不同验光方法对中年患者屈光状态的检测及其临床意义

目的: 通过散瞳验光检测40～49岁门诊患者屈光状态并加以矫正，探讨改善患者视疲劳和干眼症状的方法。方法: 选择门诊主诉为眼痛、干涩、视物模糊等视疲劳患者30例(60只眼)，年龄40～49岁，平均年龄44.43岁，其中男性11例，女性19例，经过眼科常规检查排除青光眼、白内障和眼底病等疾病。患者均无手术史和配戴近视、远视及散光镜史。常规验光后充分散瞳再次验光，同时检测泪液分泌情况、泪膜破裂时间(BUT)和角膜荧光染色情况。30例患者中视力0.8以上者43只眼，0.4～0.6者17只眼。 结果: 所有患者常规验光即散瞳前屈光度表现为－0.25DS～－1.25DS者 37只眼，散瞳后表现为+0.50DS～+1.50DS者36只眼，散瞳前为0.00DS～+1.25DS者22只眼，散瞳后屈光度表现为+0.50DS～+1.50DS者21只眼。其中27只眼诊断为中度干眼，33只眼诊断为轻度干眼。30例（60只眼）患者经过验光和配镜后，眼痛、干涩和视物模糊等视疲劳症状均有明显改善。结论:常规视力检查正常或接近正常的40～49岁患者仍存在较大调节力，出现视疲劳和干眼并伴有特殊面容（皱眉等）时可能存在远视或远视散光，小瞳下检查常存在误差易被忽视，在治疗干眼的同时应注意散瞳验光配镜是从根本上解决眼部不适症状的方法。

Detection of refractive status in middle-aged patients with different optometries and its clinical significance

Objective To detect the refractive status of the 40 to 49 years old outpatients by cycloplegic refraction and the correction and to explore the method to improve the visual fatigue and symptoms of dry eye.Methods 30 visual fatigue outpatients(60 eyes) with complaints of sore eye,dry eye,blurred vision,aged 40 to 49 years old(average 44.43 years) were selected,11 patients were male and 19 patients were female;the other diseases such as glaucoma,cataract,ocular fundus were ruled out after routine eye examination.The patients had no surgical and wearing myopia,hyperopia and astigmatism glasses history.Mydriasis refraction was porformed after conventional optometry,and the SchirmerⅠtest,tear film break-up time(BUT) detection and corneal fluorescent staining were performed simultaneously.43 eyes of 30 patients had a visual acuity of ≥ 0.8,and 17 eyes were between 0.4 and 0.6.Results Among all patients,37 eyes presented-0.25DS to-1.25DS with conventional refraction,36 eyes showed +0.50DS to +1.50DS after dilation;22 eyes presented 0.00DS to +1.25DS before dilation and 21 eyes showed+0.50DS to +1.50DS after dilation;27 eyes were diagnosed as moderately dry eye and 33 eyes were slightly dry eye.Conclusion Patients aged 40-49 years old with normal or close to normal results in conventional inspection still have considerable accommodation ability.There may exist hyperopia or hyperopic astigmatism in the patients with visual fatigue,dry eye and even a special face(frown).The examination results often exist error that is easily overlooked before dilation.The sore eye,dry eye,blurred vision and other visual fatigue symptoms in 30 patients(60 eyes) are significantly improved after optometry and optician.Therefore optometry after mydriasis and wearing glasses should be noted in the treatment of dry eye,that is the fundamental solution to relieve the symptoms of ocular discomfort completely.