干眼患者临床特点分析

Clinical Characteristics of Patients with Various Types of Dry Eye

目的比较各种类型干眼患者的临床特点及评价干眼患者的治疗偏向。方法回顾性分析154例(300只眼)干眼患者的临床资料,包括症状、病因、全身病、病程、病情严重程度、裂隙灯检查、泪膜破裂时间检查(break-upti me,BUT)、基础泪液分泌试验(Schirmer testⅠ,SIt)、角结膜荧光素(fluorescent,FL)染色、虎红(rose bangle,Rb)染色及睑板腺功能的检查。结果 154例中,水液缺乏性干眼(aqueous tear deficiency,ATD)者98例(63.6%),其中Sjgren综合征(Sjgren's syndrome,SS)ATD患者51例(33.1%),非SS水液缺乏性干眼(non-SS aqueous tear deficiency,NSTD)者47例(30.5%);蒸发过强型干眼(over evaporation dry eye or lipid tear deficiency,LTD)32例(20.8%),其中睑板腺功能障碍(meibomain gland dysfunction,MGD)者20例(13%),荧光屏综合症(video display terminals syndrome,VDT)者12例(7.8%);混合型干眼(MIX)者24例(15.6%)。干燥感是干眼患者最常见症状(89.6%),MIX和SSATD组患者干燥感最重,VDT患者干燥感最轻。经统计学检验,以上5组干眼患者在眼痒、干燥感、异物感、畏光感、睁眼困难、眼红等主觉症状评分及SⅠt、BUT、FL、Rb等体征上差异均有统计学意义(P<0.05)。除干燥感外其他主觉症状均在SSATD中表现最重,SSATD各项体征也较其他类型干眼更重。126例(81.8%)患者使用人工泪治疗,仅有31%患者认为人工泪治疗效果不错。结论通过对干眼患者眼痒、干燥感、异物感、畏光感、睁眼困难、眼红等主觉症状评分及SIt、BUT、FL、Rb等体征详细检查可分类诊断干眼。干燥感的严重程度可作为ATD和LTD两大类干眼的主要鉴别症状。畏光感是诊断VDT的主要鉴别症状,结合荧光屏接触史可初步诊断VDT。人工泪对干眼患者的治疗效果并不令人满意,还需其他治疗予以辅助。

Objective To compare the clinical characteristics of patients with various types of dry eye and evaluate the treatment bias.Methods The following items were recorded in 154 patients （300 eyes） with dry eye,including symptoms,causation,systematic diseases,course of disease,state of disease,slit-lamp examination,tear break-up time （BUT）,basal Schirmer test Ⅰ （SIt）,corneal fluorescein （FL） staining,rose bengal （Rb） staining and meibomian gland dysfunction （MGD） examination. Results In 154 patients,98 patients （63.6%） suffered from aqueous tear deficiency （ATD） which included 51 patients （33.1%） with Sjgren＇s syndrome （SS） ATD and 47 patients （30.5%） with non-SS aqueous tear deficiency （NSTD）. Thirty-two patients （20.8%） had over evaporation dry eye or lipid tear deficiency （LTD） which included 20 cases （13%） with MGD and 12 cases （7.8%） with video display terminals syndrome （VDT）. Twenty-four patients （15.6%） had mixed type of dry eyes （MIX）. Dryness （89.6%） was the commonest symptoms,the dryness of patients with MIX and SS types were the most severe,while the dryness of VDT type was the lightest. Significant differences were found among the above 5 groups of patients in the symptom scores of itching,dryness,foreign body sensation,photophobia sensation,heavy sensation,redness and SIt,BUT,FL,Rb（P0.05）. The symptoms of SSATD were the most severe in all types of dry eye except dryness,and each physical sign of SSATD was also the most severe. One hundred and twenty-six cases （81.8%） were treated with artificial tears,and only 31% of the patients considered the therapeutic effect of artificial tears was good.Conclusion Dye eye can be diagnosed and classified through the symptom scores of itching,dryness,foreign body sensation,photophobia sensation,heavy sensation,redness and detailed examination of SIt,BUT,FL,Rb. The severity of dryness can be used to distinguish ATD and LTD. Moreover,photophobia sensation is the main differential diagnostic symptom of VDT,and the preliminary diagnosis can be made combining history of exposure of video display terminals. The therapeutic effect of artificial tears is not satisfactory,which must be assisted with other treatments.