The relation between tear film tests in patients with dry eye disease

PURPOSE: The purpose of this report was to investigate the relation between dry eye diagnostic tests. METHODS: Dry eye patients were enrolled to complete a clinical examination, including the following dry eye tests: a meibomian gland evaluation, tear meniscus height, fluorescein tear breakup time, fluorescein staining of the cornea, the Schirmer 1 test, the phenol red thread test, and rose bengal staining of the conjunctiva. Statistical analyses, including correlation coefficients, the Wilcoxon sign rank test, chi-square test, and logistic regression were used to address the relation between these clinical tests of dry eye. RESULTS: There was a strong relation between the Schirmer test and fluorescein staining in all four statistical analyses. Similarly, there was also a strong relation between the phenol red thread test and both fluorescein and rose bengal staining. Finally, the results of the Schirmer test were associated with the tear breakup time test in three of four analyses. CONCLUSIONS: The results indicate that tests of aqueous deficiency (volume or production) are associated with ocular surface desiccation. This important relation should be recognized when choosing dry eye tests as outcomes in clinical trials and epidemiological studies.     

Clinical Objective Dry Eye Tests in a Population of Tannery Workers in North India

Purpose: To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers.

Methods: In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey.

Results: All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p < 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p < 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p < 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p < 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p < 0.0001).

Conclusion: Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.     

Tear Film Break-up Time Evaluated by Real-Time Hartmann-Shack Wavefront Sensing

Purpose

To develop a novel method for measuring tear break-up time (BUT) by continuously measuring higher order wavefront aberrations using a Hartmann-Shack (H-S) aberrometer.

Methods

Wavefront aberrations up to the sixth order for a 4-mm pupil were measured in six eyes of six normal subjects using an H-S aberrometer. The aberrometry was performed once every second for up to 50?s under topical anesthesia. The sequence of the points was divided into two stages, and the BUT was defined as the wavefront border of the stages (WFBUT). The WFBUT was compared with the BUT by the conventional fluorescein method (FLBUT) or by the disruption of placid-ring images (PLBUT).

Results

In three eyes, the WFBUT (average, 10.9 ± 1.1?s) was shorter than the PLBUT (average, 17.5 ± 2.5?s), while in the other three eyes the WFBUT (average, 21.5 ± 2.2?s) was longer than PLBUT (average, 8.1 ± 2.2?s). The FLBUT was shorter than WFBUT or PLBUT in most cases.

Conclusions

The tear break-up time measured by H-S aberrometer may be used as a practical measure of tear break-up.?Jpn J Ophthalmol 2006;50:85–89 © Japanese Ophthalmological Society 2006     

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。     

Tear ferning and other lacrimal tests in normal persons of different ages

Summary We investigated in normal persons of different ages ranging from 4 months to 85 years the frequency of different ferning types as well as the results of the Schirmer I test, break-up time and tear protein profile. With increasing age, ferning types of higher degree were significantly more frequent. Furthermore, a correlation was found between the ferning test and low Schirmer test values (p < 0.05) as well as break-up time (p < 0.1). No correlation exists between ferning the test and tear protein pattern. These results indicate that tear ferning is independent from single tear proteins but in correlation with secreted watery volume and plays some role in tear film stability. Furthermore, these normal values of ferning and protein pattern can be used as references for different ages.     

妊娠期糖尿病患者眼表相关指标的临床分析

目的：应用Keratogragh 5M眼表分析仪对比妊娠期糖尿病孕妇与正常孕妇眼表相关指标。

方法：选择妊娠期糖尿病患者45例45眼及正常孕妇48例48眼作为研究对象。所有对象完成眼表疾病指数(OSDI)问卷调查对眼表进行评分,应用Keratogragh 5M测量泪河高度(TMH)、非侵入性平均泪膜破裂时间(NIKBUTav)、眼红指数、睑板腺缺失评分。得出结果后对两组各项指标进行比较。

结果：妊娠期糖尿病组及正常孕妇组的OSDI、TMH、NIKBUTav、眼红指数及睑板腺缺失评分均无差异(P>0.05)。其中OSDI分别为8.02±4.25、7.50±4.28分(P=0.557),TMH值分别为0.22±0.05、0.20±0.04mm(P=0.158),NIKBUTav值分别为8.01±2.15、8.02±1.53s(P=0.971)。

结论：妊娠期糖尿病组与正常孕妇组眼表各项指标差异均无统计学意义,妊娠期糖尿病对眼表相关指标没有明显的影响,可能与血糖控制良好有关。     

糖尿病泪液功能和眼表面变化

目的:探讨糖尿病患者泪液功能和眼表面失调及其影响因素。方法:研究60例120眼非胰岛素依赖型患者,根据病程将其分为A,B,C3个组:A组患者病程<5a,B组患者病程5～9a,C组患者病程≥10a;40例80眼无糖尿病同年龄段者设为对照组。所有研究者均观察角膜荧光素染色、泪膜破裂时间及Schirmer试验;对糖尿病组及对照组各20眼行结膜印记细胞学检查。结果:糖尿病组泪膜破裂时间较对照组短(u=13.54,P<0.01),角膜荧光素染色阳性细胞检出率高于对照组(χ2=52.21,P<0.01),泪液分泌试验较对照组少(t=2.05,P<0.05)。B,C组泪膜破裂时间较A组短,泪液分泌亦减少。结膜印记细胞学检查糖尿病组结膜上皮细胞异常较多,杯状细胞数较少。结论:糖尿病患者是干眼症的易患人群;糖尿病患者的眼表疾病以泪液的质和量的失调,鳞状上皮化生、杯状细胞减少为特征。泪膜破裂时间、Schirmer试验、角膜荧光素染色检查可作为糖尿病患者的眼科常规检查。     

干眼症症状与体征的相关性研究

目的分析干眼症患者的主观症状与客观检查的相关性。方法选取2007年12月—2008年8月就诊于天津医科大学眼科中心门诊的干眼症患者126例252眼,检查前均取得患者书面同意。通过检查视力、泪膜干涉仪检查、泪液分泌试验（STⅠ）、干眼症问卷调查,并在15min后用裂隙灯检查眼前节,进行泪膜破裂时间（BUT）及荧光素（FL）染色检查。采用Spearman秩相关研究分析干眼症症状与体征间的关系。结果干眼症患者最常见的症状是视疲劳（85.7%）、干涩（75.4%）、视力波动（73.8%）、眼痒（65.9%）以及异物感（66.7%）。干眼症患者分泌物增多与STⅠ呈正相关（r=0.208,P=0.020）,流泪症状与STⅠ结果呈正相关（r=0.311,P=0.000）,眼痛与BUT呈负相关（r=-0.197,P=0.027）,眼红与FL染色呈正相关（r=0.227,P=0.011）,异物感与FL染色呈正相关（r=0.251,P=0.005）。其余干眼症症状与ST、BUT、FL染色无明显相关性（P〉0.05）,所有干眼症症状均与泪膜干涉图像分级无明显相关（P〉0.05）。结论干眼症患者症状复杂,干眼症症状与体征的相关性较差。     

The Precorneal Tear Film as a Fluid Shell: The Effect of Blinking and Saccades on Tear Film Distribution and Dynamics

We conducted a series of experiments to elucidate the behavior of the human precorneal tear film (PCTF) during blinking and horizontal and vertical saccades. Methodology included video-interferometry with subsequent image cross-correlation (tear film lipid layer [TFLL]) and video-microscopy (mucoaqueous subphase [MAS]). We observed that the TFLL interference pattern deteriorates rapidly with successive blinks and degrades slowly with repeated horizontal saccades during blink suppression when dark arcs of thinning appear in the fluorescein-stained PCTF. Furthermore, after full downgaze and a return to the primary position, a transient horizontal bright band appears, deep to the spreading TFLL. It may be followed by local disturbances in the interference pattern. Two horizontal dark bands form in the stained PCTF after the return saccade. PCTF disruption may occur below the lower band during blink suppression. We concluded that shearing during horizontal saccades is insufficient to disturb the tear film structure greatly. The MAS and TFLL move together as a fluid shell. The dark arcs/bands are caused by meniscus-induced thinning, imprinted onto the PCTF at the lid margin. Their stability during blink suppression suggests that the MAS has gel-like properties. The horizontal bright bands are probably due to transient corneal indentation in downgaze. In downgaze, the disturbance of the TFLL and MAS below the dark bands is possibly due to shearing across the MAS in the return phase. This could cause desiccating stress in everyday activities, such as working at a computer.     

Transpupillary thermotherapy – introduction

An accurate measurement of tear production is clinically important in the diagnosis and monitoring of dry eye conditions. Re-examination of the results of Schirmer test indicated that the rate of tear secretion decreased with advancing age. Fluorophotometry revealed that the tear turnover rate also decreased with age. Then reappraisal was made on the clinical tests for dry eye syndrome. The non-invasive tear film breakup time (NIBUT) showed a resonable level of accuracy with a cut-off value of 5 seconds (sensitivity 95.9% and specificity 90.8%). The concentration of lactoferrin showed an optimal level of accuracy with a cut-off value of 1.1 mg/ml (sensitivity 79.4% and specificity 78.3%). A study of the ocular surface area revealed that the decrease of ocular surface area was related to the values of NIBUT in normal subjects younger than 50 years of age. The present findings suggested that a combination of these clinical tests was needed for the diagnosis of dry eye syndrome.     

放射科技师泪膜功能的研究

目的探讨放射科技师泪膜功能。方法前瞻性研究，放射科技师及对照组各34例，分别行干眼症状询问、泪膜破裂时间测定（BUT）、角膜荧光素染色（FIS）、基础泪液分泌实验（SIt）、睑板腺功能检查。结果病例组泪膜破裂时间、基础泪液分泌试验的结果及其异常的比率与对照组比较，差异有统计学意义（P〈0．05），病例组出现干眼症状的比率高于对照组（P〈0．05），角膜荧光素染色阳性、睑板腺功能障碍的比率与对照组比较，差异无统计学意义（P〉0．05），专业工作年限与眼干症状、泪膜破裂时间、角膜荧光素染色、睑板腺功能障碍、基础泪液分泌试验之间无相关性。结论放射科技师易发生泪膜功能及泪腺分泌异常，易出现干眼症状。     

糖尿病2型患者眼表状态的改变

目的:探讨2型糖尿病患者眼表状态的改变。方法:107例(107眼)2型糖尿病患者(DM组)及100例100只正常眼(对照组),观察分析两组患者主观感觉,基础泪液分泌试验(schirmerI test,SIt),泪膜破裂时间(tear breaking up time,BUT)测定角膜荧光素染色及结膜印迹细胞学状态改变。结果:DM组患者发生干眼的几率(54.2%)较对照组(17.0%)明显增高,差异具有统计学意义。DM组基础泪液分泌试验(8.48±4.34mm)较对照组(13.73±4.79mm)降低,BUT(6.78±4.08s)较对照组(14.31±4.78s)明显缩短,角膜荧光素着色点(19.6%)较对照组(6.0%)明显增多,差异具有显著意义(P<0.05);结膜印迹细胞学检查DM组结膜杯状细胞密度平均值(80.03±40.38/mm2)较对照组(132.14±33.01/mm2)明显降低,结膜鳞状化生级别较对照组增高,两组差异有统计学意义(P<0.01)。结论:糖尿病可引起角膜、结膜状态的改变。对于糖尿病患者尤其是在各种手术时要充分考虑眼表的改变,给予恰当的治疗。     

糖尿病白内障患者超声乳化吸除术后泪膜的早期改变

目的探讨糖尿病白内障患者超声乳化吸除术后早期泪膜的改变。方法随机选择30例（38只眼）行白内障超声乳化吸除术的糖尿病白内障患者，观察分析术前、术后第1天、第1周、第1个月、第3个月的主观感觉、荧光素试验、泪膜破裂时间（bmak-up time，BUT）、基础泪液分泌试验（schinmr I test，SIt）及干眼仪检查情况。结果与术前相比，术后第1天、第1周、第1个月干燥异物感加重，术眼BUT明显缩短，干眼仪检查等级明显增高，差异有显著性（P〈0．05），术后第3个月接近术前水平，差异无显著性（P〉0．05）。术后第1天、第1周角膜荧光素着色点明显增多，差异有显著性（P〈0．05）。术后第1个月、第3个月接近术前水平，差异无显著性（P〉0．05）。术后第1天泪液分泌量明显增多，差异有显著性（P〈0．05）。术后第1周、第1个月、第3个月接近术前水平，差异无显著性（P〉0．05）。术后第1个月时，角膜荧光素染色〉2分、BUT〈5s的发生率随糖尿病病程的延长而增高，差异有显著性（P〈0．05）。BUT〈5s的发生率女性高于男性，差异有显著性（P〈0．05）。BUT与年龄呈轻度负相关（r=-0．45，P〈0．05）。结论糖尿病白内障患者超声乳化吸除术后早期可出现泪膜的异常改变，尤其表现为泪膜稳定性下降，是干眼症的易患人群，以老年、女性、糖尿病病程长者为甚。     

逍遥散联合妥布霉素地塞米松治疗睑板腺功能障碍性干眼症的研究

目的：观察逍遥散联合妥布霉素地塞米松治疗睑板腺功能障碍(MGD)性干眼症的临床疗效。

方法：选取2015-11/2017-11就诊于南阳市卧龙区第一人民医院的睑板腺功能障碍性干眼症患者106例134眼,随机分为对照组和观察组,各53例67眼。两组均给予热敷、按摩等基础治疗,对照组给予妥布霉素地塞米松治疗,观察组在对照组基础上联合逍遥散治疗。观察两组患者的临床疗效及治疗前后干眼症症状、角膜荧光染色(FL)、视功能损害眼病患者生活质量量表(SQOL DVI)评分、泪膜破裂时间(BUT)和泪液分泌量(SⅠt)等情况。

结果：治疗后,观察组患者治疗总有效率(86.6%)显著高于对照组(67.2%),干眼症症状、角膜FL评分均显著低于对照组,BUT和SⅠt值及SQOL DVI评分均显著高于对照组,差异均有统计学意义(P<0.01)。治疗期间,观察组眼压升高发生率显著低于对照组,差异有统计学意义(P<0.05)。

结论：逍遥散联合妥布霉素地塞米松治疗睑板腺功能障碍性干眼症,能够显著提高疗效,改善预后情况。     

Interfacial Phenomena and the Ocular Surface

Ocular surface disorders, such as dry eye disease, ocular rosacea, and allergic conjunctivitis, are a heterogeneous group of diseases that require an interdisciplinary approach to establish underlying causes and develop effective therapeutic strategies. These diverse disorders share a common thread in that they involve direct changes in ocular surface chemistry as well as the rheological properties of the tear film and topographical attributes of the cellular elements of the ocular surface. Knowledge of these properties is crucial to understand the formation and stability of the preocular tear film. The study of interfacial phenomena of the ocular surface flourished during the 1970s and 1980s, but after a series of lively debates in the literature concerning distinctions between the epithelial and the glandular origin of ocular surface disorders during the 1990s, research into this important topic has declined. In the meantime, new tools and techniques for the characterization and functionalization of biological surfaces have been developed. This review summarizes the available literature regarding the physicochemical attributes of the ocular surface, analyzes the role of interfacial phenomena in the pathobiology of ocular surface disease, identifies critical knowledge gaps concerning interfacial phenomena of the ocular surface, and discusses the opportunities for the exploitation of these phenomena to develop improved therapeutics for the treatment of ocular surface disorders.     

剥脱综合征患者结膜印迹细胞学的检查特征

目的:研究剥脱综合征对结膜细胞和泪液功能的影响.方法:研究共纳入剥脱综合征患者60例86眼作为试验组,年龄相仿正常人55例89眼作为对照组.所有115例175眼均接受Schirmer泪试验及泪膜破裂时间试验,并对上方和鼻下方睑裂区球结膜进行印迹细胞学检查.印迹细胞学检查结果根据Nelson方法分级.对TBUT,Schirmer泪试验及印迹细胞学结果进行相关性分析.结果:剥脱综合征患者的Schirmer试验、TBUT均较正常组显著降低,结膜细胞也有显著改变.剥脱综合征患者的印迹细胞学分级中位数为3级,而正常人组为0级.在试验组中发现45例样本出现了两种以上分级共存的现象,而对照组仅发现3例.此外,实验组中的45例样本结膜上皮细胞和杯状细胞分级出现明显差异,且均表现出杯状细胞的破坏甚于上皮细胞,而对照组未发现此种现象.结论:剥脱综合征患者的结膜细胞受到破坏,泪液分泌受到影响,极易造成眼表疾病的出现.     

Keratograph对不同阶段圆锥角膜干眼特征参数的检测及各参数对圆锥角膜的诊断价值

目的 应用非侵入式眼表综合分析仪Keratograph比较不同阶段圆锥角膜和正常角膜的干眼特征参数,探讨干眼特征参数在圆锥角膜诊断中的作用.方法 选取2015年5月至2016年12月就诊于我院的圆锥角膜患者35例(44眼)作为圆锥角膜组,另选拟进行激光角膜屈光手术患者45例(45眼)作为正常角膜组.两组患者年龄差异无统计学意义(P＞0.05).根据Amsler-Krumeich分级法将圆锥角膜患者按照严重程度分为轻度圆锥角膜19眼,中度15眼,重度10眼.利用眼表综合分析仪Keratograph检测患者双眼非侵入式首次泪膜破裂时间(tear break-up time,BUT)、平均BUT、泪河高度及眼红指数.采用ROC曲线分析不同指标对圆锥角膜的诊断价值.结果 圆锥角膜组的水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度、眼红指数均高于正常角膜组,差异均有统计学意义(均为P＜0.05).圆锥角膜组的首次BUT、平均BUT、泪河高度均小于正常角膜组,差异均有统计学意义(均为P ＜0.05).不同程度圆锥角膜患者的水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度、首次BUT、平均BUT间差异均有统计学有意义(均为P＜O.05).中度组和重度组首次BUT、平均BUT均低于轻度组,差异均有统计学意义(均为P＜0.05),但中度组和重度组间差异均无统计学意义(均为P＞0.05).平均BUT与水平中央曲率、垂直中央曲率、表面变异指数、圆锥角膜指数、角膜后表面高度均呈负相关关系(均为P＜0.05).而平均BUT与泪河高度和眼红指数间无相关性(均为P＞0.05).分别将平均BUT、泪河高度、眼红指数和圆锥角膜指数作为诊断指标,作ROC诊断曲线.圆锥角膜指数的ROC曲线下面积最大,AUC为0.985,95％置信区间为0.963 ～1.000(P＜0.001).此外,ROC曲线下面积平均BUT＞泪河高度＞眼红指数,诊断效果均差于圆锥角膜指数,差异均有统计学意义(均为P ＜0.001).结论 眼表综合分析仪Keratograph能够有效地测量角膜的干眼特征参数,其测量参数中平均BUT对圆锥角膜的诊断价值最高,对轻度圆锥角膜患者的诊断更有意义.     

干眼症发病相关因素的多因素非条件Logistic回归分析

目的 探讨干眼症发生的主要相关因素.方法 选择2006年5月至2007年11月间眼科门诊就诊的屈光不正、眼底病患者及行常规体检的健康者133人为研究对象,主要包括问卷调查和干眼病检测两个部分.问卷调查内容有人口学特征、工作环境、生活习惯与全身疾病等.先进行单因素分析,找出与干眼症发病相关联的因素,然后再对有意义的因素进行多因素综合分析,找出干眼病发生的主要危险因素.结果 单因素分析结果表明:与干眼症发病相关的因素有年龄、荧光屏接触时间、野外工作时间、工作环境、吸烟和糖尿病.行Logistic回归分析,最终有统计学意义的因素为:年龄、野外工作时间和工作环境.结论 就纳入本研究的因素而言,影响干眼症发病的主要因素是年龄、野外工作时间和工作环境,而荧光屏接触时间、吸烟及罹患糖尿病在一定程度上影响着干眼病的发生.     

去卵巢后对大鼠泪膜稳定性及角膜上皮的影响

目的 探讨去卵巢后对大鼠泪膜稳定性及角膜上皮的影响.方法 选择72只雌性SD大鼠,随机分为手术组、假手术组和正常组.分别在2、4、6、8周行泪膜破裂时间(break-uptime,BUT)和2%荧光素染色观测,采用放射免疫方法测定血清雌二醇水平.结果 手术组术后4～8周血清雌二醇的浓度显著低于正常组和假手术组(P<0.05).术后4～8周,手术组的BUT分别与正常组和假手术组比较差异有统计学意义(P<0.05).术后2～8周手术组角膜上皮荧光素染色阳性结果随时间延长而加重.血清雌二醇水平与BUT有统计学意义(r=0.9957,P<0.01);血清雌二醇水平与角膜上皮荧光素阳性染色差异有统计学意义(r=-0.9526,P<0.05).结论 卵巢切除后,血清雌二醇水平明显降低,泪膜破裂时间缩短,泪膜稳定性降低,角膜上皮出现严重的损伤现象.