干燥综合征患者眼部症状和体征的一致性分析

目的 分析干燥综合征患者眼部症状的特点并研究症状和体征之间的一致性.设计前瞻性病例系列.研究对象北京大学第一医院内科诊断为干燥综合征的患者36例.方法 对患者进行干眼症状问卷调查,包括干涩感、异物感、疼痛或刺痛感、烧灼和流泪感等;对患者进行泪膜破裂时间、角膜荧光素钠染色、结膜丽丝胺绿染色、Schirmer Ⅰ试验等体征的客观检查.统计症状的阳性率,分析症状和体征之间的一致性.主要指标泪膜破裂时间、角膜荧光素钠染色、结膜丽丝胺绿染色、Schirmer Ⅰ试验.结果 干燥综合征患者的症状明显,除异物感与角膜荧光素钠染色、结膜丽丝胺绿染色及泪膜破裂时间有关,差异有统计学意义（P〈0.05）外,其他症状的出现均和体征无关（P〉0.05 o体征和症状严重程度的一致性较差.结论 干燥综合征患者除异物感和体征有关外,其他症状和体征的一致性差.     

白介素1β在干眼患者眼表的表达

目的 探讨白介素1β（IL-1β）在干眼患者眼表的表达,及其与干眼症状、体征的相关性,阐明IL-1β在干眼发病中的作用.方法 临床试验研究.选取2012年9月至2013年2月来山西省眼科医院就诊的干眼患者30例（60眼,干眼组）,无干眼症状体征且年龄与性别构成匹配的个体15例（30眼）作为对照组.所有受检者均做如下检测：眼表失衡指数（OSDI）干眼调查问卷、泪液分泌试验（SIT）、泪膜破裂时间（BUT）、角膜荧光素钠染色、结膜丽丝胺绿染色.同时应用印迹细胞法收集所有2组对象球结膜上皮细胞,分别进行免疫组化染色,以及实时PCR检测结膜细胞中IL-1β的基因表达.采用独立样本t检验,Spearman相关进行数据分析.结果 干眼组与对照组OSDI评分值分别为24.1±2.2、14.3±1.3;SIT分别为（4.13±1.68）mm、（10.53±0.74） mm;BUT分别为（4.17±1.10）s、（8.80±1.21）s;角膜荧光素钠染色评分值分别为4.3±1.5、0.6±0.5;结膜丽丝胺绿染色评分值分别为5.7±2.0、1.9±1.4.干眼组与对照组以上5个指标比较差异均有统计学意义（t=22.23、-19.88、-18.20、12.85、9.62,P＜0.05）.干眼组IL-1β相对基因含量为0.65±0.37,对照组为0.22±0.06,二者比较差异有统计学意义（t=6.31,P＜0.05）.干眼组IL-1β在结膜上皮细胞中的表达与OSDI评分、角膜荧光素钠染色评分、结膜丽丝胺绿染色评分呈正相关（r=0.81、0.58、0.48,P＜0.05）,与SIT、BUT结果呈负相关（r=-0.43、-0.45,P＜0.05）.通过免疫组化法染色,在干眼患者结膜细胞中可见棕褐色颗粒,而在正常人群中未见棕褐色颗粒.结论 IL-1β作为炎性介质不仅参与了干眼的发病,与干眼的严重程度相关,同时也引起了眼表的损害.     

结膜松弛症的临床及病理研究

目的探讨结膜松弛症的临床特征及组织病理学改变。方法收集结膜松弛症患者26例（39只眼）的相关临床资料,并进行回顾性分析;对患病组26例（39只眼）结膜松弛症患者松弛结膜组织和对照组15例（15只眼）单纯白内障患者球结膜组织进行病理组织学检查,对照观察两组样本组织病理改变。结果结膜松弛症患者多为中老年人,性别比较差异无显著性,均为双眼发病,均有溢泪与干眼症状,不同程度的多余球结膜堆积于下眼睑与眼球之间,泪膜破裂时间（BUT）〈3S,角膜荧光素染色阳性。组织病理学改变：对照组有14只眼为正常的结膜改变,患病组39只眼中有16只眼为慢性非肉芽肿性结膜炎,17只眼为弹性组织变性。结论结膜松弛症患者多为中老年人,主要表现为溢泪与干眼症状,选择合适的手术可以有效的改善患者的病情;其主要病理改变为弹性组织变性,慢性非肉芽肿性结膜炎及炎性细胞浸润等。     

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。     

Study of tear function and the conjunctival surface in diabetic patients

ObjectivesThis study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye.MethodsA total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed.ResultsA normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46 ± 370 μm² and 235.58 ± 109.03 goblets cell/mm², respectively.ConclusionsDiabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.     

P2Y2受体激动剂局部滴眼治疗糖尿病相关干眼的临床分析

目的:观察P2Y₂受体激动剂地夸磷索钠(DQS)滴眼液治疗糖尿病相关干眼的临床疗效。方法:选取2022-01/03就诊于我院的糖尿病相关干眼患者80例160眼作为研究对象,随机分为研究组(40例80眼,使用3%DQS滴眼液治疗)和对照组(40例80眼,使用0.3%玻璃酸钠滴眼液治疗)。分别在基线、治疗后1wk, 1、3mo进行眼表疾病指数(OSDI)评分、非接触式泪河高度(NITMH)、首次非侵入式泪膜破裂时间(NIBUTf)、平均非侵入式泪膜破裂时间(NIBUTav)、睑板腺缺失评分、脂质层厚度分级、眼红分析(包括结膜等级、睫状等级)等检查,采用眼表染色评分(OSS)法进行角结膜染色评分,并分别在基线、治疗后3mo行结膜印迹细胞学和共聚焦显微镜检查。结果:治疗前后,两组患者OSDI评分、睑板腺缺失评分、结膜等级和睫状等级评分均无组间差异(P>0.05)。治疗后1、3mo,研究组OSS评分均低于对照组,NITMH、NIBUTf、NIBUTav均高于对照组(P<0.05)。治疗后3mo,研究组结膜杯状细胞密度较基线增多、角膜树突状细胞较基线减少(均P&l...     

The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity

PURPOSE: To investigate symptom profiles and clinical signs in subjects with dry eye and normal subjects in a cross-sectional multicenter study. METHODS: Subjects aged 35 to 65 were recruited according to dry eye diagnostic codes and telephone interview and completed the Dry Eye Questionnaire 2001, among others, and underwent dry eye clinical tests. RESULTS: Subjects (122) included 28 control subjects (C), 73 with non-Sj?gren's keratoconjunctivitis sicca (non-SS KCS) and 21 with Sj?gren's syndrome (SS). Subjects with SS or non-SS KCS reported discomfort and dryness most frequently and that many symptoms worsened over the day and were quite bothersome. Groups were significantly different in corneal fluorescein staining, conjunctival lissamine green staining, Schirmer 1 tear test, and tear break-up time (TBUT; chi2 and Kruskal-Wallis, P<0.0001). Statistically significant, but moderate, correlations were found between the frequency and evening intensity of dryness and discomfort and TBUT, Schirmer's tear test, overall corneal fluorescein staining, and temporal lissamine green conjunctival staining (Spearman r=0.31-0.45, P<0.01). Symptoms were moderately to highly correlated with the clinician's global grading of severity and highly correlated to patient's self-assessment of severity (r=0.46-0.86, P<0.0001), whereas signs showed lower correlations (r=0.22-0.46, P<0.0001). CONCLUSIONS: Subjects with SS or non-SS KCS reported frequent and intense ocular surface symptoms in the evening, some of which correlated moderately with clinical test results. The global clinician grade of dry eye correlated more highly with patient symptoms than did clinical signs, suggesting that patient symptoms influence dry eye diagnosis and grading of dry eye more than clinical test results.     

Efficacy of the Mineral Oil and Hyaluronic Acid Mixture Eye Drops in Murine Dry Eye

Purpose

To investigate the therapeutic effects of mineral oil (MO) and hyaluronic acid (HA) mixture eye drops on the tear film and ocular surface in a mouse model of experimental dry eye (EDE).

Methods

Eye drops consisting of 0.1% HA alone or mixed with 0.1%, 0.5%, or 5.0% MO were applied to desiccating stress-induced murine dry eyes. Tear volume, corneal irregularity score, tear film break-up time (TBUT), and corneal fluorescein staining scores were measured at 5 and 10 days after treatment. Ten days after treatment, goblet cells in the conjunctiva were counted after Periodic acid-Schiff staining.

Results

There was no significant difference in the tear volume between desiccating stress-induced groups. The corneal irregularity score was lower in the 0.5% MO group compared with the EDE and HA groups. The 0.5% and 5.0% MO groups showed a significant improvement in TBUT compared with the EDE group. Mice treated with 0.1% and 0.5% MO mixture eye drops showed a significant improvement in fluorescein staining scores compared with the EDE group and the HA group. The conjunctival goblet cell count was higher in the 0.5% MO group compared with the EDE group and HA group.

Conclusions

The MO and HA mixture eye drops had a beneficial effect on the tear films and ocular surface of murine dry eye. The application of 0.5% MO and 0.1% HA mixture eye drops could improve corneal irregularity, the corneal fluorescein staining score, and conjunctival goblet cell count compared with 0.1% HA eye drops in the treatment of EDE.     

Visiplug?泪小管塞栓治疗中度以上干眼的临床疗效分析

目的　探讨应用眼表综合分析仪评估VisiPlug^?泪小管塞栓治疗中度以上干眼的临床疗效。方法　选择2015年1月至2016年3月于我院诊断为干眼并使用人工泪液及普拉洛芬滴眼液4周后仍有症状并再次评分为中度以上干眼的患者32例（64眼）,分成治疗组和对照组,每组各16例32眼,治疗组使用泪小管塞栓联合人工泪液及普拉洛芬滴眼液进行治疗,对照组继续使用人工泪液和普拉洛芬滴眼液治疗,随访6~12个月,分别观察治疗前及治疗后2周、1个月、3个月、6个月、末次随访时干眼主观症状问卷调查得分、眼表综合分析仪中泪膜破裂时间、泪河高度、眼红指数及角膜荧光素染色检查情况并评估临床疗效。结果　治疗后1 a,主观症状问卷调查评分治疗组由术前（16.95±5.12）分降至（4.36±0.16）分,对照组由术前（17.22±5.20）分降至（5.50±0.29）分,两组治疗前差异无统计学意义（P>0.05）,治疗后1 a差异有统计学意义（P<0.01）。治疗组、对照组治疗前与治疗后不同时间点的泪膜破裂时间、泪河高度、眼红指数、角膜荧光素染色评分的差异均有统计学意义（均为P<0.05）。两组在治疗后泪膜破裂时间均较治疗前显著延长、泪河高度均较治疗前显著增加,眼红指数评分和角膜荧光素染色评分均较治疗前显著降低,差异均有统计学意义（均为P<0.05）,但治疗组与对照组相比,泪膜破裂时间更长,泪河高度改善更为明显,眼红指数评分与角膜荧光素染色评分更低。结论　VisiPlug^?泪小管塞栓治疗中度以上干眼具有良好的临床效果。应用眼表综合分析仪评估VisiPlug^?泪小管塞栓治疗中度以上干眼的临床疗效更加客观、简便。     

蓝光过滤的荧光染色观察技术在干眼病患者的应用研究

目的:探讨干眼病患者眼表上皮细胞损害的观察方法。方法:选择2006-06/2007-10在我院门诊确诊的47例(94眼)干眼病患者,对其94眼用荧光素染色后分别用钴蓝光和蓝光滤过片观察眼表结构的改变情况。结果:在眼表上皮细胞方面,钴蓝光观察94眼中有85眼染色有异常,其中染色累及睑裂部角结膜有75眼,染色累及下方结膜有10眼;而用蓝光滤过片观察后,发现染色异常的有90眼,其中染色累及睑裂部角结膜25眼,染色累及下方结膜46眼,染色累及上方结膜19眼,Kappa一致性检验,二者有差异;眼睑裂部角结膜损害方面,钴蓝光观察的94眼中有9眼平均分<1,平均分≥1分35眼,≥2分23眼,等于3分27眼;而用蓝光滤过片观察,94眼中的仅4眼平均分<1,平均分≥1分19眼,≥2分28眼,等于3分有43眼,Kappa一致性检验,二者有差异。结论:眼表结构荧光染色后的的蓝光滤过片观察方法简便、特异性、敏感性高,尤其是在结膜上皮的损害观察方面优势明显。     

The effect of time on grading corneal fluorescein and conjunctival lissamine green staining

PurposeTo explore the effect of time on grading corneal fluorescein and conjunctival lissamine green staining in dry eye disease (DED).MethodsPhotographs of 68 subjects with non-Sjogren's DED (nSS DED) and 32 with Sjogren's DED (SS DED) were taken of corneal fluorescein staining, then conjunctival lissamine green staining every 30 s for at least 5 min. Photographs of one randomly selected eye were then randomly ordered and graded on a scale from 0 to 5 (severe staining) by two clinicians, masked to both site and subject. The average time required to reach the maximum grade of staining (Gmax) was calculated.ResultsThe median time (upper and lower quartiles) to corneal fluorescein Gmax was 2.6 (1.3–5.3) minutes for nSS DED and 3.8 (2.6–5.4) minutes for SS DED, a statistically significant difference (Mann Whitney U test, p = 0.018). In contrast, the median time to the Gmax for lissamine green staining of the nasal and temporal conjunctiva was 0.5 (0.5–1.1 nasal, 0.5–0.8 temporal) minutes for nSS DED and 0.5 (0.5–0.8 nasal, 0.5–0.5 temporal) minutes for SS DED subjects, which was not statistically significant (p ≥ 0.383).ConclusionsThe time required to reach the maximum grade of corneal fluorescein staining, but not conjunctival lissamine green staining, varied widely and was significantly longer in subjects with Sjögren's Syndrome. Early observation of corneal fluorescein staining can lead to under-grading, which may impact the diagnosis and assessment of treatment in DED. Further study of the best time to assess corneal fluorescein staining in various DED populations is warranted.     

Evaluation of dry eye disease in children with blepharokeratoconjunctivitis

ObjectiveTo evaluate the symptoms and signs of dry eye disease (DED) in children diagnosed with blepharokeratoconjunctivitis (BKC).DesignProspective case-controlled studyParticipantsConsecutive patients with BKC and normal controls.MethodsAll participants underwent a comprehensive dry eye assessment including the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity test, Schirmer's test without anesthesia, slit lamp examination, tear film break-up time, corneal fluorescein staining (CFS), and lissamine green conjunctival staining (LGCS), according to the Sjögren's International Collaborative Clinical Alliance ocular staining score. For each test the result of the more severe eye was included in the statistical analysis.ResultsTwenty-five patients were recruited—11 with BKC and 14 healthy controls. No difference in symptoms was found between children with BKC (CDEA score 6.1 ± 5.5) and normal controls (CDEA score 3.6 ± 3.2; p = 0.16). Children with BKC had significantly higher mean CFS (1.1 ± 1.6 vs 0.1 ± 0.4; p = 0.04) but similar mean LGCS (1.4 ± 1.8 vs 1.5 ± 2.1; p = 0.81) than normal controls. No statistically significant differences were observed in other tests between the 2 groups. CDEA scores were significantly correlated to CFS in normal controls (r = 0.59, p = 0.03), and approached significance in children with BKC (r = 0.56, p = 0.07).ConclusionsThe only test that can distinguish DED in patients with BKC from children without BKC is the CFS score. This should guide management and monitoring of this unique patient population with DED symptoms and signs.     

Correlation between corneal sensitivity, subjective dry eye symptoms and corneal staining in Sjögren's syndrome

BACKGROUND: Previous studies have shown a poor correlation between dry eye symptoms and objective clinical signs in patients with Sj?gren's syndrome.We examined the hypothesis that reduced corneal sensitivity is associated with increased ocular surface disease and reduced symptoms in patients with Sj?gren's syndrome. METHODS: Eighteen subjects with a diagnosis of Sj?gren's syndrome attending a Sj?gren's clinic participated in the study. All participants completed the Ocular Surface Disease Index (OSDI) and the Symptom Severity of Discomfort (SSD) scale and answered a question regarding overall severity of dry eye symptoms.The subjects underwent measurement of best-corrected Snellen visual acuity, corneal sensitivity testing with the Cochet-Bonnet esthesiometer, fluorescein and lissamine green staining of the cornea, Schirmer's test I and determination of the tear film break-up time.The results were analysed using Pearson correlational analysis. RESULTS: Both fluorescein and lissamine green staining of the cornea correlated negatively with central corneal sensation (r = -0.3542, p = 0.034, and r = -0.3748, p = 0.029 respectively), indicating that corneal sensation was reduced with increased ocular surface disease. The overall symptom severity correlated negatively with lissamine green staining of the cornea (r = -0.4310, p = 0.011), suggesting reduced symptoms with increased corneal disease. INTERPRETATION: Reduced corneal sensation correlated with increased ocular surface disease. Ocular surface disease similarly demonstrated a reciprocal relation with patients' dry eye symptoms. Consequently, we found that patients with Sjogren's syndrome with advanced corneal staining tended to have fewer dry eye symptoms than patients with less corneal staining.     

Isolation of the ocular surface to treat dysfunctional tear syndrome associated with computer use

Dysfunctional tear syndrome (DTS) associated with computer use is characterized by mild irritation, itching, redness, and intermittent tearing after extended staring. It frequently involves foreign body or sandy sensation, blurring of vision, and fatigue, worsening especially at the end of the day. We undertook a study to determine the effectiveness of periocular isolation using microenvironment glasses (MEGS) alone and in combination with artificial tears in alleviating the symptoms and signs of dry eye related to computer use. At the same time, we evaluated the relative ability of a battery of clinical tests for dry eye to distinguish dry eyes from normal eyes in heavy computer users. Forty adult subjects who used computers 3 hours or more per day were divided into dry eye sufferers and controls based on their scores on the Ocular Surface Disease Index (OSDI). Baseline scores were recorded and ocular surface assessments were made. On four subsequent visits, the subjects played a computer game for 30 minutes in a controlled environment, during which one of four treatment conditions were applied, in random order, to each subject: 1) no treatment, 2) artificial tears, 3) MEGS, and 4) artificial tears combined with MEGS. Immediately after each session, subjects were tested on: a subjective comfort questionnaire, tear breakup time (TBUT), fluorescein staining, lissamine green staining, and conjunctival injection. In this study, a significant correlation was found between cumulative lifetime computer use and ocular surface disorder, as measured by the standardized OSDI index. The experimental and control subjects were significantly different (P<0.05) in the meibomian gland assessment and TBUT; they were consistently different in fluorescein and lissamine green staining, but with P>0.05. Isolation of the ocular surface alone produced significant improvements in comfort scores and TBUT and a consistent trend of improvement in fluorescein staining and lissamine green staining. Isolation plus tears produced a significant improvement in lissamine green staining. The subjective comfort inventory and the TBUT test were most effective in distinguishing between the treatments used. Computer users with ocular surface complaints should have a detailed ocular surface examination and, if symptomatic, they can be effectively treated with isolation of the ocular surface, artificial tears therapy, and effective environmental manipulations.     

Relación de índice de enfermedad de la superficie ocular con pruebas objetivas y tratamiento del ojo seco

ObjectiveTo correlate ocular surface disease index (OSDI) with objective tests on patients with dry eye on first consultation and evaluate the efficiency of topical medication administered depending on severity of symptoms reported by patients who were evaluated at 3 months.Materials and methodsWe studied a sample of 144 patients with dry eye who were evaluated with OSDI and basic diagnostic tests at first consultation: Height of lacrimal meniscus, Schirmer II test (with anesthetic), Break-up time test (BUT), and lissamine green staining. The sample was divided into four groups depending on clinical severity, taking into account results of OSDI questionnaire. Treatment was determined for each group taking into account lubricant viscosity properties: OSDI (mild) = carboxymethylcelullose, OSDI (moderate) = hidroxypropylmethylcelullose, OSDI (severe) = polyethyleneglycol and OSDI (very severe) = polyethyleneglycol + cyclosporine A 0.05%. Final OSDI was established for 56 patients who were assessed at 3 months.ResultsResults of objective tests at first consult showed a correlation between the severity of symptoms and the grade of lissamine green staining (p = 0.0421). We found significant improvement in OSDI values after topical treatment was administered in all groups of patients (p = 0.0066) at three months post treatment.ConclusionsConjuntival lissamine green staining is a useful guideline that could be routinely used to confirm diagnosis in subjective evaluations and patient follow-up. Patients with dry eye show a decrease in OSDI after being treated with the appropriate medication prescribed for each particular group, depending on severity.     

Effects of lacrimal occlusion with collagen and silicone plugs on patients with conjunctivitis associated with dry eye

PURPOSE: To determine whether canalicular occlusion with collagen and silicone plugs reduces the severity of symptoms in patients with conjunctivitis secondary to dry eye. METHODS: This was a prospective, randomized, double-masked study conducted at a single center in Mexico, in which 61 patients with dry eye/conjunctivitis were assigned to progressive lacrimal occlusion with collagen and silicone plugs or a sham procedural group. Outcome variables included total and individual dry eye and conjunctivitis symptom scores, moisturizing agent usage, best-corrected visual acuity, ocular comfort level, visual performance, corneal/conjunctival fluorescein staining, and incidence of adverse events. RESULTS: Total dry eye and conjunctival symptom scores were reduced by 43.7 and 33.7%, respectively 2 weeks after occlusion of all four lacrimal canaliculi with collagen plugs, increasing to 77.4 and 72.1% 2 weeks later following superior canalicular occlusion of both eyes with silicone plugs and inferior placement of collagen plugs. At the 8-week visit (4 weeks after silicone plug implantation of the inferior canaliculi of both eyes), the reduction in total dry eye and conjunctival symptom scores further increased to 94.2 and 93.0%, respectively, accompanied by a marked decline in each of the seven individual symptom scores (dryness, watery eyes, itching, burning, foreign body, fluctuating vision, and light sensitivity). In concert with these changes, moisturizing agent usage and corneal/conjunctival fluorescein staining decreased in a progressive fashion over the 8-week study period, and best-corrected visual acuity, ocular comfort, and visual performance improved in the absence of any treatment-related adverse events except for one case of epiphora. The response of patients to lacrimal occlusion can be sharply contrasted with the sham procedure group, which remained relatively unchanged from baseline at each of the study visits. CONCLUSIONS: Progressive lacrimal occlusion with collagen and silicone plugs was of clinical benefit to patients with dry eye and conjunctivitis.     

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.     

泪道激光联合引流管植入术对泪道阻塞患者眼表的影响

目的：研究泪道激光联合引流管植入对泪道阻塞患者眼表状态影响以及安全性分析。
　　方法：选取2012-06/2015-09本院泪道阻塞患者200例200眼,进行泪道激光联合引流管植入术治疗,分别评估术前和术后1 mo患者眼表情况,包括泪膜破裂时间、泪液羊齿状结晶、干眼症状问卷调查、丽丝胺绿染色、角膜荧光素染色等。
　　结果：经过泪道激光联合引流管植入术后1mo,患者眼表出现泪液的分泌量明显增加,拔管之后,患者泪液分泌量比术前明显减少差异有统计学意义(P<0.05)。问卷调查结果显示,患者在进行泪道激光联合引流管术后,流泪症状明显改善。手术前后以及拔管之后泪膜破裂时间、泪液羊齿状结晶评级、结膜杯状细胞均未见明显改变。
　　结论：泪道激光联合引流管植入术对泪道阻塞患者可以显著改善患者的流泪症状,提高其生活质量。     

Ocular manifestations in moderate-to-severe psoriasis in India: A prospective observational study

Purpose:Ocular manifestations in psoriasis are due to direct eye involvement with psoriatic plaques or psoriasis-related, immune-mediated inflammatory processes. The commonly reported pathologies are blepharitis, conjunctivitis, keratitis, dry eyes, and uveitis. Limited data is available on the ocular findings in psoriasis patients in India. In this study, we evaluated various ocular changes associated with moderate-to-severe psoriasis.Methods:In this prospective cohort study, treatment-naive psoriasis patients with Psoriasis Area Severity Index (PASI) score of more than 10 were included. The Ocular Surface Disease Index (OSDI) score, Schirmer’s score, tear film breakup time (TBUT), corneal and conjunctival staining score, and meibomian gland dysfunction score were noted. All these parameters were re-evaluated at 8 weeks of follow-up after systemic treatment.Results:Sixty-eight patients were enrolled in the study. The most common ocular pathologies observed in this study were tarsal hyperemia and anterior blepharitis in 128 (94.1%) and 64 (47%) eyes, respectively. Mild, moderate, and severe dry eyes were seen in 26 (19.1%), 14 (10.2%), and 34 (25%) eyes, respectively. Thirty-nine (57.3%) patients complained of significant difficulty watching television or digital screen. In 21 patients evaluated on follow-up at 8 weeks, cornea and conjunctiva’s ocular surface staining score increased and TBUT decreased significantly.Conclusion:The most common ocular pathologies observed in this study were anterior blepharitis and moderate dry eye, which significantly affected most patients’ daily routines. Screening patients with greater severity of psoriasis would help in early management of such problems.     

Ocular surface changes in keratoconjunctivitis sicca with silicone punctum plug occlusion

PURPOSE: To evaluate histopathologic and clinical response to silicone plug insertion in dry eye patients. METHODS: Punctal plugs were placed in 32 eyes of 18 dry eye patients with aqueous deficiency who were on maximum medical therapy and who had Schirmer testing with topical anesthetic measuring less than 5 mm. Pre-treatment and post-treatment (6 weeks and 1 year) evaluations included temporal and inferior quadrant impression cytology examinations, Schirmer-1, BUT, corneal fluorescein and rose-bengal staining patterns and questionnaire scores. The cytology samples were graded according to the method described by Nelson. RESULTS: There was an improvement in subjective symptoms of patients 6 weeks after punctal occlusion. Corneal fluorescein and rose-bengal staining scores decreased from a mean of 5.33 +/- 1.74 to 1.37 +/- 1.48 and from 5.90 +/- 1.2 to 2.45 +/- 1.89 (p < 0.05) respectively. BUT values increased from 2.98 +/- 1.1 to 11.3 +/- 3.1 seconds (p < 0.05) at 6 weeks post-treatment. Increase in goblet cell density was observed after punctal occlusion at 6 weeks (p < 0.05) and at 1 year (p < 0.05) compared to the pre-treatment values. After occlusion, 3% of temporal specimens had Grade 0 squamous metaplasia, 63% had Grade 1, 34% had Grade 2; while 25% of inferior specimens had Grade 0, 56% had Grade 1, 19% had Grade 2 squamous metaplasia. CONCLUSIONS: Punctum plug occlusion in keratoconjunctivitis sicca provides improvement of tear film stability, ocular surface staining scores, conjunctival squamous metaplasia grades and goblet cell density. Increased ocular surface exposure to essential tear components with punctal occlusion may be important for the genesis of these changes.