Tear film osmolarity in patients with thyroid ophthalmopathy

PURPOSE: To compare tear film osmolarity between patients with thyroid ophthalmopathy and normal healthy subjects. METHODS: The tear film osmolarity in 15 normal subjects (15 eyes) (control group) and 21 patients (21 eyes) with thyroid ophthalmopathy was evaluated. Tear film osmolarity in milliosmole (mOsm) was determined by using an auto-osmometer. The palpebral fissure width, degree of proptosis, and tear break-up time (BUT) were also determined. The results for the two groups were compared statistically. RESULTS: The mean palpebral fissure width was 9.13 +/- 0.74 mm in the healthy subjects and 13.33 +/- 1.55 mm in the thyroid ophthalmopathy patients. This difference was statistically significant (P = 0.0001). The mean proptosis was 15.33 +/- 1.39 Hertel units in the healthy subjects and 20.71 +/- 0.95 Hertel units in the patients. This difference was also statistically significant (P = 0.0001). The mean tear BUT was 6.35 +/- 1.56 s in the patients and 18.27 +/- 1.53 s in the healthy subjects, and this difference was also statistically significant (P = 0.0005). The mean tear film osmolarity was 290.80 +/- 13.58 mOsm in the healthy subjects and 340.38 +/- 18.74 mOsm in the patients. There was a statistically significant difference between the groups (P = 0.0001). CONCLUSIONS: The significantly higher tear film osmolarity in patients with thyroid ophthalmopathy was most likely due to the increased proptosis and lid fissure width. These conditions may lead to injury of the ocular surface.     

Ocular surface drying and tear film osmolarity in thyroid eye disease

Five factors potentially associated with corneal exposure--palpebral fissure width, exophthalmos, blink rate, lagophthalmos, and lid lag--were evaluated in 17 patients with Graves' disease to determine which were associated with ocular surface damage. Multiple regression analysis revealed that increased palpebral fissure width and increased blink rate were both significant predictors of ocular surface damage (as measured by rose Bengal staining). Tear osmolarity and tear film break-up time were measured to determine the type of drying mechanism involved in thyroid eye disease. All eyes examined except one had blink rates adequate to prevent dry-spot formation. Fourteen of 33 eyes had abnormally high tear osmolarity. Increasing palpebral fissure width and increasing blink rate were both significant predictors of elevated osmolarity in tears obtained from the inferior marginal tear strip. We suspect that increased palpebral fissure width accelerates tear film evaporation, thus increasing tear film osmolarity with resultant ocular surface damage.     

Postural variation of exophthalmometry in Graves' ophthalmopathy

30 patients with Graves' ophthalmopathy were subjected to exophthalmometry in the upright and supine positions to determine if the difference in exophthalmometer readings in these two situations are significantly different and would help in distinguishing the early and late Graves' ophthalmopathy patients. The cases were divided into two groups (of 15 patients each) of early Graves' ophthalmopathy (Grades 0,1,2) and late Graves' ophthalmopathy (Grades 3,4,5) according to the American Thyroid Association classification. In addition, 15 age and sex matched normal individuals who served as controls, also underwent similar investigation. Contrary to earlier observations, the results showed statistically insignificant increase in exophthalmometer readings when going from the erect to the supine position. It was concluded that postural change in exophthalmometer readings neither helps in distinguishing normal subjects from patients of Graves' ophthalmopathy nor can it differentiate between various grades of Graves ophthalmopathy.     

睑缘炎所致泪膜损害23例

目的探讨睑缘炎对泪膜的损害作用。方法对23例严重睑缘炎患者进行详细裂隙灯检查、泪膜破裂时间、泪液分泌试验测定及角膜上皮荧光素染色。观察经药物治疗后上述各项的改变。结果23例患者睑缘充血、不规则,睫毛根部及睑板腺开口处黄色分泌物及痂皮附着,泪膜破裂时间缩短,角膜弥漫着色,泪液分泌试验在正常范围。结论睑缘炎引起脂质分泌减少及成分异常,破坏泪膜稳定性,导致蒸发过强型干眼。     

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。     

Study of tear film flow and break up time (BUT) in trachoma

Tear film flow and stability studies were carried out in patients suffering from cicatrizing trachoma by Schirmer test I and tear film break-up-time (BUT) measurements, respectively. Both Schirmer test I and BUT values were decreased significantly (t-test, P less than 0.001) depicting aqueous as well as mucin deficiency and hence, an unstable tear film in this condition.     

甲状腺相关眼病患者的眼表功能分析

目的 观察甲状腺相关眼病患者的眼表功能变化.方法 对68例(136只眼)甲状腺相关眼病患者和39例(78只眼)正常对照组,详细记录甲亢治疗、糖皮质激素治疗、眼球突出度、睑裂、眼球运动、眼表相关症状、体征、泪液分泌试验(基础Schirmer Ⅰ试验,SIt)、泪膜破裂时间(break up time,BUT)、角膜荧光素染色等项目检查,并作统计学分析.结果 (1)病例组BUT均值6.97/s,低于对照组9.77s,(P=0.006).(2)病例组SIt均值8.10mm/min,与对照组8.18mm/min,无明显差异(P=0.935).(3)病例组BUT与SIt存在正相关(P=0.034);与眼球突出度存在负相关(P=0.024)关系.(4)病例组SIt与睑裂高度(P=0.006)、眼球突出度(P=0.050)、上睑退缩程度(P=0.02)、下睑退缩程度(P=0.005)、上睑迟落程度(P=0.045)、眼睑闭合不全程度(P=0.002)、眼球上转受限程度(P=0.005)、眼球运动受限程度(P=0.002)、TAO的NOSPECS分级(P=0.004)存在正相关关系.结论 (1)甲状腺相关眼病继发蒸发过强型干眼.(2)甲状腺相关眼病患者基础泪液分泌降低,反射性泪液分泌增强.     

Analysis of tear proteins in Graves' ophthalmopathy by high performance liquid chromatography

Using high performance liquid chromatography, we analyzed tears from 50 patients with Graves' ophthalmopathy and 20 controls. With this technique, tear constituents are separated according to size; a normal tear protein profile consists of five peaks. An increase in one or more peaks was observed in 14 patients (28%) and in none of the controls. No decreased values were observed. No relation was observed between abnormalities of tear composition and the clinical NO SPECS classification. There was a tendency for increased tear protein peaks in those patients with long-standing disease. Most patients with an increase in one or more tear protein levels had normal thyroid function after treatment for hyperthyroidism. Our findings suggested that the inflammatory process in the orbit occurring in Graves' ophthalmopathy also had an effect on the lacrimal gland, which was reflected in the composition of the tears.     

2型糖尿病患者泪液分泌及泪膜功能的初步研究

目的 探讨2型糖尿病患者泪液分泌及泪膜功能。方法 非增生型糖尿病视网膜病变(NPDR)患者25例(50眼)；增生型糖尿病视网膜病变(PDR)患者25例(50眼)；正常对照25例(50眼)。观察指标包括泪膜破裂时间、孟加拉玫瑰红染色及SchirmerI试验。NPDR组、PDR组及对照组各10例(10眼)测定泪液总蛋白和泪液主要蛋白质含量。结果 糖尿病组分别与对照组比较，Schirmer I测定值降低，泪膜破裂时间缩短，孟加拉玫瑰红染色阳性率增加，PDR患者尤其显著。泪液总蛋白含量三组间两两比较差异均无显著性。糖尿病组分别与对照组比较，溶菌酶、乳铁蛋白及泪液特异性前白蛋白浓度降低，PDR患者尤其显著。结论 糖尿病患者易发生泪液分泌及泪膜功能异常，PDR患者泪膜功能低下更加明显。泪液SDS-PAGE有助于发现糖尿病患者泪液蛋白质的变化。     

The diagnostic significance of Fourier-domain optical coherence tomography in Sjögren syndrome, aqueous tear deficiency and lipid tear deficiency patients

Purpose: To determine the role of Fourier-domain optical coherence tomography (FD-OCT) in tear meniscus imaging and evaluate its diagnostic significance in Sj?gren syndrome (SS), non-Sj?gren's aqueous tear deficiency (ATD) and lipid tear deficiency (LTD) patients. Methods: Two hundred and thirty-six dry eye patients and 174 healthy controls were enrolled in this study. All subjects were grouped as follows: group A (ATD), group B (LTD), group C (SS) and group D (normal controls). All subjects underwent dry eye questionnaire, FD-OCT scanning, tear film break-up time (BUT), corneal fluorescence staining and Schirmer I test (SIT). Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100). The area under the receiver operating characteristic curve and the cut-off point were determined using a logistic regression model. Results: Mean TMH, TMD, TMA, BUT and SIT of dry eye patients were significantly lower than those of the controls (p?相似文献   

The diagnostic significance of Fourier‐domain optical coherence tomography in Sjögren syndrome,aqueous tear deficiency and lipid tear deficiency patients

Purpose: To determine the role of Fourier‐domain optical coherence tomography (FD‐OCT) in tear meniscus imaging and evaluate its diagnostic significance in Sjögren syndrome (SS), non‐Sjögren’s aqueous tear deficiency (ATD) and lipid tear deficiency (LTD) patients. Methods: Two hundred and thirty‐six dry eye patients and 174 healthy controls were enrolled in this study. All subjects were grouped as follows: group A (ATD), group B (LTD), group C (SS) and group D (normal controls). All subjects underwent dry eye questionnaire, FD‐OCT scanning, tear film break‐up time (BUT), corneal fluorescence staining and Schirmer I test (SIT). Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus cross‐sectional area (TMA) were measured using FD‐OCT (RTVue‐100). The area under the receiver operating characteristic curve and the cut‐off point were determined using a logistic regression model. Results: Mean TMH, TMD, TMA, BUT and SIT of dry eye patients were significantly lower than those of the controls (p < 0.05). Tear meniscus values were significantly decreased in patients with SS compared with ATD and LTD patients. Tear meniscus values were significantly correlated with clinical examination results in all groups. Accuracy of dry eye diagnosis by FD‐OCT is highest in patients with SS and lowest in LTD patients. The clinical diagnostic critical points were quite different between groups. Conclusions: Fourier‐domain optical coherence tomography could provide precise measurement of the tear meniscus with favourable repeatability. Diagnostic significance is more conspicuous in patients with SS. Tear meniscus measurement by FD‐OCT is expected to become a valuable technique in ATD dry eye screening and diagnosis.     

Tear film profile in patients with active thyroid orbithopathy

Dry eye symptoms and tear film profile were examined in 21 patients with Graves' disease complicated by active thyroid orbitopathy (OT). Dry eye symptoms and clinical tests: break-up time (BUT), Schirmer I, fluorescein and lissamine green staining in OT patients, were comparable with control group. Dry eye symptoms were present in 85% of OT patients compared with 30% in control group. BUT (5.84 +/- 3,31sec.) and Schirmer test (11.11 +/- 9,14mm) were significantly lower when compared with control group (11.4 +/- 3,75sec and 20.5 +/- 9,65mm). Lissamin green staining intensity score (3.61 +/- 1,74) as well as positive fluorescein staining in OT patients, were significantly higher when compared with control.     

Tear film profile in dry eye

Tear film profile was studied in 100 consecutive patients with dry eye along with 100 age and sex matched controls. The frequency of abnormal tear function tests observed in patients with dry eye and controls was: marginal tear strip 93% and 11%, rose bengal staining 89% and 0%, lissamine green staining 87% and 0%, BUT 79% and 14%, Schirmer test 79% and 3% and fluorescein staining 69% and 0%, respectively. No significant difference was observed between tear pH of patients with dry eye and that of normal healthy subjects. A new, simple and effective objective criteria of confirming and grading dry eye based upon a points scoring system derived from the results of various tear film tests is suggested.     

超声乳化白内障吸除术后泪膜的变化

目的　了解超声乳化白内障吸除术对泪膜的影响。方法　随机抽取行超声乳化白内障吸除术的老年性白内障患者 6 8例 (79只眼 ) ,分别于术前 ,术后 1、2、7、14、30及 180d行泪膜破裂时间(breakuptime ,BUT)、基础泪液分泌试验 (SchirmerⅠtest,SⅠt)、角膜荧光素染色、干眼仪检查及下睑中央泪河高度检查。结果　与术前相比 ,术后 1及 2d ,BUT明显缩短 ,SⅠt、下睑中央泪河高度、角膜荧光素染色程度及干眼仪检查等级明显增高 (P <0 0 1) ;术后 7d时SⅠt,14d时下睑中央泪河高度 ,30d时BUT、角膜荧光素染色程度和干眼仪检查等级恢复至术前水平 ,与术前比较差异无显著意义(P >0 0 5 )。术后 30d ,19 3%的患眼泪膜未能恢复至术前水平 ;术前泪膜正常的患者中 1/9发生干眼。术后 1、7、14及 30d ,术前BUT <10s的术眼BUT <5s的发生率高于术前BUT≥ 10s的术眼(P <0 0 5 ) ;术后 14、30及 180d ,术前角膜荧光素染色评分 >2分的术眼术后角膜荧光素染色评分 >2分的发生率高于术前角膜荧光素染色评分≤ 2分的术眼 (P <0 0 5 ) ;术后 14d ,术前干眼仪检查等级≥Ⅲ级的术眼术后干眼仪检查等级≥Ⅲ级的发生率高于术前干眼仪检查等级 <Ⅲ级的术眼(P <0 0 5 )。结论　超声乳化白内障吸除术可影响泪膜的稳定性 ,使部分患     

结膜松弛症患者泪膜稳定性、杯状细胞及黏蛋白5AC表达的变化

目的 检测和观察结膜松弛症患者泪膜稳定性、杯状细胞变化及黏蛋白5AC的表达情况,探讨结膜松弛症的发病机制.方法 收集在我院就诊的结膜松弛症患者30例(30眼)为结膜松弛症组,另选取单纯老年性白内障手术患者15例(15眼)为正常对照组,对所有入选者进行眼部症状评价[国际眼表面疾病指数(ocular surface dis-ease index,OSDI)积分法]、泪膜破裂时间检测、Schirmer Ⅰ试验、泪液羊齿状结晶试验,分别对结膜松弛症组和正常对照组的结膜组织标本行HE染色、AB染色、黏蛋白5AC免疫组织化学染色观察,行统计学分析.结果 结膜松弛症组OSDI评分为(37.80±8.94),高于正常对照组(11.40±4.08) (P＜0.01).结膜松弛症组泪膜破裂时间为(6.70±2.76)s,低于正常对照组(13.67±3.48)s(P ＜0.01).Schirmer Ⅰ试验结膜松弛症组为(6.23±3.13)mm,明显低于正常对照组(13.40±3.74) mm (P＜0.01).结膜松弛症组患者泪液中羊齿状结晶较正常对照组明显减少(,=14.309,P=o.003).光镜下结膜松弛症组较正常对照组球结膜厚度变薄,胶原纤维少,弹力纤维缺失,固有层间质淤血水肿,杯状细胞减少,黏蛋白5AC染色阳性细胞数低于正常对照组(x2=9.499,P=0.023).结论 结膜松弛症患者泪膜功能受到影响,杯状细胞减少,泪液中羊齿状结晶减少,黏蛋白5AC含量减少,最终导致球结膜过度松弛,出现眼表泪液学异常.     

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.     

Decreased tear lipocalin concentration in patients with meibomian gland dysfunction

BACKGROUND/AIM: Recent studies have demonstrated that tear lipocalin (TL) and phospholipids have a crucial role in maintaining tear film stability. The level of TL in patients with meibomian gland dysfunction (MGD) was examined and these data were correlated with the severity of their clinical disorder. METHODS: 12 patients with obstructive MGD, 12 patients with seborrhoeic MGD, and 12 age matched normal control subjects participated in this study. 3 mul of unstimulated tears were collected with a micropipette from the inferior tear meniscus in the right eye of all subjects. Tear samples were fractionated by high performance liquid chromatography, and TL concentrations were assayed with a bicinchoninic acid technique. RESULTS: The mean concentration of TL in patients with obstructive and seborrhoeic MGD was significantly lower than in normal controls. TL concentration correlated positively with tear film break up time and negatively with fluorescein staining scores. CONCLUSION: These results suggest that TL deficiency may be a predisposing factor for the manifestation of symptoms in MGD.     

Evaluation of tear osmolarity and tear function in patients with Behçet’s syndrome

Objective

To evaluate the effects of Behçet’s syndrome (BS) on tear osmolarity and tear film function tests.

Alterations in conjunctival cytology and tear film dysfunction in patients with beta-thalassemia

PURPOSE: Patients with beta-thalassemia (beta-tha) represent a group with lifelong transfusion-dependent anemias. This study aimed to describe the conjunctival changes and tear film parameters in these patients. METHODS: A total of 52 patients (104 eyes) with beta-tha major and 22 normal control subjects (44 eyes) were studied during 1999 through 2000. Tear film break-up time (BUT), Schirmer test, rose Bengal staining, and cytologic evaluation of the conjunctival epithelium were performed in all subjects. The Papanicolaou and May-Grümwald-Giemsa staining procedures were performed on all smears. Patients and control subjects were compared for tear function parameters and conjunctival changes. RESULTS: The BUT, Schirmer test, and rose Bengal staining values were significantly lower (P < 0.001) in beta-tha patients than in control subjects. Keratinized cells were observed in conjunctival samples in 41% of patients, with a decrease in the number of goblet cells per slide in 64% of patients. In 9% of beta-tha patients, there were a slightly greater number of inflammatory cells than in control eyes. CONCLUSION: Ocular surface disorder of these patients was characterized by goblet cell loss and conjunctival squamous metaplasia. Our findings were correlated positively with the variable age. Epithelial damage by toxic reaction and disorder of tear quality and quantity are implicated as important factors in the pathogenesis of the ocular surface disease in beta-tha patients.     

结膜松弛症泪液黏蛋白及球结膜杯状细胞的研究

目的:评价结膜松弛症泪液功能及结膜杯状细胞的组织病理学及超微结构改变。方法:结膜松弛症与正常对照组各30例(60眼)进行泪膜破裂时间(tearbreakup time,BUT)SchirmerⅠ试验、泪液羊齿状试验(tear ferning test,TFT)检查。对10例松弛球结膜组织和10例对照组球结膜对应区组织,采用PAS,AB和HE染色,对照观察组织病理及超微结构改变。结果:结膜松弛症组BUT(7.72±2.90s)较对照组(14.40±3.68s)减少明显(P<0.05)。基础Schirmer试验中结膜松弛症组(13.20±4.07mm)较对照组(16.73±4.41mm)明显降低(P<0.05)。结膜松弛症组泪液中羊齿状结晶明显减少,与对照组间比较差异有显著意义(P<0.05)。结膜松弛症球结膜上皮中的杯状细胞密度为2.75±2.68/100个上皮细胞,对照组为4.64±3.25/100个上皮细胞,两组间差异无显著性(t=1.42,P=0.172)。随着结膜松弛症程度加重,球结膜杯状细胞密度降低。结膜松弛症球结膜杯状细胞组织形态和超微结构有异常。结论:结膜松弛症泪膜稳定性下降、泪液分泌减少,泪液中黏蛋白减少,结膜杯状细胞数量减少,超微结构有异常。