中重度眼睑痉挛的临床特征及治疗体会

Clinical characteristics and treatment of moderately severe blepharospasm

目的探讨中重度眼睑痉挛患者的临床特征及治疗效果。方法取病例为2009年1月至2010年12月在眼科门诊就诊的中重度眼睑痉挛患者34例，其临床资料包括眼部症状、泪河高度、基础泪液分泌实验（Schiemer Itest，SIt）、泪膜破裂时间（break—uptime，BUT）、角膜荧光素染色（fluorescent，F1）。治疗方法选择A型肉毒毒素眼周注射联合人T泪液治疗，必要时加行泪点栓塞术，观察治疗效果并随访1年。结果34例中20例中度（Ⅲ级）痉挛，14例为重度（Ⅳ级）痉挛，所有患者均主诉不自主频繁眨眼或眼周皮肤跳动，同时伴发眼十涩感、视疲劳、眼痒及视物模糊等症状。相关检查，泪河高度均小于0．3mm，SIt≤5mm者26例，5mm〈SIt≤10mm者8例；BUT≤5S者32例，5s〈BUT≤10S者2例；FI染色评分为7．1±2．8；治疗后完全缓解者19例（55．9％），明显缓解15例（44．1％），有效率100％；29．4％患者痉挛缓解维持时间4-6个月，32．4％为6-8个月，大于8个月者为38．2％。结论大部分中重度眼睑痉挛合并有干眼，采用眼周皮下注射A型肉毒毒素，并坚持人T泪漓治疗．一诉兽时行汨点栓寨术对眼呤瘩奎合并干眼不失为一条筒堕可行的有效方浃。

Objective To explore clinical characteristics and treatment of moderately severe blepharospasm. Methods Thirty-four patients with moderate to severe blepharospasm were recruited from our outpatient clinic from January 2009 to December 2010 as case group. The following items were recorded in these patients, including symptoms, slit-lamp examination, tear-up time, basal Schiemer test, fluorescent staining. These patients were treated with Botulinum toxin A injection com- bined with artificial tears, and lacrimal plug was applied in some severe patients, therapeutic effect were observed and post-treatment follow-up visits were performed. Results In 34 patients, 20patients were moderate blepharospasm, while 14 were severe. All patients complained frequently involuntary blinks, and also complained about sensation of dryness, asthenopia, itching and blurred vision. Slit-lamp examination showed all patients＇ lacrimal river under 0.3mm, 26 cases＇ Schiemer I test equal or lower than 5mm, 8 cases were between 5 and 10mm. BUT of 32 cases were equal or low- er than 5s, while 2 cases were between 5 and 10s. The score of fluorescent staining were 7.1±2.8. After treatment, there was 55.9% cases complete remission, 44.1% cases partial remission, efficiency rate was 100%. The duration of remission between 4-6 months were 29.4% cases, between 6-8 months were 32.4%, higher than 8 months were 38.2%. Conclusions Many patients with moderate to severe blepharospasm also suffer from dry eye. Botulinum toxin A injection combined with artifi- cial tears, lacrimal plug as needed, is simple and effective in relieving blepharospasm and successful in treating dry eye syndrome.