损害.但泪腺中炎症因子IL-17A、IL-1β、IL-6、TNF-α的表达增加.     

Evaluation of tear secretion and tear film stability in pseudoexfoliation syndrome.

PURPOSE: In pseudoexfoliation syndrome, a material of unknown composition is deposited at the anterior structures of the eye and at periorbital tissues such as the conjunctiva, where goblet cells and accessory lacrimal glands are located. In this study, the possible effect of pseudoexfoliation on tear secretion and tear film stability was investigated. METHODS: Tear film break-up time and Schirmer tests were performed on 108 eyes of 57 patients with pseudoexfoliation and 120 eyes of 60 normal subjects. Results were statistically analyzed. RESULTS: Both Schirmer test and break-up time scores were significantly lower in the pseudoexfoliative patients (average values 10.13 mm and 6.91 sec, respectively) compared to the control group (average values 12.75 mm and 12.75 sec, respectively). The difference was more prominent in males. CONCLUSION: The lower scores in Schirmer and break-up time tests in the pseudoexfoliation group could be attributed to conjunctival involvement. Pseudoexfoliative patients could be more prone to developing xerophthalmia, especially if they are treated with beta blockers.     

Ocular surface alteration after long-term treatment with an antiglaucomatous drug.

BACKGROUND: This study was undertaken to see whether long-term locally applied ocular medications produced any alterations in the ocular surface, and, in particular, whether it caused damage to the mucus layer of the tear film. METHODS: The authors studied the ocular surface of 40 control subjects (group 1), 21 patients (group 2) chronically treated with a commercial preparation of 0.5% timolol maleate, and 20 previously untreated glaucomatous patients (group 3) in need of treatment with the same drug. Parameters studied were Schirmer's test, lacrimal meniscus height, break-up time, fluorescein and rose Bengal stains, conjunctival impression cytology, mucus staining, and the ferning test. RESULTS: Patients in groups 2 and 3 showed a significant decrease (P less than 0.001) in the number of normal Schirmer's and break-up time tests. All had positive vital stains. Results showed a significant decrease (P less than 0.001) in goblet-cell density, mucus granules, and reticular sheets, and an increase (P less than 0.001) in pathologic crystallization patterns. CONCLUSION: These results demonstrate that chronic application of a commercial preparation of timolol maleate damaged the ocular surface, especially the mucus layer of the tear film.     

Alterations of the tear film and ocular surface health in chronic smokers

OBJECTIVE: To investigate the effects of chronic smoking on ocular surface and tear functions. METHODS: Fifteen right eyes of 15 healthy chronic smokers (9 men, 6 women; age range: 36-47 years) who smoked 20 cigarettes per day for 20 years and 20 eyes of 20 control non-smokers (12 men, 8 women; age range: 38-43 years) were included in this prospective study. All subjects underwent measurements of breath and haemoglobin CO concentration, tear lipid layer interferometry, evaporimetry, tear film break-up time (TBUT), Schirmer's I test, corneal fluorescein staining, conjunctival impression, and brush cytology. RESULTS: The mean Hb CO level was significantly higher in smokers compared to non-smokers. TBUT was also significantly shorter in smokers. Tear lipid layer showed significant slowing in spread over the tear film with a concomitant significant increase in tear evaporation rate. Conjunctival impression cytology revealed significant loss of goblet cells and squamous metaplasia in smokers. Brush cytology showed significant conjunctival neutrophil infiltration in smoker subjects. CONCLUSION: Chronic smoking induced distinctive quantitative and qualitative disturbances on the ocular surface health.     

抗青光眼滤过术中应用5-氟尿嘧啶和丝裂霉素C对泪膜的影响

目的　观察抗青光眼滤过术中应用5-氟尿嘧啶（5-fluourouracil,5-Fu）和丝裂霉素C（mitomycinC,MMC）对泪膜的影响。方法　回顾性分析难治性青光眼71例,其中使用5-Fu组24例（24只眼）,MMC组17例（17只眼）,对照组（未用药）30例（30只眼）,观察指标包括眼部异物感、干涩、畏光、痒感、结膜充血、分泌物、角膜荧光素染色及结膜、角膜虎红染色、泪膜破裂时间、Schirmer试验及眼压测量值。结果　5-Fu组患者的眼部症状和体征明显,泪膜功能受损,与对照组比较差异有显著性（P<0.05）,MMC组患者眼部干涩症状明显（P<0.05）,而其他观察指标与对照组相比差异无显著性。结论　抗青光眼滤过术后应用5-Fu可明显损害泪膜的功能。     

Two cases of lacrimal gland agenesis in the same family--clinicoradiologic findings and management

BACKGROUND: Lacrimal gland agenesis is extremely rare. This condition is occasionally associated with salivary gland agenesis and abnormalities in the lacrimal drainage system, particularly occlusions of the lacrimal puncta and canaliculi. The detailed presentation of clinicoradiologic findings and treatment modality has not been previously reported. METHODS: A 6-year-old boy was presented to our department complaining of severe foreign-body sensations in both eyes. Punctate epithelial erosions and mucous filaments were noted in both eyes. His tear break-up time (TBUT) was less than 1 second, and a Schirmer's test (both eyes) detected less than 1 mm of wetting in 5 minutes. His mother had similar complaints dating back to childhood. RESULTS: Orbital computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed the absence of both lacrimal glands and all major salivary glands. After the insertion of a lacrimal punctal plug, punctate epithelial erosions and mucous filaments decreased remarkably within 2 weeks. MRI scans of the patient's mother confirmed the absence of both lacrimal glands and salivary glands. She had been using artificial tears for a long time. INTERPRETATION: The absence of lacrimal glands can be confirmed by clinicoradiologic findings, and the punctal plug may be an effective tool for the treatment of patients who retain a patent lacrimal drainage system.     

干眼症检查的进展

干眼症是导致眼部不适,甚至引起视力障碍的常见病,其病因及病理生理十分复杂。在干眼症的诊断中,传统的泪液分泌试验、泪膜破裂时间、眼表面荧光素染色、虎红染色等检查均存在其不足。近年来干眼症的检查手段得到很大发展,检查方法达数十种之多,不仅提高了此病诊断的准确性,而且可进行病因诊断和病情严重程度的分析。复习了近年来关于传统的和新发展的干眼症检查方面的文献,对各检查方法的原理,优缺点及适应证进行综述。     

干眼患者115例的临床特点分析

目的　分析各种类型干眼患者的临床特点。方法　回顾性分析 115例 ( 2 2 9只眼 )干眼患者的临床资料 ,包括症状、病因、全身病、裂隙灯检查、泪膜破裂时间检查 (break uptime,BUT)、基础泪液分泌试验 (SchirmerⅠtest,SⅠt)、反射泪液分泌试验 (SchirmerⅡtest,SⅡt)、角结膜荧光素(fluorescent,Fl)染色、虎红 (rosebangle ,Rb)染色及睑板腺功能的检查。对Sj gren综合征 (Sj grensyndrome,SS)者行血清类风湿因子、自身抗体及涎腺分泌功能检查。结果　 115例中 ,水液缺乏性干眼(aqueousteardeficiency ,ATD)者 5 6例 ( 48 7% ) ,蒸发过强型干眼者 40例 ( 34 8% ) ,混合型干眼者 16例( 13 9% ) ,结膜松弛综合征者 4例 ( 3 5 % )。SS患者 13例 ( 11 3% )。在各型干眼患者中 ,女性多于男性 ,尤其是ATD患者 ,原发性SS ATD患者 10 0 %为女性 ,43例非SS水液缺乏性干眼 (non SSaqueousteardeficiency ,NSTD)者中女性 35例 ( 81 4% )。临床特点 :干涩症状者 6 3例 ( 84 0 % ) ,视疲劳者 5 4例( 72 0 % ) ,异物感者 48例 ( 6 4 0 % ) ,视力波动者 42例 ( 5 6 0 % ) ,睑板腺功能障碍 (meibomainglanddysfunction ,MGD)者 35例 ( 30 4% )。各类型干眼患者的BUT、Rb、Fl间均有明显的相关性 ,Rb与Fl间相关性高 (r =     

剥脱综合征患者结膜印迹细胞学的检查特征

目的:研究剥脱综合征对结膜细胞和泪液功能的影响.方法:研究共纳入剥脱综合征患者60例86眼作为试验组,年龄相仿正常人55例89眼作为对照组.所有115例175眼均接受Schirmer泪试验及泪膜破裂时间试验,并对上方和鼻下方睑裂区球结膜进行印迹细胞学检查.印迹细胞学检查结果根据Nelson方法分级.对TBUT,Schirmer泪试验及印迹细胞学结果进行相关性分析.结果:剥脱综合征患者的Schirmer试验、TBUT均较正常组显著降低,结膜细胞也有显著改变.剥脱综合征患者的印迹细胞学分级中位数为3级,而正常人组为0级.在试验组中发现45例样本出现了两种以上分级共存的现象,而对照组仅发现3例.此外,实验组中的45例样本结膜上皮细胞和杯状细胞分级出现明显差异,且均表现出杯状细胞的破坏甚于上皮细胞,而对照组未发现此种现象.结论:剥脱综合征患者的结膜细胞受到破坏,泪液分泌受到影响,极易造成眼表疾病的出现.     

大鼠泪液缺乏型干眼症眼表组织中IL-6和TNF-α的表达

目的:探讨白介素6(interleukin-6,IL-6)和肿瘤坏死因子(tumor necrosis factorα,TNF-α)在泪液缺乏型干眼症发病机制中的作用。方法:SD大鼠48只随机分成实验组和对照组两组,实验组通过摘除泪腺的方法制作干眼模型,对照组不做处理,分别于实验前1d及实验后1,2,4wk检测泪液的分泌、泪膜破裂时间及观察角膜荧光素染色,术后4wk将动物脊髓离断致死,用免疫组织化学方法检测结膜及角膜组织中IL-6和TNF-α的表达。结果:实验组大鼠SchirmerⅠ滤纸湿长较正常组缩短(P<0.01),泪膜破裂时间较正常组缩短(P<0.01);IL-6和TNF-α在两组均有表达,在实验组表达较强,对照组表达较弱,两者差异有统计学意义(P<0.05)。结论:IL-6和TNF-α在泪液缺乏型干眼的发病机制中起着重要的作用,泪液缺乏型干眼的发病机制与炎症有关。     

Study of mucin layer of tear film in patients with pterygium

PURPOSE: The aim of this study was to investigate the tears film, particularly mucin layer in patients with pterygium. MATERIAL AND METHODS: We examined 31 patients with pterygium--14 women and 17 men. Pterygium in one eye was found in 19 patients, in both eyes in 12. The control group consisted of 43 persons--21 women and 22 men. In our study were evaluated: marginal tears film, tears film break-up time (BUT), Schirmer's test and mucus fern patterns. RESULTS: The results showed no statistically significant difference in Schirmer's test in both groups. Marginal tears film was incorrect in 65.12% of the eyes with pterygium and in 34.89% eyes of the control group. Tears film break-up time was reduced statistically significant, in patients with pterygium. Abnormal mucus fern patterns (type III and IV) was observed in 38.95% of the eyes with pterygium and in 13.94% of the eyes in the control group. CONCLUSIONS: Disturbances of the tear film stability were found in the eyes with pterygium. The results of BUT and mucus fern patterns showed, that abnormalities of mucin layer to be responsible for these changes. Perhaps these observations will contribute to prevention of pterygium.