The Effect of Horizontal Rectus Muscle Surgery on Clinical and Eye Movement Recording Indices in Infantile Nystagmus Syndrome

Objective: To determine the relationship between horizontal rectus muscle surgery and eye movement recording in infantile nystagmus syndrome.

Methods: In this prospective, interventional, non-randomized study, patients with infantile nystagmus syndrome were assigned to one of three treatment groups. Group I with head postures of less than 20°, binocular visual acuity of less than 20/30, and heterotropia less than 30^Δ underwent recessions of all 4 horizontal rectus muscles. Group II with head postures of less than 20°, binocular visual acuity of less than 20/30, and heterotropia more than 30^Δ underwent large recessions of two horizontal rectus muscles. Group III with head postures of more than 20° underwent Kestenbaum-Anderson surgery. Baseline and follow-up evaluations included best corrected visual acuity for distance and near, cycloplegic refraction, head posture, and eye movement recordings.

Results: Fifty-eight (58)patients with a mean age of 18.7 (SD ± 9.10 years) were enrolled. Four horizontal rectus muscle recessions were performed in 29 cases, 2 rectus recession in 23, and Kestenbaum-Anderson surgery in 6 cases. Mean follow-up period after surgery was 18?±?7.4 months. Distance visual acuity improved in all three groups, but only in the 2 rectus muscle surgery group was the change significant for both monocular and binocular vision (P < 0.001). In all 3 groups speed and amplitude of nystagmus waves were changed in positive or negative direction but only in 4-recti recession decrease was statistically significant (P = 0.02 & 0.04).

Conclusion: Horizontal rectus muscle surgery in subjects with infantile nystagmus syndrome improves the visual acuity and nystagmus intensity.     

A Review of the Tenotomy Nystagmus Surgery: Origin,Mechanism, and General Efficacy

Tenotomy nystagmus surgery neither “weakens” nor “strengthens” the extraocular muscles; it is not strabismus surgery. Tenotomy effectively decreases the gain of the ocular motor plant to small, non-saccadic signals and was hypothesized to be efficacious for other types of nystagmus in addition to infantile nystagmus; it has subsequently been shown to damp various types of acquired nystagmus (pendular and jerk, horizontal and vertical) and reduce their associated oscillopsia. The eXpanded Nystagmus Acuity Function now allows visual acuity improvements to be estimated prior to surgery—something never before possible. More research into proprioceptive tension control should provide non-surgical methods to achieve the therapeutic improvements of tenotomy.     

Surgery for the treatment of vertical head posturing associated with infantile nystagmus syndrome: results in 24 patients

Background: The study of the clinical and electrophysiological effects of eye muscle surgery on patients with infantile nystagmus has broadened our knowledge of the disease and its interventions. Design: Prospective, comparative, interventional case series. Participants: Twenty‐four patients with a vertical head posture because of electrophysiologically diagnosed infantile nystagmus syndrome. The ages ranged from 2.5 to 38 years and follow up averaged 14.0 months. Methods: Thirteen patients with a chin‐down posture had a bilateral superior rectus recession, inferior oblique myectomy and a horizontal rectus recession or tenotomy. Those 11 with a chin‐up posture had a bilateral superior oblique tenectomy, inferior rectus recession and a horizontal rectus recession or tenotomy. Main Outcome Measures: Outcome measures included: demography, eye/systemic conditions and preoperative and postoperative; binocular, best optically corrected, null zone acuity, head posture, null zone foveation time and nystagmus waveform changes. Results: Associated conditions were strabismus in 66%, ametropia in 96%, amblyopia in 46% and optic nerve, foveal dysplasia or albinism in 54%. Null zone acuity increased at least 0.1 logMAR in 20 patients (P < 0.05 group mean change). Patients had significant (P < 0.05) improvements in degrees of head posture, average foveation time in milliseconds and infantile nystagmus syndrome waveform improvements. Conclusions: This study illustrates a successful surgical approach to treatment and provides expectations of ocular motor and visual results after vertical head posture surgery because of an eccentric gaze null in patients with infantile nystagmus syndrome.     

Clinical and electrophysiological effects of extraocular muscle surgery on patients with Infantile Nystagmus Syndrome (INS)

The purpose of this report is to summarize clinical and electrophysiological effects of extraocular muscle surgery in patients with INS. Our hypothesis is that surgery on the extraocular muscles of patients with INS changes their nystagmus resulting in improved vision and visual functions. All patients had all four virgin horizontal recti operated on, either for strabismus alone, nystagmus alone, for a head posture due to an eccentric null zone alone or for a head posture due to an eccentric null zone plus strabismus. All patients have been followed for at least 12 months. Subjective outcome measures include the pre- and post-operative binocular best optically corrected null zone acuity (NZA) in 75 patients and gaze dependent acuity (GDA) in 12 patients. Objective outcome measure included null zone width (NZW) in 75 patients. The results are summarized as follows: NZA increased .1 LogMar or greater in 75% with those patients 相似文献   

Effect of Rigid Gas Permeable Contact Lenses on Nystagmus and Visual Function in Hyperopic Patients with Infantile Nystagmus Syndrome

Purpose: To determine the effect of rigid gas permeable contact lenses (RGPCL) on involuntary eye movements and visual function in hyperopic patients with infantile nystagmus syndrome. Methods: This prospective interventional case series was conducted on 16 patients with infantile nystagmus and hyperopia equal or more than +0.5 D and astigmatism more than -1 D over a 2-year period. A complete ophthalmological examination including determination of best corrected visual acuity (BCVA), contrast sensitivity, and videonystagmography was performed for all patients before and after at least 3 months of RGPCL use, and the outcomes were compared. Results: Thirty-two eyes of 16 patients with mean age of 18.6±4.9 years were enrolled. Mean spherical equivalent refractive error was +1.5±2.35 (range +1 to +6.25) diopters (D); corresponding values were +2.45±2.44 D (range +0.5 to +7.5) for spherical error and +1.90±0.83 D (range +1 to +4) for astigmatism. Monocular BCVA improved from 0.56±0.23 to 0.51±0.23 Log MAR (P=0.007), and binocular BCVA improved from 0.54±0.25 to 0.48±0.24 Log MAR (P=0.01) after fitting RGPCL. Following the use of RGPCL, contrast sensitivity was significantly improved at low (P=0.02) and intermediate (P< 0.001) frequencies but not at high frequencies (P=0.6). The frequency, amplitude, and intensity of nystagmus were decreased significantly after RGPCL use (P<0.001). Conclusion: RGPCL improved monocular and binocular BCVA and contrast sensitivity in hyperopic patients with infantile nystagmus syndrome. Motor indices of nystagmus (frequency, amplitude, and intensity) were also significantly improved after RGPCL use.     

Gaze-dependent and time-restricted visual acuity measures in patients with Infantile Nystagmus Syndrome (INS)

PURPOSE: We report a new method of measuring visual function in patients with INS by demonstrating the effects of eccentric gaze and forced time restriction on optotype recognition. DESIGN: Cross-sectional, comparative case-series. METHODS: No-time-restricted acuity (NTRA) and time-restricted acuity (TRA) for 19 patients and 18 controls were measured at multiple horizontal gaze angles. RESULTS: INS patients showed a significant lower visual acuity than controls (P < 0.0001). The TRA were significantly decreased in most gaze positions relative to NTRA in INS patients (P = 0.03) while there were no difference among controls. About half of the INS patients showed that their best visual acuity was gaze dependent, matching the preferred head posture in both NRTA and TRA paradigms. CONCLUSIONS: Gaze-dependent visual acuity tested with and without time restriction may be a useful measure of visual function in INS patients and could be used in interventional clinical trials.     

Predictive Value of Age,Angle, and Refraction on Rate of Reoperation and Rate of Spontaneous Resolution in Infantile Esotropia

In the Early vs. Late Infantile Strabismus Surgery Study (ELISSS), 13.5% of children operated at 20 months vs. 3.9% of those operated at age 4 had gross binocular vision (Titmus Housefly). Reoperation rates were 28.7% in the former vs. 24.6% in the latter group and, although all were eligible for surgery at baseline at 11 SD 3.7 months, 8% in the early group vs. 20% in the late group were never operated, mostly because their angle decreased spontaneously. We assessed the predictive value of age, angle, and refraction in these matters.

Methods: The ELISSS reoperation rates were first compared with those found in nine series of consecutive cases in nine university clinics operated during one particular year, between 6 and 23 years previously. Logistic regression was used to estimate the effect of postoperative angle and clinic on the chance of reoperation. Secondly, a meta-regression analysis was done of these and other reported reoperation rates. The mean age at operation and the mean duration of follow-up were regressed on the logistically transformed reported reoperation rates. Finally, to estimate the chance of spontaneous decrease of the angle without surgery, a random-effects model was fitted on the 6-monthly orthoptic measurements of angle and refraction in the ELISSS that antedated surgery, loss to follow-up, or final examination. In the random-effects model (see online-only supplement link or visit, www.simonsz.net), for ELISSS patients the random effect was defined as the deviation of the average angle, the fixed effect. A vector was defined based on age and spherical equivalent of the patient. The variance around the prediction consisted of uncertainty in the estimations, random effects, and residuals.

Results: In the retrospective study, 204 patients who had been first operated between 6 and 23 years previously were eligible. A reoperation had been performed in 32 (19.3%) of the remaining 166 children who were 4.33 SD 1.35 years old at first surgery. The reoperation rate was 7.3% for those with a postoperative angle of ?4° to +4° (N?=?82), 25% for postoperative divergence > 5°, and 29% for postoperative convergence 10° to 14°. Strabismologists overestimated the reoperation rates at double. In the meta-regression analysis, 12 studies were included. Reoperation rates were between 60% and 80% for children first operated around age 1 and approximately 25% for children operated around age 4 (best fit: ?0.221 Ln [age in months] + 1.1069; R²?=?0.5725). Finally, in the predictions of random-effects model, a small angle at age 1 and hyperopia of approximately +4 increased the chance of spontaneous decrease of the angle into a microstrabismus.

Discussion: The benefit of early surgery for gross binocular vision is balanced by a higher reoperation rate and an occasional child being operated that would have had a spontaneous decrease into a microstrabismus without surgery. The fact that, in the ELISSS, hyperopia was associated with a decrease of the angle underscores the benefit of early refractive correction.     

Extraocular muscles: Basic and clinical aspects of structure and function

Although extraocular muscle is perhaps the least understood component of the oculomotor system, these muscles represent the most common site of surgical intervention in the treatment of strabismus and other ocular motility disorders. This review synthesizes information derived from both basic and clinical studies in order to develop a better understanding of how these muscles may respond to surgical or pharmacological interventions and in disease states. In addition, a detailed knowledge of the structural and functional properties of extraocular muscle, that would allow some degree of prediction of the adaptive responses of these muscles, is vital as a basis to guide the development of new treatments for eye movement disorders.     

An expanded nystagmus acuity function: intra- and intersubject prediction of best-corrected visual acuity

The Nystagmus Acuity Function (NAF) provides an objective measurement of the foveation characteristics of nystagmus waveforms and an assessment of potential visual acuity for subjects with congenital (CN) or latent/manifest latent (LMLN) nystagmus. It is based on the subjects' ability to maintain fixation within a physiologically based `foveation window' of ±0.5° and ±4.0°/s. However, some subjects are incapable of controlling fixation well enough to remain within this window with duration sufficient for good foveation. To obtain a measure of the CN waveforms of these individuals, we are proposing an eXpanded Nystagmus Acuity Function (NAFX) that relaxes either the position limit, the velocity limit, or both. Data used in this study comes from 11 human subjects with CN (10 idiopathic and 1 with achiasma) and a Belgian sheepdog with achiasma. Visual acuity was tested with a standard Snellen chart and eye movements recorded with infrared oculography or scleral search coil. For the NAFX to be useful, it must not only be applicable for subjects who cannot maintain fixation within the standard limits of the NAF, but also must yield results equivalent to those obtained with the NAF when testing subjects who are capable of maintaining good fixation control. For the latter subjects, the amount of time when position and velocity fell within the expanded limits was measured, the standard deviations of the position and velocity during these times were calculated, and a -surface for the exponential function was generated to guarantee the equivalence between the NAF and the NAFX. We developed an automated NAFX equivalent to the original NAF. We demonstrated that equivalence in 10 subjects and the use of the NAFX on two additional (1 human and 1 canine) subjects who were incapable of maintaining fixation within the standard position and velocity limits. We demonstrated the effects of surgery and related the results to visual acuity. We found the results to be comparable to those seen when applying the NAF to subjects who had good fixation control. The NAFX can be determined for CN and LMLN subjects with poor control of fixation by extending the standard NAF position and/or velocity limits for foveation. The resulting function can be used along with the longest foveation domain (derived from the NAFX to measure breadth of a high-NAFX region) to identify the gaze or convergence angles with the best waveform and to predict the best-possible visual acuity that could be achieved with the reduction of their nystagmus.     

Nightblindness-Associated Transient Tonic Downgaze (NATTD) in Infant Boys with Chin-Up Head Posture

Eleven infant boys presented with chin-up head posture, tonic downgaze and, on attempted upgaze, large-amplitude upward saccades with deceleration during the slow phase downward. The gaze-evoked upward saccades disappeared at the age of 2 or 3 years. In addition, they had high-frequency, small-amplitude horizontal pendular nystagmus that remained. Among these infant boys were 2 pairs of maternally related half-brothers, 2 cousins, and 2 siblings. Visual acuity ranged from 0.1 to 0.6, ERG-amplitudes (both A- and B-wave) were reduced, and severe myopia was found in 5 cases. Eight boys had CACNA1F mutations, and 1 boy had a NYX mutation, compatible with incomplete or complete congenital stationary nightblindness (iCSNB or cCSNB), respectively. This points to a defective synapse between the rod and the ON-bipolar cell causing the motility disorder: CACNA1F is located on the rod side of this synapse, whereas NYX is located on the side of the ON-bipolar cell. The coexistence of horizontal and vertical nystagmus has been previously described in dark-reared cats.     

Final Report of the Early vs. Late Infantile Strabismus Surgery Study (ELISSS), a Controlled,Prospective, Multicenter Study

Background: The optimal age for surgery for infantile esotropia is controversial. Proponents of early surgery believe that further loss of binocular vision can be prevented by early surgery, a minority believes that binocular vision can even be restored by early surgery. The ELISSS compared early with late surgery in a prospective, controlled, non-randomized, multicenter trial. Methods: Fifty-eight clinics recruited children aged 6–18 months for the study. Each clinic operated all eligible children either ‘early’, i.e. at age 6–24 months, or ‘late’, i.e. at age 32–60 months. At baseline the angle of strabismus, refraction, degree of amblyopia and limitation of abduction were assessed. Intermediate examinations took place every six months. Children were evaluated at age six in the presence of independent observers. Primary endpoints were (i) level of binocular vision, (ii) manifest angle of strabismus at distance and (iii) remaining amblyopia. Secondary endpoints were number of operations, vertical strabismus, angle at near and the influence of surgical technique. Results: A total of 231 children were recruited for early and 301 for late surgery. Age at entry examination was 11.1 months (SD 3.7 months) in the early group and 10.9 (SD 3.7) months in the late group. Refraction, amblyopia and limitation of abduction were distributed equally in the early and late groups, but the angle of strabismus was slightly larger in the early group. Dropout-rates were 26.0% in the early and 22.3% in the late group. At age six, 13.5% of the early vs. 3.9% of the late group recognized the Titmus Housefly; 3.0% of the early and 3.9% of the late group had stereopsis beyond Titmus Housefly. No significant difference was found for angle of strabismus. 35.1% of the early group and 34.8% of the late group did not have an angle between 0° and 10°, the thresholds set for re-operation. For ratio of the visual acuities (remaining amblyopia) there was a small but significant advantage for the early group. There was hardly any correlation between the baseline parameters and the primary endpoints. Children scheduled for early surgery had first been operated at 20 (SD 8.4) months, but 8.2% had not been operated at age six. Children scheduled for late surgery had been operated at 49.1 (SD 12.7) months, but 20.1% had not been operated at age six. The number of operations per child was 1.18 (SD 0.67) in the early and 0.99 (SD 0.64) in the late group. Age at recruitment, age that strabismus reportedly had started and refraction at entry examination were similar among operated and non-operated children. Only the angle of strabismus at entry predicted, to some extent, whether a child had been operated at age six. Discussion: Children operated early had better gross stereopsis at age six as compared to children operated late. They had been operated more frequently, however, and a substantial number of children in both groups had not been operated at all.     

Effects of Unilateral Ocular Motor Nerve Palsies on Smooth Pursuit Eye Movements in Adult Patients

Aim: The aim of this study was to investigate the influence of single ocular muscle weakness on smooth pursuit eye movements. Methods: Infrared video recordings of horizontal and vertical eye movements were obtained from 14 adult patients with either unilateral abducens nerve palsy or trochlear nerve palsy. During the recordings, subsequent series of horizontal, vertical and oblique ramp stimuli of 10°/s constant target velocity and ±10° amplitude were presented under monocular viewing conditions. Results: In both forms of ocular nerve palsies, similar changes of pursuit eye movements were observed in the pulling plane of the paretic muscles. The movements of the covered paretic eye showed the lowest amplitude and gain values as well as the lowest numbers of catch-up saccades. The highest amplitude and gain values were calculated from the movements of the covered sound eye. The highest numbers of saccades, however, were produced by the fixating paretic eye. Conclusions: We conclude that the fixating paretic eye compensates for the paresis by raising the pursuit gain and the number of catch-up saccades. In the covered paretic eye, however, monocular adaptation is connected with a symmetric low pursuit gain and a reduced number of saccades in the pulling plane of the paretic muscle.     

Analysis and Outcomes of Cataract Surgery in Patients with Acquired Immunodeficiency Syndrome

Purpose: To investigate the surgical outcomes, complications and postoperative progression in HIV patients undergoing cataract surgery in a teaching hospital.

Methods: A retrospective cohort study of patients with HIV/AIDS who had cataract surgery from January 2000 until December 2011 at a tertiary referral multidisciplinary hospital in Singapore.

Results: We identified 44 eyes from 29 patients. Preoperatively, 41.3% had no ophthalmic manifestations of HIV/AIDS, while 16 eyes had quiescent cytomegalovirus retinitis (CMVR). Postoperatively, 1 eye developed new CMVR, while 1 eye had reactivation of previous CMVR. Of eyes with new or previous CMVR, 1 eye developed rhegmatogenous retinal detachment (RD) postoperatively. Only 3 eyes had prolonged postoperative inflammation. There were no cases of endophthalmitis or cystoid macular edema. Postoperative improvement of at least two Snellen lines was achieved in 86.6% of eyes.

Conclusions: Cataract surgery in HIV patients is generally safe, regardless of CD4 count, but their general and ocular health should be optimized preoperatively.     

The Role of Eye Movements During Reading in Patients with Age-Related Macular Degeneration (AMD)

AMD patients often have particular difficulty reading, even when the text is magnified to compensate for reduced visual acuity. This study explores whether reading performance can be explained by eye movement factors. Forty patients with advanced AMD were tested with a high-speed video eye tracker to evaluate fixation stability and saccadic eye movements. Reading speed was measured for standardized texts viewed at the critical print size. Visual acuity and contrast sensitivity were unrelated to reading speed, but fixation stability, proportion of regressive saccades and size of forward saccades were all significantly associated with reading performance, accounting for 74% of the variance. The implications of these findings for low-vision training programmes are discussed.     

Neuroendocrine Tumor (Carcinoid) Metastatic to Orbital Extraocular Muscle: Case Report and Literature Review

Purpose: To report a patient who showed neuroendocrine tumor (carcinoid) metastasis to the medial rectus muscle and to review patients’ characteristics of carcinoid metastases to the extraocular muscles.

Case: A 72-year-old woman, who initially presented with spindle-shaped enlargement of the right medial rectus muscle, was followed for 3 years with a diagnosis of orbital myositis. Initial biopsy of the medial rectus muscle showed inflammation only. She showed remission and exacerbation of right proptosis and eyelid swelling, which responded to oral and intravenous steroids. On the occasion of abdominal computed tomography for ischemic colitis, a large retroperitoneal mass was detected and diagnosed as well-differentiated neuroendocrine tumor. The gradual increase of the medial rectus muscle with optic nerve compression, and hence, visual reduction, prompted a second excisional biopsy of the medial rectus mass, which proved to be neuroendocrine tumor metastasis. Whole body 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography fused with computed tomography revealed abnormal uptake only in the right orbit (maximum standardized uptake value: SUVmax?=?3.83), and the patient underwent radiation to the right orbit with the subsidence of the residual mass.

Results: The literature review found 15 patients, including this patient, with neuroendocrine tumor metastases to the extraocular muscles. Frequent symptoms and signs were diplopia, proptosis, and ocular motility limitation.

Conclusions: Neuroendocrine tumor appears to have propensity to extraocular muscle metastases and its slow growth might pose difficulty in differential diagnoses of orbital myositis.     

Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma

PurposeTo investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications.MethodsParticipants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year.ResultsThe change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score.ConclusionsSignificant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.     

准分子激光角膜屈光手术后开角型青光眼患者的临床特征

目的：观察具有准分子激光角膜屈光手术（简称准分子术）史的开角型青光眼患者的临床特征。方法：回顾 性病例研究。纳入2005─2018年北京大学第三医院眼科中心就诊、具有准分子术史且随访2年以上的 开角型青光眼患者。记录一般情况以及特殊检查结果,选取每例视野较差的眼或双眼相似者随机1眼 作为研究眼。对视野进展分析采用非参数分析（NPA）法。采用独立样本t检验及秩和检验进行分析。结果： 共纳入33例患者,青光眼确诊均在准分子术后,手术至青光眼确诊间隔（10.3±6.1）年,确诊时年龄 （37.5±10.4）岁,最高眼压<21 mmHg（1 mmHg=0.133 kPa）者27例（82%）;中央角膜厚度为（456±47）μm。 眼底照相显示视网膜神经纤维层缺损18例（55%）,无法辨认的15例（45%）;杯/盘比为0.7±0.1。视 野平均缺损（MD）绝对值小于6的有18例（55%）,6～12有8例（24%）,12以上有7例（21%）。其中随 访2年以上21例,随访时间为（4.5±2.2）年;视野进展13例（62%）,视野进展速度为（0.5±0.6）dB/年。 视野进展组与非进展组治疗后降眼压幅度分别为（28.3±20.7）%和（15.4±11.0）%（t=-1.867,P=0.078）, 屈光回退发生率分别为92%和25%（P=0.003）。21例中屈光回退14例（64%）,屈光回退组中12例 （12/14）视野进展,无回退组中1例视野进展（1/7）（P=0.003）;屈光回退组的视野进展[（0.7±0.7）dB/年] 快于无回退组[（0.1±0.1）dB/年]（t=-2.899,P=0.011）。结论：准分子术后的青光眼患者确诊时大多 处于病情早中期,4/5患者眼压在21 mmHg以下,通过眼底照相能明确视网膜神经纤维层缺损的只 占一半病例。随访中约2/3患者视野恶化,可能与屈光回退有关。     

Sj(o)gren综合征患者眼部临床特征及检查方法评价

目的:了解Sj(o)gren综合征(Sj(o)gren syndrome,SS)患者眼部临床特征,并评价Schirmer试验、泪膜破碎时间(BUT)和角结膜染色在确定SS中的临床意义.方法:选择初次确诊的原发性SS患者62例,依次进行外眼以及裂隙灯活体显微镜眼前节检查、Schirmer Ⅰ试验、BUT、荧光素角膜染色、丽丝胺绿结膜染色,并选择62例正常人作为对照,进行相同的检查.结果:取SS患者左眼右眼数据分别进行分析,各项检查数值左右眼无显著性差异.取SS组与对照组右眼数据进行分析,以Schirmer值≤5mm/5min为标准,68%SS患者表现出泪液分泌功能障碍,以BUT≤5s作为标准,84%SS患者具有泪膜不稳定的表现,以角结膜染色评分数值大于4分为标准,87%SS患者明确具有干眼病的眼表损伤体征,3项检查特异性依次为83%、87%和92%.结论:SS患者干眼病检查表现出明显异常,在诊断意义上角结膜染色评分大于BUT检查,BUT检查进而大于Schirmer试验.