睑缘炎相关角膜病变特点及其睑板腺功能的临床观察

目的 观察睑缘炎相关角膜病变的临床特点，探讨其与睑缘炎和睑板腺功能的关系。设计 回顾性病例系列。研究对象 2012年1~10月北京同仁眼科中心睑缘炎患者84例（168眼）。方法 裂隙灯下观察睑缘炎类型、睑板腺分泌物性状及脂质排出难易度、角膜病变临床表现及病变范围，并进行评分。分析角膜病变特点及病变范围与睑缘炎类型及睑板腺功能的关系。主要指标 睑缘炎类型、睑板腺分泌物性状、脂质排出难易度和角膜病变范围。结果 84例（168眼）睑缘炎患者平均病程（22.25±40.46）个月。其中前部睑缘炎1例（2眼），后部睑缘炎42（84眼）例，混合型睑缘炎41例（82眼）。其中65例（104眼）出现角膜病变。角膜周边或中周部上皮下或浅基质浸润44例（73眼，70.2%），角膜周边或中周部溃疡10例（15眼，18.3%），角膜云翳或瘢翳5例（8眼，7.7%），角膜点片状上皮混浊、糜烂3例（4眼，3.8%）。17眼（10.1%）角膜病变范围超过1/2角膜，10眼（6%）到达角膜中央，其中1例角膜中央融解、变薄。与后睑缘炎相比，混合型睑缘炎角膜浸润和溃疡更多见（P=0.003）；与无角膜病变者相比，有角膜病变者的睑板腺分泌难易程度和睑脂性状评分均较高（t=-4.606和13.418，P=0.033和0.000）。结论 睑缘炎相关角膜病变临床表现多样。混合型睑缘炎更容易发生角膜浸润和角膜溃疡。睑缘炎患者是否合并角膜病变与睑板腺功能密切相关。

Clinical observation of the characteristics and meibomian gland function in patients with keratitis associated with blepharitis

Objective To observe the clinical characteristics of keratitis associated with blepharitis and the relationship among keratitis, blepharitis and meibomian gland dysfunction (MGD). Design Retrospective cases series. Participants Eighty-four patients (168 eyes) with blepharitis who presented in Beijing Tongren Eye Center from January to October 2012. Method The type of blepharitis, secretion function of meibomian gland, clinical characteristics of keratitis associated with blepharitis were evaluated and scored by slit lamp microscope. The relationship between the signs and extent of keratitis and the type of the blepharitis, MGD were analysed. Main Outcome Measures blepharitis type, secretion function of meibomian gland, and clinical characteristics of keratitis. Results The histories of blepharitis in the participants was 10 days to 12 years (average 22.25±40.46 months). Of all the patients, 1 case (2 eyes) was anterior blepharitis, 42 cases (84 eyes) were posterior blepharitis, and 41 cases (82 eyes) were mixed blepharitis. Among them, 65 cases (104 eyes) were diagnosed as associated keratitis as well. Typically clinical findings consisted of punctuate epithelial erosions, marginal infiltrates, corneal ulcer，and cornea scar. Corneal infiltration and ulcer were more common in mixed blephatitis than in posterior blepharitis（P=0.003）. The scores of the secretion difficulty and the meibum in the patients with keratitis were higher significanly than in the patients without keratitis (t=-4.606 and 13.418, P=0.033 and 0.000). Conclusion The clinical signs of keratitis associated with blepharitis were various. Patients with mix blepharitis would be more commonly suffered infiltrates and ulcer in the cornea. The keratitis associated blepharitis is related closely to the dysfunction of the meibomain gland.