Keratoconjunctivitis sicca in juvenile rheumatoid arthritis

PURPOSE: To compare the symptoms, signs, and results of objective tests for keratoconjunctivitis sicca (KCS) in patients with juvenile rheumatoid arthritis (JRA) and controls. METHODS: Sixty-four patients with JRA and 64 age- and sex-matched controls were compared in terms of symptoms, signs, and results of objective tests for KCS. Relation between tear film breakup time (TBUT), Schirmer test results, and JRA-related variables such as age of onset, duration, and type of JRA; presence of antinuclear antibodies (ANAs); and history of uveitis were evaluated. Analysis of variance, multivariate regression analysis, Kruskall-Wallis, Student t tests, and chi tests were used for statistical analysis. RESULTS: Twelve and a half percent of patients with JRA complained of dry eye symptoms compared with 1.5% of the controls (P = 0.031). Dry eye signs were detected in 10.9% of patients with JRA compared with 1.5% of controls (P = 0.038). TBUT and Schirmer test results were lower in the JRA group than in controls (P = 0.032 and P = 0.029, respectively). Seven patients (10.9%) had definite and 1 (1.5%) had probable diagnosis of KCS in the JRA group compared with no children in the control group (P = 0.034). Within the JRA group, Schirmer test and TBUT results were significantly lower in male patients and ones with longer duration of disease. CONCLUSIONS: The prevalence of symptoms, signs, and definite diagnosis of KCS is higher and basal tear secretion and tear film stability are lower in children with JRA than in controls. Among children with JRA, male sex and longer duration of disease are independent risk factors for having decreased basal tear secretion and tear film stability.     

Tear film lipid layer alterations in allergic conjunctivitis

PURPOSE: To assess the alterations of the tear film lipid layer and tear functions in patients with seasonal allergic conjunctivitis (SAC) and to compare the results with healthy control subjects. METHODS: Seventy-eight eyes of 39 consecutive patients diagnosed as SAC (mean age 32.6 years; 11 male, 28 female) as well as 20 eyes of 10 healthy control subjects (mean age 32.5 years; 6 male, 4 female) underwent slit-lamp examinations, tear film breakup time measurements (BUT), corneal fluorescein stain scoring, Schirmer test, and tear film lipid layer interferometry. The 2 groups were then compared for the examined parameters. RAST and serum IgE level evaluations were also carried out in the patients to confirm the diagnosis of allergy. RESULTS: The mean BUT was 3.4 +/- 1.5 seconds in patients with SAC compared with the mean value of 12.4 +/- 2.4 seconds in the controls (P < 0.05). There were no significant differences in relation to Schirmer test values between the 2 groups; 78% of the patients with SAC had grade 3 or above dry eye change in tear film lipid layer interferometry, whereas none of the controls had an interferometry grade greater than 3 (grade 1-2 normal; grade 3-4 dry eye; grade 5 severe dry eye). Eyes with SAC had significantly higher tear film lipid layer thickness ranges compared with the control eyes (P < 0.05). CONCLUSION: SAC was associated with advanced tear instability and thickening of the tear film lipid layer. Evaluation of the tear film lipid layer thickness might be useful in the assessment of the extent of dry eye disease and the treatment outcomes in patients with allergy.     

干眼与类风湿性关节炎活动性的相关性研究

目的 研究类风湿性关节炎、干燥综合征和干眼的关系,探讨干眼严重程度与类风湿关节炎病情活动度的相关性.方法 回顾性分析2003年1月至2006年12月风湿内科住院的158例类风湿性关节炎患者病历资料,干眼指标取SCH、BUT、FL,类风湿性关节炎活动度指标取ESR、CRP、RF.对其进行典型相关性统计分析.结果 约11%的类风湿性关节炎患者继发干燥综合征,其干眼严重度与类风湿活动度有相关性,在类风湿性关节炎合并继发干燥综合征18例患者各典型变量中,SCH,FL和RF、CRP、ESR典型相关系数Corr(W,V)为0.716752,为最大,其中SCH与RF、CRP、ESR均呈负相关,而FL与RF、CRP、ESR均呈正相关.非继发干燥综合征患者干眼与类风湿活动度无相关性(P>0.01).结论 干燥综合征和非干燥综合征干眼的发病机制可能不同,类风湿性关节炎继发干燥综合征的干眼患者,其干眼程度与类风湿关节炎活动度有相关性.     

The features of dry eye disease in a Japanese elderly population.

PURPOSE: The purpose of this study is to assess the features of dry eye disease in a Japanese elderly population. METHODS: One hundred thirteen left eyes of 113 pensioners (50 males, 63 females; mean age, 67.5 +/- 5.7 years) aged over 60 years were recruited in this study. The subjects underwent careful slit-lamp examinations of the conjunctiva, ocular surface, and the eye lids. Tear film breakup time (BUT) examinations, Schirmer test-I, and fluorescein staining of the ocular surface and transillumination of the eyelids were also performed. Dry eye symptomatology was assessed with a symptom questionnaire. Japanese Dry Eye Diagnostic Criteria were used in this study. RESULTS: Ocular tiredness, irritation, dryness, and foreign body sensation were the most frequently reported symptoms by the patients. A total of 73.5% of the eyes had definite dry eyes. A total of 39.8% of the eyes had a Schirmer test reading <5 mm. Mean Schirmer test value was 9.4 +/- 7.8 mm. The mean BUT score was 4.0 +/- 2.8 seconds. A total of 76.9% of the eyes had positive fluorescein staining of the cornea. Meibomian gland dysfunction and conjunctivochalasis were found as frequent factors in relation to dry eye disease with meibomian grand dropout showing positive correlation with tear instability. CONCLUSION: Qualitative and quantitative disorders of the tear film were far more common than recognized in this population of elderly subjects, meibomian gland dysfunction being the most common associate of the tear film disorder and dry eye status. Conjunctivochalasis (conjunctival laxity), although commonly associated with dry eye disease in the elderly, was observed not to be related to age or gender in this study.     

Tear film flow and stability in seropositive patients of rheumatoid arthritis

Tear film flow and stability studies were carried out in 25 serologically positive patients with rheumatoid arthritis, who were without ocular symptoms, by performing Schirmer test I and break-up time (BUT) measurements. The values of BUT and Schirmer in 25 cases were decreased significantly when compared with 25 matched controls. Further, an inverse relation was observed between the values of these tear function tests and the serum immunoglobulin levels, thereby depicting that higher values of serum immunoglobulins in rheumatoid arthritis may be helpful in segregating the cases who may eventually develop dry eyes.     

Impression cytology in patients with dry eye syndrome and various rheumatic diseases

PURPOSE: The aim of this study was to evaluate the cytological changes of bulbar conjunctiva in patients with various rheumatic diseases and dry eye syndrome. MATERIAL AND METHODS: 60 patients with rheumatoid arthritis (RA), systemic scleroderma (SScl), primary Sjbgren syndrome (pSS), systemic lupus erythematosus (SLE) and dry eye syndrome were studied. The ocular examination consisted of Schirmer I, break- up time of tear film (BUT), fluorescein and lissamine green staining and impression cytology of bulbar conjunctiva. RESULTS AND CONCLUSIONS: The morphological alternations of bulbar conjunctiva seen in impression cytology specimens correlated with clinical signs of dry eye syndrome.     

Pterygium and dry eye

PURPOSE: To assess the correlation between dry eye and pterygium. METHODS: Tear breakup time (BUT), Schirmer test with/without anesthesia and tear function index were evaluated in both eyes of patients with unilateral pterygium. RESULTS: Tear BUT, was shortened significantly in the eye with pterygium. The Schirmer test with anesthesia was shortened and the tear function index was decreased in the eye with pterygium with marginal significance. CONCLUSION: There is a correlation between pterygium formation and shortened BUT. Unstable tear film may contribute to the initiation of pterygium.     

A classification for dry eyes following comparison of tear thinning time with Schirmer tear test.

In a double-blind study a non-invasive method of examining the stability of the precorneal tear film was used to record tear thinning time on a population of 34 independently diagnosed dry eye patients. The results were compared with those for tear output, as inferred from the standard Schirmer tear test, and a correlation coefficient of 0.20 determined. The mean tear thinning time and Schirmer results for the population sample were 6.87 +/- 2.97 sec, and 5.62 +/- 5.69 mm wetting in 5 min, respectively. From a plot of tear thinning time against Schirmer a simple classification for dry eyes can be made. A Type A with normal tear stability and low output accounting for 14.70% of the dry eyes. A Type B with low tear stability and normal output, also accounting for 14.70% of the dry eyes. A Type C with low stability (less than 9.84 sec), and low output (less than 11.31 mm wetting in 5 min) accounting for 70.60% of the dry eyes.     

2型糖尿病患者干眼症发生情况及相关因素探讨

目的：分析2型糖尿病患者并发干眼症情况及相关影响因素。

方法：选取45例90眼2型糖尿病患者和40例80眼非糖尿病患者为研究对象,分析其泪膜破裂时间、基础泪液分泌试验以及角膜荧光素染色指标间的差异,并分析其相关因素。

结果：观察组患者平均泪膜破裂时间为6.23±2.36s,显著短于对照组; 泪液分泌试验滤纸条平均浸润长度为8.65±3.82mm,显著低于对照组; 角膜荧光素染色评分为1.89±1.31分,显著高于对照组; 干眼症发病率达58%,显著高于对照组,差异均具有统计学意义(P<0.05)。Logistic多因素分析显示泪液基础分泌量和泪膜破裂时间为2型糖尿病患者合并干眼症重要的危险因素。

结论：2型糖尿病患者泪膜破裂时间缩短、基础泪液分泌值减少以及角膜荧光素染色评分升高。泪液基础分泌量和泪膜破裂时间为2型糖尿病患者合并干眼症重要的危险因素。     

Efficacy of topical cyclosporine 0.05% in the treatment of dry eye associated with graft versus host disease

PURPOSE: To assess the efficacy of topical cyclosporine 0.05% (Restasis) in patients with dry eye associated with graft versus host disease after stem cell transplantation. METHODS: After completing a 3-month run-in period of using only artificial tears to control dry eye symptoms in both eyes, patients who failed to achieve adequate relief (n = 8) were instructed to instill topical cyclosporine twice a day. Visual acuity, slit-lamp appearance, and intraocular pressure were evaluated every 2 weeks for a minimum of 3 months. In addition, Schirmer basal secretion tests, noninvasive fluorescein breakup time, and tear lysozyme were also performed. Patients were also given a dry eye questionnaire regarding symptoms of burning, tearing, and blurred vision. RESULTS: Dry eye signs improved significantly with cyclosporine treatment in 7 of 8 patients. Cyclosporine provided statistically significant improvements in Schirmer basal secretion scores (P = 0.003), tear breakup time (P = 0.002), and tear lysozyme levels (P = 0.033) after 3 months of treatment. CONCLUSION: The findings in this prospective study suggest that dry eye associated with graft versus host disease can be effectively treated with topical cyclosporine, especially in patients unresponsive to other treatment modalities. These findings should be further evaluated in large-scale, controlled clinical trials.     

角膜地形图仪评价白内障患者术前泪膜分布特征的研究

目的初步阐述年龄相关性白内障患者术前泪膜的分布特征及破裂规律。方法选取于本院白内障专科门诊就诊的年龄相关性白内障患者82例(150眼),检测泪膜破裂时间、基础泪液分泌试验及角结膜荧光素染色,行四代角膜地形图仪泪膜分析系统检测。结果以60岁及75岁为分段点,各年龄组之间干眼患病率,差异无统计学意义(χ2=1.017,P=0.601);所有参评眼的泪膜首次破裂位点均集中于下方泪膜,且干眼者的泪膜首次破裂位点分布区域明显大于非干眼者。结论四代角膜地形图仪能够非侵入式精确地评估白内障患者术前泪膜首次破裂的位置及泪膜的动态变化,为白内障围术期干眼的预防和控制提供了有效的依据。     

Ocular manifestations of congenital insensitivity to pain with anhidrosis

PURPOSE: To describe ocular manifestations in Japanese patients with congenital insensitivity to pain with anhidrosis (CIPA), focusing particularly on the status of the ocular surface. DESIGN: Observational case series. METHODS: Eighteen patients with CIPA underwent applicable ophthalmologic examinations, including visual acuity, refraction, slit-lamp examination, fundus examination, tear breakup time, Schirmer 1 test, corneal sensitivity, and corneal topography. RESULTS: Superficial punctate keratopathy (SPK) was observed at the interpalpebral area in 23 (64%) of 36 eyes. Corneal opacity was observed in three eyes (8.3%). Tear breakup time was below the lower limit of the normal range in all examined eyes, and the value of Schirmer 1 test was above the lower limit of the normal range in most of the examined eyes. CONCLUSIONS: Superficial punctate keratopathy is observed in most cases of CIPA, which might predispose patients to corneal infection. Investigation of dry eye in patients with CIPA will provide unique opportunities to explore the critical roles of the autonomic sympathetic nervous system as well as the sensory nervous system in the physiology of tear production.     

贝复舒（重组bFGF）滴眼液治疗干眼症的临床研究

目的：评价贝复舒滴眼液治疗干眼症的临床效果。方法：32例（64只眼）干眼症患者,双眼自身对照,随机分为贝复舒组和对照组。贝复舒组采用贝复舒滴眼液滴眼,每日4次;对照组不用药或双眼点用珍珠明目液。连续用药一周后复诊。分别检查记录用药前后Schirmer-1试验、泪液膜破裂时间（BUT）及荧光素染色结果,并询问干眼症程度。结果：治疗后两组BUT、角膜荧光素染色程度分级结果及临床症状有明显差异（P＜0．05）;Schirmer-1试验结果无显著差异（P＞0．05）。结论：贝复舒滴眼液对干眼症有明显的治疗作用。     

The ocular surface in cystic fibrosis

Seventeen patients with cystic fibrosis and 17 age-, race-, and sex-matched controls were examined under standardized conditions. Testing included slit-lamp biomicroscopy, fluorescein staining, rose bengal staining, Schirmer's basic tear test, tear film break-up time, tear pH, tear lysozyme, tear protein, lid and conjunctival cultures, and conjunctival impression cytology. Cystic fibrosis patients showed a statistically significant increase in the incidence of fluorescein staining and clinical blepharitis, as well as significantly decreased Schirmer testing and tear lysozyme. Ocular surface abnormalities in these patients may be attributable to aqueous and lipid tear film deficiencies. Cystic fibrosis patients showed normal conjunctival epithelial cell morphology, grew no pathogenic organisms, and had a decreased incidence of conjunctival bacterial colonization.     

干眼仪在干眼诊断中的价值初步评价

目的：评价干眼仪对干眼的诊断价值。方法：对25例(25只眼)正常人和35例(35只眼)干眼患者分别行泪膜破裂时间(BUT)、泪液分泌试验(Schirmer 1)、角膜荧光素染色(FL)、干眼仪检查和泪高度测量五项检查。结果：干眼患者的干眼仪检测等级与正常人差异显著(χ^2=32．22，P=0．000)。干眼仪诊断干眼的特异度为80％，灵敏度为83％。干眼仪检查为Ⅲ级脂质层形态图像者患干眼的机率约为。75％(15／25)。干眼患者的干眼仪检测等级越高，BUT和Schirmer 1试验越短(r=-0．783，-0．368，P=0．000，0．015)，角膜荧光素染色越多(r=0．806，P=0．000)，而与泪河高度无相关(P=0．178)。正常人的干眼仪检测等级也与BLrr和SchirmerI试验呈负相关(r=-0．398，-0．656，P=0．024，0．000)。干眼患者的干眼仪显示图像的稳定性较正常人差。干眼仪的检查结果具有较高的重复性。结论：干眼仪能较直观地观察角膜中央脂质层的光干涉图像，是一种快速、无创伤、重复性强、操作简单的检查方法。对干眼的诊断及客观反映病情的严重程度具有临床应用价值。     

Correlation between dry eye and rheumatoid arthritis activity

PURPOSE: To evaluate the incidence of dry eye in rheumatoid arthritis (RA) patients with or without Sj?gren syndrome (SS), and to investigate the correlation between dry eye and RA activity. DESIGN: Prospective case-control study. METHODS: In 72 RA patients, the severity of dry eye was assessed by the Schirmer test, tear break-up time, rose bengal staining, and fluorescein staining. The RA activity was evaluated by the Lansbury index (LI), which is based on the duration of morning stiffness, erythrocyte sedimentation rate (ESR), grip strength, and joint score. RESULTS: Ten percent of patients met the Japanese criteria for SS. No difference in dry eye tests or LI was observed between SS patients and non-SS patients. Even in the non-SS group, 90% of patients were diagnosed with probable dry eye. In SS patients, positive correlations were observed between LI and Schirmer test (P = .048), ESR and Schirmer test (P = .035), ESR and rose bengal staining (P = .001), and grip strength and rose bengal staining (P = .047). No such correlations were observed in the non-SS patients. CONCLUSIONS: Dry eye is common in RA patients, including those without SS. We found that there was a correlation between LI and Schirmer test in RA patients with SS, but no correlation when the entire group was analyzed. Dry eye always should be taken into consideration regardless of the RA activity, because the severity of dry eye is independent of RA activity.     

应用角膜地形图仪观察老年干眼患者最早泪膜破裂位置

目的:观察老年干眼患者最早泪膜破裂位置的特征。方法:横断面研究。选取2019-07/12在我院诊治的老年干眼患者154例267眼,143眼为右眼,124眼为左眼。其中男71例,女83例,年龄68~90(平均73.40±4.13)岁。应用角膜地形图仪对患者进行最早发生泪膜破裂位置的测量,破裂位置以仪器观察的角膜方位按逆时针顺序分为4个区域,分别对应右眼的鼻上、颞上、颞下、鼻下4个区域和左眼的颞上、鼻上、鼻下、颞下4个区域。记录哪个区域泪膜最先出现破裂,同时记录最早破裂位置距角膜中心的距离。结果:右眼出现泪膜首先破裂最多的区域为鼻下(28.7%),然后是颞下(27.3%)、鼻上(20.3%)、颞上(11.2%),同时出现2~3个区域泪膜破裂占12.6%。左眼出现泪膜首先破裂最多的区域也为鼻下(31.5%),然后是颞下(25.0%)、鼻上(23.4%)、颞上(11.3%),同时出现2~3个区域泪膜破裂占8.9%。双眼之间泪膜破裂区域构成比的比较无差异(χ2=1.443,P=0.837)。双眼鼻下方泪膜破裂位置距角膜中心距离均以>1.5~2mm和>2~2.5mm为主。结论:老年干眼患者泪膜的破裂位置有一定的规律,双眼泪膜首次破裂均以角膜鼻下方为主,双眼没有显著性差异。     

The repeatability of clinical measurements of dry eye

PURPOSE: The repeatability of individual dry eye diagnostic tests has been reported in the literature on normal samples of patients and to a lesser degree in dry eye patients. In this study, the repeatability of a battery of clinical diagnostic tests for dry eye was assessed on mild to moderate dry eye patients. METHODS: A dry eye examination was performed on 75 patients on two occasions by a single examiner. The battery of dry eye tests included symptom assessment, contact lens and medical history, slit-lamp biomicroscopic evaluation of the eyelids, evaluation of Meibomian glands, assessment of tear film quality, tear meniscus height, assessment of blink quality, fluorescein tear breakup time (TBUT), fluorescein and rose bengal staining of the cornea and conjunctiva, phenol red thread test, and Schirmer test. RESULTS: The repeatability of subjective report of dryness (kappaW = 0.62) and grittiness (kappaW = 0.73) was moderate to high. In contrast, the repeatability of Meibomian gland disease classification (kappaW = 0.20), presence or absence of inferior corneal fluorescein staining (kappa = 0.25), and inferior conjunctival rose bengal staining (kappa = 0.21) was poor. When a summed staining score of corneal and conjunctival regions was evaluated, weighted kappa reliability was fair. The repeatability of tear breakup time was substantial [95% limits of agreement -5.71 to 5.83 seconds; intraclass coefficient coefficient (ICC) 0.65], and improved when the two timed readings were averaged. Repeatability of the Schirmer test is more variable as wetting scores increase. When the average Schirmer scores 相似文献   

Diagnostic tests in patients with symptoms of keratoconjunctivitis sicca

We compared the relative value of the tear film breakup time, Schirmer test, lactoferrin immunologic assay and rose bengal staining in 156 patients with varying severity of symptoms characteristic of keratoconjunctivitis sicca and in 39 controls. Statistical analysis showed that in patients with minimal ocular irritation the Schirmer test in combination with the lactoferrin immunologic assay provided an optimal balance between high test sensitivity and low false-positive rates. In patients with moderate to severe ocular burning, foreign body sensation, or pain but with no systemic symptoms of dry mouth or arthritis, and in patients with both ocular and systemic complaints, the lactoferrin assay alone provided statistically significant results. Tear film breakup time and staining with rose bengal were not useful and the Schirmer test had limited value in measuring the rate of tear secretion in these patients.