睑缘炎患者睑板腺形态变化及其与干眼的关系

背景 睑缘炎是一种常见的眼表疾病,常累及睑板腺体,而睑板腺体所分泌的脂质是泪膜的重要组成成分之一.泪膜稳定性的破坏可导致干眼相关症状,可以说睑缘炎是干眼发病的因素之一,但二者之间的关系有待进一步研究. 目的 使用非接触式红外线睑板腺观察仪观察睑缘炎患者睑板腺腺体的形态,并与干眼相关检查进行相关性分析. 方法 采用病例观察的设计方法对睑缘炎患者睑板腺形态改变与干眼症的关系进行研究.选取2010年9月至2011年4月于河南省眼科研究所眼科门诊依据PPP标准诊断为睑缘炎的患者83例83眼,取得患者的知情同意后,在裂隙灯下行眼前节检查睑缘畸形评分、泪液分泌( Schirmer Ⅰ)试验、泪膜破裂时间(BUT)、角膜荧光素染色评分及结膜充血评分,采用泪膜干涉仪行泪膜形态分级,采用非接触式红外线睑板腺摄像仪行睑板腺腺体缺失分级,对睑缘炎睑板腺腺体缺失分级与上述检查结果的关系进行评估.结果 不同年龄组不同性别间睑缘炎的频数分布差异无统计学意义(x2=2.69,P=0.75).睑缘炎患者的睑板腺腺体缺失分级与年龄星弱的正相关(r=0.58,P=0.00),但与性别无明显相关性(r=-0.09,P=0.99)；患者睑板腺体缺失与睑缘畸形评分及结膜充血评分均呈弱的正相关(r=0.64,P=0.00；r=0.50,P=0.00)；与泪膜影像分级及角膜染色评分均呈弱的正相关(r=0.23,P=0.04；r=0.50,P=0.00),与BUT呈弱的负相关(r=-0.32,P=0.00),但与Schirmer Ⅰ试验结果无明显相关性(r=-0.05,P=0.69).不同年龄组男性和女性的睑板腺缺失分级评分差异无统计学意义(Z=-0.09,P=0.93).结论 睑缘炎可引起蒸发过强型干眼,且患者的睑板腺体随年龄的增长缺失程度加重.非接触式红外线睑板腺观察仪作为一种有效、快速、无刺激地观察睑板腺体形态的仪器,可作为一项常规检查来辅助诊断睑缘炎.

Morphologlc changes of the meibomian gland and its correlation with dry eye in blepharitis patient

Background B]epharitis is a common ocular surface disease. It is associated with the disorder of lipid secretion of meibomian gland. The change of tear film stability can cause dry eye symptoms, so blcpharitis is thought to be one of the factors causing dry eye, but the relation between them is in study. Objective This study was to observe the morphology of meibomian gland in blepharitis patients and to investigate the correlation of morphology of meibomian gland with dry eye. Methods A series of case-observational study was designed in this study. A total of 83 eyes of consecutive 83 blepharitis patients were enrolled in Henan Eye Institute from October 2010 to April 2011. Blepharitis was diagnosed based on American Preferred Practice Pattern Guidelines. Some relevant ocular examinations were performed under the informed consent of the subjects, including the anterior segment manifestation by the slit lamp, such as meibography,lid margin abnormality, and the dry eye-relevant examinations, such as tear film break-up time （BUT） ,Schirmer test I and corneal fluoreseein staining also been carried out. Tear film shape was examined by film interference images and scored. Absent degree of meibomian gland was graded under a Noncontact Infrared Meibography. The correlations of absent degree of meibomian gland with ocular syndrome score, dry eye examination results were evaluated using Spearman rank correlation coefficients. Informed consent was obtained prior to this trail. Results No significant difference in the frequencies of blepharitis was found between male and female among different ages （Х^2 = 2.69, P = 0.75 ）. Absent grading of the meibomian glands was positively correlated with age of bepharitis patients （ r = 0.58, P = 0.00 ） , lid margin abnormality scores （ r = 0.64, P = 0.00 ） , conjuntival hyperemia score （ r = 0. 50, P = 0. O0 ） , tear film interference imaging grade （ r = 0.23, P = 0. 04 ） , corneal fluorescein staining score（ r = 0.50, P = 0.00 ） but was negatively correlated with BUT （ r = - 0.32, P = 0.00 ）. No significant correlation was found between meibography grading and gender（ r=-0. 09 ;P = O. 99） or Sehirmer test I （r = -0.05 ;P = 0. 69）. No significant difference was found in meibography grading between male and female in different age groups（Z=-0. 09,P= 0. 93）. Conclusions Blepharitis can irriter dry eye symptom because of overevaporation of tear fluid and abnormality of secreting function of meibomian glands. The missing of the meibomain glands increases with age in the patients with blepharitis. Noncontact Meibography System is an assistant tool to the diagnosis of blepharitis.