碱烧伤后的泪膜功能测定(第一部分) 生理性泪液分泌的测试——新Schirmer试验

The test of lacrimal secretion after alkali burn(PartⅠ) The test of physiological lacrimal secretion new Schirmer test.

目的 Schirmer试验是否使用表面麻醉剂 ,均无法反映人体真实的生理性泪液分泌。我们设计了“点麻”技术来检测人体真实的泪液分泌。方法 研究对象 11人 (2 2眼 ) ,无任何眼部疾病或外伤史 ,不滴用任何滴眼剂 ,无远视状态。平均年龄 2 7 5岁。在一定环境下每眼分别做 3次实验 :正常状态 (Schirmer试验Ⅰ)、点麻状态 (Schirmer试验Ⅱ)和表麻状态 (Schirmer试验Ⅲ )。结果 比较了 3种Schirmer试验中平均 5分钟滤纸湿长 ,Schirmer试验Ⅰ为 (15 72 7± 11.45 )mm ,Schirmer试验Ⅱ为 (11 0 45± 7.88)mm ,Schirmer试验Ⅲ为 (6 4 5 5± 4.82 )mm。经统计学检验 ,Schirmer试验Ⅱ和Schirmer试验Ⅲ的平均 5分钟滤纸湿长之间差异具有显著性意义 (P <0 .0 5 ) ,说明Schirmer试验Ⅱ(点麻 )和Schirmer试验Ⅲ (表麻 )两种不同的麻醉方式对试验的影响存在着根本的区别。点麻状态中角膜和结膜敏感度处于非麻醉和表麻状态之间。结论 运用点麻技术的新Schirmer试验更接近于反映人体真实的泪液分泌———生理性泪液分泌。

Objective The Schirmer test is commonly used for the examination of the precorneal film.In traditional,there are two Schirmer tests.But neither can represent the situation of physiological.So point anesthesia technique was used.Methods 11 cases (22 eyes) were involved.Under certain circumstance,three kinds Schirmer test were done in each eye:no anesthesia(Schirmer test Ⅰ),point anesthesia(Schirmer test Ⅱ) and topical anesthesia(Schirmer test Ⅲ).In Schirmer test Ⅰ which was used to examine basic and reflex secretion a piece of standard Schirmer filter paper(5 mm wide and 35 mm long)was placed on the lateral on third of the lower tarsal conjunctiva and 5 minutes mean wetting length and increased mean Schirmer test values were recorded.In Schirmer test Ⅱ which was used to examine physiological secretion,1% dicaine was spread on the lateral on third of the lower tarsal conjunctiva where the filter paper was and 5minutes mean wetting length was recorded.In Schirmer test Ⅲ which was used to examine basic secretion,two or more drops 1% dicaine are instilled in conjunctival sac of eye.After waiting 5minutes for complete topical anesthesia,the filter paper was used,as in the Schirmer test Ⅰ and Ⅱ.5 minutes mean wetting length was recorded.Results The results of 5 minutes mean wetting length in three different Schirmer test were compared.The result was 15.727±11.45 mm in Schirmer test Ⅰ,while 11.045±7.88 mm in Schirmer test Ⅱ and 6.455±4.82 mm in Schirmer test Ⅲ.This represented a 42% mean reduction in wetting a significant difference( P<0.05 )between point anesthetic and topical anesthesia.Meanwhile,the difference in anesthesimter values was obtained.Point anesthesia reduce the sensitivity of tarsal conjunctiva while topical anesthetic reduce the sensitivity both cornea and conjunctiva.Conclusion It is believed that the result of Schirmer test Ⅱ (point anesthesia technique) comprised the amount of basic secretion and normal reflex secretion,named physiological lacrimal secretion.