结膜松弛与泪溢关系的临床研究

目的：观察球结膜松弛与泪溢的关系。探索手术治疗的结果。方法：选择24例46只眼球结膜松弛并有泪溢患者系统观察,由于球结膜松弛阻碍了泪液的流向,或直接堵塞下泪小点开口处,引起泪溢,故手术切除松弛的球结膜以解除泪溢,随访2-8周。结果：切除松弛结膜术后4周;78.2%患者自觉泪溢得到改善;60.8%患者室内观察泪溢消失;78.2%患者裂隙灯检查结膜松弛完全消除,结论：结膜松弛症是泪溢的主要原因之一,手术切除松弛结膜治疗泪溢有效。     

结膜松弛综合征的临床研究

目的观察球结膜松弛的临床症状,探索保守治疗和手术治疗的效果。方法选择30例(58只眼) 球结膜松弛并有泪溢或干眼等症状的患者系统观察,进行症状评估、泪河观察、BUT测定、眼表荧光素染色,并观察手术后球结膜及下睑缘变化。32只眼由于轻度球结膜松弛及干眼症状,局部给予0．1％爱丽滴眼液缓解症状; 26只眼中重度球结膜松弛引起泪溢,经手术解除泪溢。随访2-4月。结果32只眼给予0．1％爱丽滴眼液干眼症状改善者26只眼(81．25％);BUT≥10秒者29只眼(90．63％);眼表荧光素染色正常者24只眼(75．00％)。26 只眼手术后泪溢症状改善者22只眼(84．62％),BUT≥10秒者18只眼(69．23％);眼表荧光素染色正常者19只眼 (73．08％);裂隙灯显微镜检查眼球与下睑缘、内、外眦部之间无松弛结膜皱褶者20只眼(76．92％);下睑缘位置正常者23只眼(88．46％);泪河恢复正常者21只眼(80．77％)。结论选择适宜治疗方式治疗结膜松弛症是安全、有效的。     

部分结膜切除术治疗结膜松弛症性溢泪的疗效

目的：评价球结膜部分切除术治疗球结膜松弛症患者溢泪的安全性和有效性。方法：回顾性病例系列研究。对2015年6月到2017年12月在陆军军医大学附属西南医院眼科确诊为结膜松弛症并伴有溢泪症状,接受部分结膜切除手术治疗的患者31例（31眼）,完成随访的27例（27眼）进行统计分析。所有患者的结膜松弛症均为Ⅲ级或以上,接受球结膜部分切除术后,检查患者自觉症状及结膜脱垂体征变化。采用配对t检验比较术前及术后1、6、12个月泪膜破裂时间变化以及术前和术后6个月的下泪河高度变化。结果：术后患者的溢泪症状均消失。拆除结膜缝线后未见切口处的结膜裂开。至术后平均15个月的随访期间,裂隙灯显微镜检查未见结膜松弛症复发。术后随访各时间点泪膜破裂时间均显著提高（P<0.001）,术后12个月下泪河高度较术前提高（t=-14.642,P<0.001）。结论：切除松弛脱垂的球结膜,间断缝合球结膜切口,并固定于浅层巩膜上,可有效避免手术中结膜撕裂和术后结膜切口裂开等手术并发症,能够改善患者的溢泪,一定程度上稳定泪膜,且安全、有效。     

结膜松弛致溢泪临床疗效观察

为了观察结膜松弛与溢泪的关系，探讨其手术治疗效果，我们选择１２例（２４只眼）结膜松弛症溢泪患者进行临床疗效观察，现报告如下。资料与方法（１）对象：１２例（２４只眼）溢泪患者。溢泪时间１～１５年，平均６．５年；年龄４５～８２岁，平均６２．３岁。选择标准...     

结膜新月形切除术治疗结膜松弛症的临床研究

研究结膜新月形切除术治疗结膜松弛症的临床效果。方法对35例（56只眼）结膜松弛症患者应用结膜新月形切除术进行治疗,观察患者术后结膜松弛变化情况、泪河连续完整性、泪膜破裂时间和自觉症状评估。结果术后随访1年有效率为85．7％。结论结膜松弛是泪溢的原因之一,结膜新月形切除术治疗结膜松弛症安全、有效。     

189例主诉流泪患者的病因分析

目的 分析以流泪为主诉患者的病因。设计 回顾性病例系列。研究对象 2013年1月～2014年12月以流泪为主诉就诊于大连大学附属中山医院的成年患者189例（321眼）。方法 所有患者完成问卷调查,外眼、裂隙灯显微镜、鼻腔检查及泪道冲洗。有眼干涩或异物感等症状或泪河高度偏低者行泪液分泌试验及泪膜破裂时间（BUT）检查。主要指标 病因构成比。结果 321眼中各种原因泪道狭窄或阻塞174眼（54.21%）,干眼症27眼（8.41%）,结膜松弛8眼（2.49%）,泪阜肥大2眼（0.62%）,眼睑松弛2眼（0.62%）,鼻腔疾病2眼（0.62%）,结膜炎8眼（2.49%）,鳄鱼泪2眼（0.62%）,视疲劳20眼（6.23%）。2种以上原因76眼（23.68%）,其中泪道狭窄或阻塞合并干眼症43眼（13.40%）,泪道狭窄或阻塞并干眼症与结膜松弛6眼（1.87%）,泪道狭窄并干眼症与结膜炎2眼（0.62%）,干眼症及结膜松弛6眼（1.87%）,泪道狭窄或阻塞合并结膜松弛9眼（2.80%）,结膜松弛及泪阜肥大5眼（1.56%）,泪道狭窄或阻塞合并结膜松弛及眼睑松弛3眼（0.94%）,泪道阻塞合并泪阜肥大1眼（0.31%）,泪道阻塞合并倒睫1眼（0.31%）。结论 泪道狭窄或阻塞是主诉流泪者的主要原因,多因素原因中干眼症合并泪道狭窄或阻塞比例较大。（眼科,2016, 25：343-346）     

结膜松弛症性溢泪的手术治疗

目的 :探讨结膜松弛性泪溢症手术治疗效果。方法 :设计 7种松弛结膜切除方法 ,对 31例 5 2眼结膜松弛性泪溢症患者手术切除松弛结膜。结果 :术后 4周 5 2眼中自觉溢泪改善达 76 92 % ;5 7 6 9%患眼室内观察溢泪得到改善 ;76 92 %患眼裂隙灯观察松弛结膜完全消除。结论 :手术切除松弛结膜对治疗结膜松弛性泪溢症有效     

眼结膜松弛的临床分级探讨

结膜松弛症是指结膜过度松弛堆积在眼球与下睑缘、内、外眦部之间 ,引起眼表异常的一组病变。 1996年 3月至2 0 0 1年 9月我们收集了 80例 (147只眼 )结膜松弛的病例 ,进行了系统的观察 ,并对 31例 5 2只眼结膜松弛性泪溢症患者手术治疗。结膜松弛症有轻重之分 ,合理的分级对指导临床诊治有着重要意义。现试提出结膜松弛的临床分级标准。1　结膜松弛临床分级标准Ⅰ级 :患者无结膜松弛引起的泪溢、异物感、干涩等相关症状。裂隙灯显微镜检查 ,在眼球与下睑缘、内、外眦部之间 ,球结膜松弛成细小的皱褶 ,在原位眼时不明显 ,眼球下转时加重 ,上…     

结膜松弛症球结膜组织中热休克蛋白的表达

结膜松弛症是老年人常见的年龄相关性眼病[1-2].随着人口老龄化加快,结膜松弛症的患病人数将日趋增多.组织病理学研究显示结膜松弛症结膜组织发生弹力纤维变性[3].弹性组织变性是睑裂斑、翼状胬肉等的组织病理学特征,是以紫外线为主的光线引起的光化学损害的标志.有研究表明,结膜松弛症还与眼表面的炎症反应有关[4].无论是紫外线等光线还是炎症反应,或两者共同作用或联合其他因素,都可能会作为应激原诱导结膜细胞产生应激反应.     

结膜松弛症的发病机理研究

结膜松弛症的发病机理是出现了球结膜、泪液和睑缘三者平衡失调,眼表自动反馈调节系统失灵。球结膜组织发生以弹力纤维减少为主要的组织病理改变,泪液中出现蛋白质及酶的异常表达,在瞬目或闭眼时下睑缘张力增高向上推压已经过度变薄、弹性下降、张力降低、与其下方组织结合疏松的球结膜,松弛结膜就会明显堆积在下睑缘上、内、外眦部之间,形成皱褶,突出于眼表曲面,影响泪液的流动、分布、排泄,在松弛结膜上不能形成正常泪膜,而发生干燥、充血、水肿、上皮角化、泪河变窄或残缺不全,泪液不能正常流动到泪湖区,泪湖不能聚泪,泪液不能进入泪点,使泪液排泄出现障碍,泪液清除延缓又可导致大量降解酶的堆积,可能使胶原纤维溶解,弹力纤维变性,引起眼表泪液学异常的病理循环,而发生结膜松弛症。     

Case-controlled clinical and histopathological study of conjunctivochalasis

BACKGROUND/AIMS: Conjunctivochalasis, a secondary cause of the watery eye, is frequently seen in the older age group as an elevation of the bulbar conjunctiva lying along the lateral or central lower lid margin. A prospective, interventional, case-controlled clinical and histopathological study was conducted. The relevant features of 18 patients (29 eyes) who had their conjunctivochalasis resected as part of the surgical management of their watery eye syndrome were examined. In the control group, tissue was obtained from an age matched series of 24 normal subjects undergoing routine cataract surgery. METHODS: 24 controls (24 specimens) and 18 patients (29 specimens) had conjunctival strip biopsies, taken from the usual lid margin level bulbar conjunctiva in line with the inferior limbus (controls), and the clinically apparent conjunctivochalasis (patients). These were submitted for histological study. RESULTS: 23 of 24 control sections demonstrated normal conjunctival variation. Four of 29 patient specimens demonstrated a chronic non-granulomatous conjunctivitis, while three eyes of the patient group (two patients) demonstrated features of elastosis. Of the four patients who had the inflammatory infiltrates, three had functional nasolacrimal duct obstructions (FNLDOs) and one had a primary acquired nasolacrimal duct obstruction (PANDO). Of the two patients who had elastosis, one had an FNLDO and the other had normal lacrimal drainage and was Jones 1 positive. CONCLUSION: Six of 18 patients--that is, seven of 29 specimens of conjunctivochalasis demonstrated signs of elastosis or of chronic non-granulomatous inflammation. Clinically, patients had a spectrum of aetiologies of their watery eye syndrome.     

结膜松弛症的组织病理学观察

目的观察结膜松弛症组织病理学的改变。方法对病变组17例结膜松弛症患者松弛结膜组织和对照组15例单纯白内障患者球结膜组织,采用苏木精一伊红染色、Verhoeff弹力纤维染色、Masson三色染色和Mallory磷钨苏木素染色方法。对照观察两组组织病理改变。结果结膜松弛症患者结膜组织表现为结膜鳞状上皮增生,角化不全,基底细胞疏密不等的色素沉着,固有层间质出血,弹力纤维减少。结论结膜松弛症患者的松弛结膜组织发生了结膜上皮增生,弹力纤维减少及慢性炎性病变等病理改变。弹力纤维的减少可能是本病的主要发病原因之一。     

Clinicopathologic analysis of conjunctivochalasis and paste-pinch-cut conjunctivoplasty for management

ObjectiveTo correlate the histopathologic results of conjunctival specimens with clinical findings in patients with conjunctivochalasis and report the results of the paste-pinch-cut technique for management.Design: Retrospective chart review.SettingSingle tertiary ophthalmological centre (Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.).MethodsTwenty-five patients (32 eyes) with clinically significant conjunctivochalasis. All patients were referred for clinically significant dry eye without previous diagnosis of chalasis. Sixteen patients had an underlying inflammatory systemic condition. Intervention or Observation Procedure(s): Patients underwent surgery with paste-pinch-cut technique. Subjective dry eye symptoms and ocular surface staining scores (corneal and conjunctival staining using fluorescein and lissamine green respectively) were assessed at every visit.Main Outcome MeasuresChange in patient symptoms and ocular surface staining scores and histopathologic findings in conjunctival specimens.ResultsAfter surgery, significant improvement was achieved in dry-eye symptoms as well as both corneal and conjunctival staining scores in 29 eyes on reduced topical therapy. Only 3 eyes had persisting conjunctival lissamine staining. Light microscopic examination disclosed mild to moderate lymphoplasmocytic inflammation of the conjunctivae with areas of epithelial goblet cell loss, squamous metaplasia, stromal edema, and fibrosis.ConclusionConjunctivochalasis appears to be associated with significant inflammation in the setting of dry eye and underlying inflammatory systemic conditions. Although topical anti-inflammatory treatment could be attempted in the initial management, surgical excision should be considered in the absence of clinical response.     

结膜松弛症手术前后眼表泪液动力学的变化

目的探讨结膜松弛症（CCh）患者眼表泪液特征及手术前后的变化。方法对Ⅲ级以上A组单纯CCh患者11例（21眼）和B组伴有水性泪液缺乏的CCh患者4例（6眼）进行结膜半月形切除,检测手术前后的临床症状、泪河线高度及形态、泪膜破裂时间（BUT）、SchirmerⅠ试验、荧光素活体染色（FL）、氯霉素尝味试验,并进行比较。结果术前两组患者的主要临床症状均有刺激感或异物感、视物模糊及分泌物增多,干涩、泪溢是A组患者的常见症状,泪河线均异常,氯霉素尝味试验大部分异常,BUT、FL评分均明显异常,B组SchirmerⅠ试验异常。手术后3个月A组各症状及B组刺激感或异物感症状明显改善（P〈0．05）,BUT、FL评分两组均改善（P〈0．05）,A组泪河线及氯霉素尝味试验大部分恢复正常（P〈0．01）,B组无变化,但泪河线形态恢复;两组SchirmerⅠ试验无变化。结论CCh明显影响眼表泪液,松弛结膜新月形切除能缓解或消除CCh的临床症状及眼表损害。     

青光眼白内障联合手术对眼表泪膜功能的影响

目的：探讨青光眼白内障联合手术中眼表及泪膜功能的变化。方法：选取施行青光眼白内障联合手术的患者75例75眼,以手术眼为手术眼组,以未手术眼为对照眼组。于术后1mo对干眼相关症状、泪液分泌试验（ Schirmer Ⅰ test, SⅠt）、泪膜破裂时间（ break－up time, BUT）、角膜荧光素染色、眼压、视力等项目进行检查评分,并比较两组间各项结果差异。结果：患者术后1mo的平均眼压为16．25±0．46mmHg,与术前3 d的眼压45．29±4．39 mmHg相比较,差异性具有统计学意义（P＜0．05）。术前平均视力0．08±0．06,术前矫正视力：＜0．05为23眼,≥0．05～＜0．1为16眼,≥0．1～＜0．3为36眼。术后1mo矫正视力：＜0．05者7眼（9％）,≥0．05～＜0．1者11眼（15％）,≥0．1～＜0．3者38眼（51％）,≥0．3～＜0．5者11眼（15％）,≥0．5者8眼（11％）,术后平均视力0．15±0．1。患者术眼视力与术前相比有明显提高,差异有统计学意义（P＜0．05）。两组间术后的术眼干眼症状与对照组眼相比均呈增高趋势,干眼症诊断性试验各项指标与对照眼组相比,差异具有统计学意义（P＜0．05）。结论：青光眼白内障联合手术可在术后对眼表和泪膜功能造成影响,使泪膜稳定性受到破坏而产生干眼症。     

Amniotic membrane transplantation with fibrin glue for conjunctivochalasis

PURPOSE: To evaluate the feasibility of performing sutureless amniotic membrane transplantation (AMT) using fibrin glue for conjunctivochalasis. DESIGN: Noncomparative interventional case series. METHODS: In 25 eyes of 16 patients with refractory conjunctivochalasis (CCh), AMT using fibrin glue was performed to cover the bare sclera. RESULTS: The mean age was 55.2 +/- 18.5 years with nine patients (56.2%) younger than 60 years. The Tenon capsule was dissolved in all eyes. Fibrin glue was effective in securing the amniotic membrane to the sclera. For a mean follow-up of 10.6 +/- 4.3 months, all eyes achieved a smooth conjunctival surface with complete or significant improvement of symptoms in 44% and 56%, respectively. Complications included focal conjunctival inflammation in four eyes and pyogenic granuloma in one eye. CONCLUSION: AMT using fibrin glue can be performed for refractory CCh resulting in alleviating its symptoms and signs.     

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.     

Controlled study of the use of autologous serum in dry eye patients.

PURPOSE: To determine the efficacy and safety of topical autologous serum as a treatment of dry eye patients. METHODS: A 2-month, prospective, single-masked, placebo-controlled study was conducted in patients with bilateral severe dry eye. One eye was randomized to receive the patient's own serum as a tear substitute, and the fellow eye received unpreserved normal saline solution as a placebo. Subjective symptoms and clinical parameters of dry eye including conjunctival impression cytology were assessed at baseline and 1 week, 1 month, and 2 months after treatment. RESULTS: Twelve dry eye patients were enrolled. Both subjective symptoms (discomfort, foreign-body sensation, dryness, and photophobia), objective signs (fluorescein and rose bengal staining and conjunctival impression cytology) improved significantly in treated eyes compared with baseline. Control eyes also had improvement in symptoms, signs, and rose bengal staining compared with baseline. Neither Schirmer test results nor tear break-up time improved in either group. The means score of all parameters were improved in both groups, and the results of conjunctival impression cytology were better in treated eyes; however, these results are not significantly different. There were no serious adverse effects observed in this study. CONCLUSIONS: There was a trend toward improvement in symptoms and signs of dry eye including cytologic changes after application of autologous serum in severe dry eye patients. However, this trend was not statistically significant. A larger scale study is warranted.     

Dry eye after LASIK: Comparison of outcomes for Asian and Caucasian eyes

Background : Dry eye is a common complication of LASIK surgery. Our clinical impression was that post‐LASIK dry eye was more problematic for our Asian patients. The aim of this study was to determine if dry eye after LASIK is more prevalent, more sustained and more severe in Asian eyes compared with Caucasian eyes. Methods : This study was based on a retrospective analysis of a clinical database. Data (n = 932 eyes, 932 patients) was collected before and after (week 2 and months 1, 3 and 6) LASIK surgery. Patients were defined as Asian if both parents were of East Asian ethic origin. Assessments included dry eye symptoms, ocular surface staining, tear volume, tear secretion, tear film stability and corneal sensation. Results : Asian eyes had greater ocular surface staining, poorer tear film stability and lower tear volume before LASIK and at all times after LASIK. Dry eye symptoms occurring ‘often or constantly’ were more prevalent at all time points after LASIK in Asian eyes. Chronic dry eye persisting six months or more after LASIK was diagnosed in 28 per cent of Asian eyes and 5 per cent of Caucasian eyes (p < 0.001). Asian patients with chronic dry eye were predominantly female, reported dry eye symptoms, had greater ocular surface staining and lower tear secretion, stability and volume before surgery. After LASIK, Asian eyes had a slower return to pre‐operative values for ocular surface staining, tear volume and corneal sensation. Discussion : The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.