睑缘炎患者泪膜功能的临床观察

目的观察睑缘炎患者的泪膜功能。方法随机选取2013年3月至2014年1月于我院就诊的睑缘炎患者39例(72只眼),以及正常体检者37例(74只眼)。所有患者均接受泪河高度、泪膜破裂时间、角膜荧光素染色和基础泪液分泌实验等检查,并将所得检查结果进行统计学分析。结果睑缘炎组患者的泪膜破裂时间为(7.43±2.77)s,显著低于对照组(14.32±6.14)s(P<0.05);睑缘炎组和对照组的角膜荧光素染色评分分别为(1.02±0.69)分和(0.61±0.43)分,差异有显著统计学意义(t=-2.97,P=0.01);泪河高度和基础泪液分泌实验显示两组差异均无统计学意义(P>0.05)。结论睑缘炎患者基础泪液分泌功能正常,但泪膜稳定性降低,是蒸发过强型干眼的易患人群。     

慢性睑缘炎患者泪膜功能的临床分析

目的探讨慢性睑缘炎患者的泪膜功能与正常人泪膜功能的差异,分析与干眼症的相关性。方法选择2008年4月~2010年6月在本院眼科门诊就诊,诊断为慢性睑缘炎患者34例(64只眼)作为睑缘炎组。其中男性13例,女性21例。另选择32例(64只眼)排除外眼疾病的健康体检者作为对照组。对每位符合入选条件者进行角膜荧光素染色、泪膜破裂时间测定(BUT)以及基础泪液分泌试验I(SIt)。结果睑缘炎组角膜荧光素染色阳性率高于对照组,泪膜破裂时间较对照组短,但基础泪液分泌试验两组比较差异无显著意义。结论慢性睑缘炎患者角膜染色阳性率高,泪膜稳定性差,是蒸发过强性干眼症的易患人群,也是慢性结膜炎、角膜炎迁延不愈的原因之一。     

糖尿病患者泪膜功能的研究

目的　探讨糖尿病患者泪膜功能及其影响因素。方法　前瞻性研究 10 0例 ( 2 0 0只眼 )2型糖尿病患者 ,根据病程将其分为A、B、C 3个组 :A组患者病程 <5年、B组患者病程 5～ 9年、C组患者病程≥ 10年 ;80例 ( 16 0只眼 )无糖尿病者设为对照组 ;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 2 0只眼行结膜印迹细胞学检查。结果　糖尿病组泪膜破裂时间较对照组短 (u =12 6 0 ,P <0 0 1) ,角膜荧光素染色阳性细胞检出率高于对照组 ( χ2 =71 370 ,P <0 0 1) ,两组Schirmer试验比较 ,差异无显著意义 (P >0 0 5 )。B、C组泪膜破裂时间较A组短(q =6 72 ,7 5 7;P <0 0 1)。A、B、C 3个组比较 ,角膜荧光染色阳性检出率与病程呈正相关。病程≥ 5年的患者中 ,女性角膜荧光素染色阳性检出率均高于男性 ,尤其病程为 5～ 9年者 ,差异有显著意义( χ2 =5 171,P <0 0 5 )。糖尿病组泪膜破裂时间与女性年龄呈负相关。结膜印迹细胞学检查 ,糖尿病组患者结膜上皮细胞异常较多。糖尿病患者的泪膜功能较差 ,表现为泪膜稳定性下降 ,角膜荧光素染色 ,结膜杯状细胞数减少。结论　糖尿病患者是干眼症的易患人群 ;糖尿病患者常规角膜荧光素染色检查有助于早期发现糖尿病引起的角膜病变。泪膜破     

非侵人性泪膜功能检查在干眼诊断中的初步应用

目的采用Oculus四代角膜地形图仪分析干眼患者泪膜功能及首发破裂部位的分布情况。设计前瞻性比较性病例系列。研究对象2013年7-9月在北京同仁眼科中心就诊的干眼患者51例（51眼）及对照组86例（86眼）。方法对受检者进行眼表疾病评分指数（Ocular Surface Disease Index,OSDI）问卷调查,使用Oculus四代角膜地形图仪进行非侵入性泪膜破裂时间（noninvasive tear breakup time,NITBUT）及泪河高度（tear meniscus height,TMH）测定。分析干眼组及对照组OSDI评分、首发泪膜破裂时间（the first NITBUT,NITBUTf）、平均泪膜破裂时间（the average NITBUT,NITBUTav）及泪河高度差异及各项指标之间的相关性。以角膜中心点为圆心,1 mm间距将角膜划分为1～8环,并以横、纵坐标为界划分为四个象限,这样将角膜划分为29个区域。分析每位受检者首次泪膜破裂的部位,并比较分析两组受检者组间差异。主要指标OSDI评分、NITBUTf、NITBUTav、泪河高度及泪膜破裂首发部位。结果干眼组与对照组OSDI分值、NITBUTf及NITBUTav分别为（31.41±14.20）分和（4.80±7.40）分,（3.99±0.61）s和（8.90±3.51）s,（7.54±3.11）s和（11.76±4.30）s（P=0.000,0.000,0.016）,两组泪河高度分别为（0.22±0.098）mm和（0.25±0.096）mm（P=0.217）。OSDI评分与NITBUTf、NITBUTav呈线性负相关（r=-0.760、-0.490,P均=0.000）,NITBUTf与NITBUTav呈线性正相关（r=0.671,P=0.000）,泪河高度与OSDI评分、NITBUTf、NITBUTav均无相关性（P均〉0.05）。干眼组及对照组泪膜破裂首发部位主要分布在2~5环（分别占73.08%、75.42%）;泪膜破裂首发部位在不同环间出现的概率,两组受试者均具有统计学意义（χ2=13.897、30.017,P=0.031、0.000）。以四个象限为分区单位,干眼组及对照组泪膜破裂首发部位出现概率均无统计学意义（χ2=2.103、5.186,P=0.551、0.159）。结论 Oculus四代角膜地形图仪能客观地检查泪?     

角膜散光对干眼患者泪膜的影响

目的探讨角膜散光对干眼患者泪膜的影响。方法对临床确定为干眼的患者(除外其他任何眼病)进行电脑验光,筛查出存在散光的干眼患者和无任何散光的正视眼干眼患者,分别对其进行泪膜干涉成像仪检查(DR-1)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)以及泪膜破裂时间测定(break-up time,BUT)。将所得到的数据进行统计学分析。结果散光的干眼患者与正视眼干眼患者DR-1及BUT结果比较其差异有统计学意义,但SⅠt结果差异无统计学意义;散光患者的DR-1及BUT、SⅠt结果与散光的屈光度之间不存在相关性;近视散光、远视散光患者的DR-1检查及BUT之间的差异无统计学意义;逆规和顺规散光患者相比其DR-1差异有统计学意义,BUT差异有统计学意义;斜轴和顺规散光患者相比其DR-1差异有统计学意义,BUT差异有统计学意义;逆规散光与斜轴散光的DR-1和BUT比较差异均无统计学意义。结论(1)角膜散光对干眼患者泪膜稳定性存在一定的影响;(2)逆规散光患者的泪膜稳定性较顺规散光和斜轴散光差。     

翼状胬肉切除联合羊膜移植术对患者泪膜功能的影响

目的:研究翼状胬肉切除联合羊膜移植术对患者泪膜功能的影响.方法:选取我院2013-10/2015-10住院部收治的翼状胬肉患者82例122眼,根据随机数表法将所有患者分为观察组39例61眼和对照组43例61眼,对照组采取单纯翼状胬肉切除术,观察组采取翼状胬肉切除联合羊膜移植术.对比术前、术后1、3mo两组患者泪膜破裂时间(break-up time, BUT)和Schirmer I试验(SⅠt),比较术后2mo 两组患者眼球表面温度及干眼症状评分.结果:术前对照组和观察组的BUT和SⅠt差异无统计学意义(P>0.05);术后1mo,观察组BUT为5.79±1.53s,明显高于对照组(4.28±0.98s),差异有统计学意义(t=2.478,P=0.012),观察组SⅠt为4.39±1.69mm/5min,高于对照组(3.51±0.89mm/5min),差异无统计学意义(t=1.529,P=0.079);术后3mo,观察组的BUT为7.49±1.79s,明显高于对照组(6.71±1.89s),差异有统计学意义(t=2.271,P=0.026),观察组的SⅠt为9.58±1.30mm/5min,高于对照组(8.91±1.49mm/5min),差异无统计学意义(t=1.857,P=0.068);术后2mo,观察组眼球表面温度为34.29℃±0.67℃,对照组为34.18℃±1.58℃,差异无统计学意义(t=1.033,P=0.278);术后2mo,观察组干眼症状评分为3.87±0.14分,明显低于对照组(5.34±0.78分),差异有统计学意义(t=14.463,P<0.01).结论:翼状胬肉切除联合羊膜移植术能有效改善干眼症,有利于泪膜功能的稳定.     

Keratograph眼表综合分析仪观察2型糖尿病患者泪膜功能变化的研究

目的运用Keratograph眼表综合分析仪观察2型糖尿病患者泪膜功能变化。方法对2014年1月至2015年12月厦门市中医院内分泌科确诊为2型糖尿病并到眼科会诊的患者和同期在我院眼科门诊就诊的非糖尿病患者进行前瞻性研究。糖尿病组患者40例(80只眼),非糖尿病组50例(100只眼)。所有患者均行首次泪膜破裂时间(FTBUT)、平均泪膜破裂时间(ATBUT)、非侵入式泪河高度(NITMH)、脂质层厚度分级、睑板腺腺体完整度评分检测。结果糖尿病组患者与非糖尿病组患者相比,FTBUT、ATBUT缩短,NITMH变低,睑板腺完整度的评分下降,差异均具有统计学意义(P均<0.05)。结论 Keratograph眼表综合分析仪可以客观、精确地用于评估2型糖尿病患者泪膜的功能变化,这类患者是干眼的高发人群,要重视其防治。     

微创玻璃体手术对糖尿病患者泪膜功能的影响

目的:观察糖尿病患者经微创玻璃体视网膜切除手术后泪膜的早期变化及其后期的恢复情况。方法:自2009-03/07行微创玻璃体视网膜切除手术的连续病例116例116眼,其中伴有2型糖尿病患者30例30眼作为A组,无糖尿病的患者86例86眼作为B组,对侧眼作为对照,均于手术前1d,术后1,3,10d;1,3mo行干眼不适症状(dryeyessymptom,DES)评分、泪膜破裂时间测定(break-uptime,BUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)及角膜荧光素染色(corneal fluorescein staining,CFS)等检查。对比分析两组泪膜之间的变化,根据临床检查结果评分进行统计学分析。结果:A组与B组比较:术前A组30%患者诉眼干、眼痒等不适症状,术前1d,A组与B组之间差异有统计学意义(P=0.029);A组泪液分泌量少于B组,BUT时间短于B组,但两者之间没有统计学差异。两组术后1,3d,患者未感到明显不适,术后1d,A组与B组之间差异有统计学意义(P=0.034),17%患者主诉有轻度痛痒感及红肿;CFS评分两组术眼之间无统计学差异,对照眼术后3d之间有统计学差异(P=0.039);BUT:术眼术后1d两组之间差异有统计学意义(P=0.001),对照眼之间术后3d差异有统计学意义(P=0.007);SⅠt术眼之间、对照眼之间各时间点均无差异,但A组整体泪液分泌量趋势明显少于B组。B组术眼与对照眼:术后1,3d,眼部不适感、BUT,SⅠt均有差异(P<0.05);CFS评分各时间点均有差异(P<0.05)。结论:糖尿病患者本身的泪膜稳定性差,微创玻璃体切除术影响泪膜的稳定性,糖尿病患者经微创玻璃体视网膜切除手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和泪液分泌量的下降,且术后泪膜恢复比较慢。     

基于泪膜破裂方式的干眼诊断新思路

泪膜的不同组成成分通过相互作用共同维持眼球表面的湿润,从而维持眼部健康.当这些组成成分出现病理性改变,将会不同程度的影响泪膜稳态,从而导致干眼的发生.而瞬目运动一定程度上影响着泪膜组成成分的分布,随着对干眼相关机制研究的逐步深入,以泪膜为导向的诊断(tear-film-oriented diagnosis,TFOD)的...     

人类免疫缺陷病毒感染者泪膜功能的研究

目的探讨人类免疫缺陷病毒(HIV)感染者的泪膜功能.方法前瞻性研究34例HIV/AIDS患者,对照组为40例HIV阴性者.分别行眼干症状询问、泪膜破裂时间测定(TBUT)、角膜荧光素染色和基础泪液分泌试验(SIt).结果病例组TBUT和SIt结果及TBUT和SIt异常和角膜荧光素染色的比率与对照组比较,差异均无显著性意义(P＞0.05).病例组出现眼干症状的比率明显低于对照组(P＜0.05).C组与A、B组比较,C组SIt结果较低(P＜0.05),角膜染色评分较高(P＜0.05),SIt结果异常者较多(P＜0.05).不同眼底病变组比较,SIt和TBUT结果无显著性差异(P＞0.05).结论HIV感染者发生泪膜功能异常的比率并不高于正常人群.HIV感染者较不容易出现干眼症状.重症AIDS患者是发生干眼症的易患人群.     

Changes in visual function and optical and tear film quality in computer users

Purpose

To assess changes in visual function and optical and tear film quality in computer users.

Methods

Forty computer workers and 40 controls were evaluated at the beginning and end of a working day. Symptoms were assessed using the Quality of Vision questionnaire (QoV), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye version II (SANDE II). Tear film quality was evaluated using the Medmont E300 dynamic corneal topography tool to measure the tear film surface quality (TFSQ), TFSQ area and auto tear break-up time (TBUT). Optical quality was assessed by measuring high, low and total ocular aberrations with a Hartmann–Shack wavefront sensor. Visual performance was assessed by measuring photopic and mesopic visual acuity, photopic and mesopic contrast sensitivity and light disturbance.

Results

Poorer DEQ-5, QoV and SANDE II scores were obtained in computer workers at the end of the working day compared with controls (p ≤ 0.02). Computer workers exhibited a higher (worse) TFSQ and TFSQ area at visit 2 compared with visit 1 (p ≤ 0.04), while no significant differences in TBUT (p = 0.19) or ocular aberrations were observed (p ≥ 0.09). Additionally, both light disturbance (p ≤ 0.04) and mesopic and photopic contrast sensitivity worsened at several spatial frequencies (p ≤ 0.04) throughout the working day in computer workers, while visual acuity remained unchanged (p ≥ 0.07). In contrast, control subjects exhibited no decrease in any variable during the day.

Conclusions

While visual acuity remained unchanged, several aspects of visual function and quality of vision decreased over a day of computer use. These changes were accompanied by greater dry eye symptoms and tear film changes, which are likely to have played a fundamental role. The present study provides insight into new metrics to assess digital eye strain.     

Tear ferning in contact lens wearers

Tear ferning (TF) has shown good sensitivity and specificity in the diagnosis of dry eye, but is a relatively uncommon test, especially in contact lens wearers. The aim of this study was to investigate the relationship between TF, ocular comfort and tear film stability amongst contact lens (CL) wearers and non-contact lens (NCL) wearers. Subjects (36 NCL, 24 CL; mean age 23.2 ± 4.8 years) underwent assessment of non-invasive tear break up time (NIBUT), fluorescein tear break up time (FBUT) and completed the Ocular Comfort Index (OCI) questionnaire. Non-stimulated tears were collected from the inferior tear meniscus with a glass capillary. Samples of 1.5 μL were air dried, observed by light microscopy and the TF pattern quantified according to Rolando's grading scale. Significantly higher grades of TF pattern and discomfort (higher OCI scores) were observed in CL wearers compared to NCL wearers (Mann–Whitney U -test; p  < 0.005 and p  < 0.05 respectively). Differences in tear film stability were not significant between groups. Even when asymptomatic (low OCI scores) CL and NCL subjects were compared, TF remained significantly different ( p  < 0.005). In both CL and NCL subjects, TF displayed poor correlation with tear film stability tests and OCI scores. Higher TF grades in CL wearers, even if asymptomatic, indicate an unfavourable ratio of salt to macromolecule concentration within the tear film of such subjects. The lack of significant difference in TF between symptomatic CL and NCL wearers could suggest similar aetiology (tear film hyperosmolarity) in each cohort. The TF technique demonstrates limited sensitivity and specificity for the prediction of ocular surface comfort in both CL and NCL wearers.     

Tear film and ocular surface tests in animal models of dry eye: uses and limitations

Many ocular surface tests have been developed for the clinical diagnosis of keratoconjunctivitis sicca, and several have been used to 'validate' animal models of Sjogren's and non-Sjogren's dry eye. However, many of these tests themselves have not been systematically studied or standardized, and yet their use in animal models of dry eye is common. This review provides a rational approach and systematic review of the tear film and ocular surface tests described in the literature that may be applicable to the current animal models of dry eye, with particular emphasis on their limitations, along with some suggestions regarding their standardization and applications in eye research.     

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.     

Sialic Acid in Human Tear Fluid Decreases in Dry Eye

Purpose To evaluate the association between tear mucin and dry eye, we compared tear fluid sialic acid concentration in dry eye patients with that in normal volunteers. We also compared the sialic acid concentration with the results of several different types of dry eye examinations.Methods Subjects comprised 16 age-matched, normal healthy controls and 45 dry eye patients. Dry eye examinations included fluorescein staining, rose bengal staining, Schirmer I test, cotton thread test, and fluorescein breakup time. Tear samples were collected with a micropipette after the instillation of 50µl saline. The sialic acid concentration was measured by high-performance liquid chromatography.Results The sialic acid concentration was significantly lower in the dry eye group (5.3 ± 4.3µg/ml) than in the control group (37.1 ± 28.3µg/ml) (P < 0.001). Also, the sialic acid concentration correlated significantly with the results of dry eye examinations (P < 0.0002).Conclusions The different sialic acid levels in the control and dry eyes may imply differences in the quantity or quality of glycoprotein in tears between these two groups. Thus, sialic acid, a component of mucin, may play a key role in the dry eye condition. Jpn J Ophthalmol 2004;48:519–523 © Japanese Ophthalmological Society 2004     

甲状腺相关眼病患者干眼症患病率与泪膜功能及角膜状况研究

目的：研究甲状腺相关眼病(TAO)患者干眼症患病率与泪膜功能及角膜状况。

方法：选取2014-09/2016-08在本院接受治疗并确诊为TAO的患者218例436眼,依据TAO的临床活动度评分(CAS)把患者分成两组：评分≥4分为活动期患者,共72例144眼; 评分<4分为非活动期患者,共146例292眼; 依据患者病程情况分成三组,低于1a为短病程组,共133例266眼; 病程1～2a为中病程组,共40例80眼,大于2a为长病程组,共45例90眼; 对比患者进行角膜荧光素染色(FS)、泪膜破裂时间(BUT)和泪液分泌试验(S I t)检测情况。

结果：患者218例中共有138例276眼诊断是干眼症; 其中活动期患者患病率高于非活动期患者,差异有统计学意义(P<0.05),短病程组患者患病率高于中病程组和长病程组,和长病程组对比差异有统计学意义(P<0.05); 三组不同病程患者在BUT与S I t检测方面比较,差异无统计学意义(P>0.05),在FL检测方面对比差异有统计学意义(P<0.05); 非活动期患者和活动期患者在FS、BUT和S I t检测方面对比差异均有统计学意义(P<0.05)。

结论：多数TAO患者泪液分泌不充分、泪膜不够稳定,近1/3 TAO患者的角膜上皮出现损坏,患干眼病几率比正常人显著增加。     

Short tear film breakup time-type of dry eye in India

Purpose:The aim of this study was to describe the clinical characteristics and risk factors of short tear film break-up time (TBUT) type of dry eye disease and compare it with other types of dry eye diseases.Methods:This cross-sectional study included 570 patients (≥ 20 years) from the outpatient department using systematic random sampling.Results:The age-adjusted prevalence of short TBUT type of dry eye disease was 5.4% (95% confidence interval: 3.2–6.8%). There was no difference (P > 0.05) between the total and subscale scores of the Ocular Surface Disease Index^® questionnaire between patients with short TBUT and those with aqueous tear deficiency. Both these groups differed significantly (P < 0.05) in the findings of TBUT, Schirmer I test, and Lissamine green staining score. The common symptoms in patients with short TBUT type of dry eye disease were eye fatigue (25.4%), heaviness in the eye (19.7%), and an uncomfortable sensation (14.1%). The symptoms in the aqueous tear deficiency group were light sensitivity (28.2%), dryness (19.2%), burning (13.0%), foreign body sensation (12.8%), and blurring of vision (14.1%). The risk factors associated with short TBUT type of dry eye disease were the presence of meibomian gland dysfunction (odds ratio: 3.759 [95% confidence interval: 2.135–6.618], P < 0.0001) and female sex [odds ratio: 1.954 (95% confidence interval: 1.042–3.667), P = 0.037].Conclusion:Patients with short TBUT type of dry eye disease have symptom severity similar to aqueous tear-deficient dry eyes, but the pattern is different. The finding of this type of dry eye disease in India indicates its global presence, and ophthalmologists should consider it in their differential diagnoses.     

Tear evaporimeter for measuring water evaporation rate from the tear film under controlled conditions in humans

The rate of water evaporation from the tear film depends on the conditions under which it is determined. If measured in a controlled and easily reproducible setting, tear evaporation rate could serve as a useful diagnostic and research tool. We have developed a tear evaporimeter that provides a non-invasive method for evaluating water evaporation rate in eyes with normal or pathologic tear films. The subject is fitted with a pair of swimmer's goggles modified so that the air over the test eye is conditioned to a desired baseline of relative humidity (29·5%) and temperature (23 ± 1°C). To eliminate other sources of water, the lids and skin under the goggles are covered with petroleum jelly. The subject is asked to keep his/her eye open and to avoid blinking during the 1-min test. The increase in relative humidity due to water evaporation from the tears is then determined. The surface area of the eye exposed to evaporation is calculated from the lid aperture.We measured the water evaporation rate in 52 normal eyes (average = 4·07 × 10^?7 ± 0·40 × 10^?7 g/cm²/sec) and compared the results with values obtained in 52 eyes with various tear-film abnormalities (average = 8·17 × 10^?7 ± 2·65 × 10^?7 g/cm²/sec). The difference between the two groups is statistically significant (P < 0·01). In normal eyes, after the instillation of one drop of 0·5% proparacaine, the increase in evaporation rate was statistically significant.