上海市社区中老年干眼患者局部特征与影响因素分析

目的:调查上海庙行镇社区中老年干眼患者眼部特征,探讨引起干眼症状的相关因素.方法:于2013-11/2014-12采用自行设计的调查表收集上海宝山区庙行镇社区中老年干眼患者的相关临床信息,包括患者一般及眼部情况、全身疾病史、生活习惯等,完成眼表疾病指数(ocular surface disease index,OSDI)问卷,评估患者干眼严重程度,并对筛查阳性患者进行干眼客观体征及眼部全面检查.结果:共618例1236眼患者完成调查,其中男142例284眼(23.0％),女476例952眼(77.0％),症状中以干涩感最为常见,约占66.8％;80.9％出现三种以上症状.50～60岁年龄组中,屈光不正(远视、老视)、翼状胬肉较其他组所占比例更高,分别为21.6％和21.6％ (P=0.014、0.009);常见诱因视频终端综合征(visual display terminal,VDT)、长期驾车较其他组所占比例亦更高(比例分别为37.3％、9.3％),在三组之间的差异有统计学意义(P=0.004、0.001).61 ～ 70岁年龄组中暴露于棋牌室等烟雾环境中比其他年龄组所占比例较高,为20.6％(P＜0.05).71 ～ 80岁组结膜松弛、白内障较其他组常见,所占比例分别为28.6％、78.9％ (P＜0.05),三个年龄组中常见眼部相关因素还包括睑板腺功能障碍(MGD)、长期使用含防腐剂局部眼液包括青光眼患者,各年龄组之间无统计学差异(P＞0.05).618例1236眼干眼患者有150例300眼(24.3％)曾有眼部手术史,以白内障、翼状胬肉、眼睑手术常见.181例362眼(29.3％)患者角膜荧光素染色阳性,染色阳性者出现异物感、畏光、眼红、眨眼频繁、流泪症状的频率高于染色阴性者(P＜0.05).结论:中老年的干眼症状可能是多种因素综合形成的,不同年龄群采取针对病因宣教和综合治疗,以提高以干眼相关的中老年群体的生活质量.

Investigation of ocular characteristics and effect in middle aged and elderly people with dry eye disease in the community of Shanghai

AIM: To investigate the ocular features of the elderly patients with dye eye disease in the community of Shanghai, and to explore the related factors of dry eye disease''s symptoms.

METHODS: The clinical information about the elderly patients with dry eye disease in Miaohang Community Shanghai Baoshan District from Nov. 2013 to Dec. 2014 with self-designed questionnaire were collected. General information, the eye conditions, the history of systemic disease, habits and customs were collected. All patients completed the ocular surface disease index(OSDI)questionnaire which assessed the severity of dry eye disease. The positive patients would have a comprehensive examination of the eye.

RESULTS: A total of 618 validated questionnaires were collected and included in analysis. There were 142 males(23.0%)and 476 females(77.0%). The most common symptoms, dry eye feeling, accounted for about 66.8%. Eighty point nine percent patients had more than three kinds of symptoms. The proportion with refractive errors(hyperopia or presbyopia), pterygium is higher in 50-60 age group than other groups. Visual display terminal(VDT)and driving for a long time had significant difference between the three groups(the proportion was 37.3% and 9.3% respectively, P=0.004, 0.001). The patients exposed to smoke environments, such as chess room, had higher proportion in the 61-70 age group than any other age group, the proportion was 20.6%(P<0.05). The proportion of conjunctivochalasis and cataract was higher in the 71-80 age group than other groups, with proportion of 28.6% and 78.9% respectively(P<0.05). Meibomian gland dysfunction(MGD), long-term use of eye drops especially in glaucoma patients had no difference in three groups(P>0.05). One hundred and fifty patients had surgery history, the common operations were cataract, pterygium and blephar. One hundred and eighty-one patients(29.3%)had positive corneal fluorescein staining, with higher proportion in the symptoms of foreign body sensation, photophobia, conjunctival congestion, frequent blinking and lacrimation.

CONCLUSION: The risk factors of dry eye disease''s symptoms were various in different age groups. According to thus, we should take different measures with relevant education about the cause of disease and comprehensive treatment to improve quality of life in elderly people with dry eye disease.