干眼患者角膜结膜染色特点及相关因素分析

 目的  观察干眼患者角膜结膜染色特点,并分析其与主观症状和其他客观检查的关联性。方法  对105例干眼患者依据眼表疾病指数(ocular surface disease index,OSDI)问卷进行评分,并分为轻度症状组(0~20分),中度症状组(20~45分)和重度症状组(45~100分)。所有患者行角膜荧光素钠染色、结膜丽丝胺绿染色、泪膜破裂时间(tear break up time,BUT)、SchirmerⅠ等相关干眼检查。采用Oxford评分法进行染色评分,分析染色结果及相关因素。结果  3组患者角膜和结膜染色评分差异均有统计学意义(P<0.01),左右眼无差异(P>0.05)。角膜和结膜染色评分与OSDI正相关(r=0.497,P<0.01;r=0.434,P<0.01),与BUT无关(P>0.05)。角膜评分与SchirmerⅠ无关(r=-0.112,P=0.107),结膜评分与SchirmerⅠ负相关(r=-0.166,P<0.05)。Sjogren综合征患者眼表各区域均有染色,以中下方角膜和下方结膜多见,睑板腺功能障碍(meibomian gland dysfunction,MGD)患者以下方角膜染色多见。结论  干眼角膜结膜染色与患者主观症状密切相关,对干眼的诊断有重要意义。

Analysis of characteristics and related factors of corneal and conjunctival staining in dry eye patients

Objective  To observe the characteristics of corneal and conjunctival staining in dry eye patients and to analyze the correlation between staining and subjective symptoms.Methods  One hundred and five dry eye patients were investigated by ocular surface disease index (OSDI) questionnaire and were stratified into 3 groups by OSDI score:mild symptom group (0-20),moderate symptom group (21-45) and severe symptom group (45-100).Corneal fluorescence staining,conjunctival lissamine green staining,tear film break up time (BUT) and SchirmerⅠtest were performed in all patients.Staining scores were analyzed based on the Oxford system.Results  There was significant difference among 3 groups of staining scores (P<0.01) and no difference in bilateral eyes (P>0.05).Corneal and conjunctival staining scores had positive correlation with OSDI scores (r=0.497,P<0.01;r=0.434,P<0.01),no correlation with BUT (P>0.05).SchirmerⅠwas negatively correlated with conjunctival staining scores (r=-0.166,P<0.05),not with corneal staining scores (r=-0.112,P=0.107).Staining was found in each region of ocular surface in patients with Sjogren syndrome,especially in central and inferior cornea.Staining was frequently observed in inferior cornea in meibomian gland dysfunction (MGD) patients.Conclusions  Corneal and conjunctival staining
were closely related to subjective symptoms,and were essential for the diagnosis of dry eye.