视频终端干眼患者眼表及睑板腺的分析

Analysis of ocular surface and meibomian glands in visual display terminal dry eye patients

目的探讨睑板腺腺体缺失和睑板腺脂质排出难易程度在年轻视频终端干眼患者眼部不适症状中的作用。方法选择2014年10月至2015年1月就诊于天津医科大学眼科医院屈光角膜门诊临床诊断为视频终端干眼的患者50例(100眼)。根据视频时间分为2组:短视频组(每天≤4 h)28例、长视频组(每天>4 h)22例。根据眼表疾病评分指数(ocular surface disease index,OSDI)分为2组:轻、中度症状组(13.0≤OSDI≤32.5)30例,重度症状组(32.5<OSDI≤100.0)20例。利用眼表分析仪及裂隙灯显微镜分别进行泪河高度、泪膜破裂时间、睑板腺、角膜荧光素染色及睑板腺脂质排出状况的评估。根据数据的正态分布和方差齐性,采用两独立样本t检验。结果长视频组与短视频组OSDI分别为28.15±11.28、22.93±9.75,泪膜破裂时间分别为(5.84±1.95)s、(4.75±1.59)s,角膜荧光素染色评分分别为3.08±1.70、2.21±2.02,睑板腺缺失等级分别为2.50±1.11、1.89±0.91,睑板腺脂质排出难易度评分分别为2.11±0.80、1.75±0.86,两组间差异均有统计学意义(均为P<0.05)。长视频组与短视频组泪河高度分别为(0.19±0.04)mm、(0.20±0.04)mm,差异无显著性(P=0.069)。严重症状组与轻、中度症状组的泪膜破裂时间[(4.68±1.77)s、(5.61±1.81)s]、角膜荧光素染色评分(3.50±1.50、2.10±2.01)、睑板腺缺失等级(2.48±1.01、2.05±1.03)及睑板腺脂质排出难易度评分(2.23±0.62、1.80±0.90)相比差异均有统计学意义(均为P<0.05),严重症状组与轻、中度症状组的泪河高度分别为(0.19±0.05)mm、(0.20±0.04)mm,差异无显著性(P=0.428)。睑板腺缺失与OSDI评分及角膜荧光素染色评分呈正相关(r=0.222,P=0.026;r=0.241,P=0.016);睑板腺脂质排出难易程度与OSDI评分及角膜荧光素染色评分呈正相关(r=0.205,P=0.041;r=0.311,P=0.002)。结论视频终端干眼患者泪液量与视频时间和眼部症状严重程度无显著相关性。睑板腺缺失及睑板腺脂质排出难度增加可能是引起视频终端干眼眼部不适的重要因素。

Objective To evaluate the role of meibomian gland dropout and expression of meibum in symptoms of young visual display terminal（ VDT） dry eye patients. Methods Fifty clinically diagnosed VDT dry eye patients（ 100 eyes） were enrolled between October 2014 and January 2015 in refractive and corneal outpatient of Tianjin Medical University Eye Hospital. All volunteers were divided into two groups,28 volunteers of short time VDT group（ per day ≤ 4hours） and 22 volunteers of long time VDT group（ per day 4 hours）. All volunteers were further classified into two groups according to the ocular surface disease index（ OSDI） score,30 volunteers of mild to moderate symptomatic（ 13. 0 ≤OSDI ≤32. 5） group,20 volunteers of severe symptomatic（ 32. 5 OSDI≤100. 0） group. Tear river height,tear film break-up time,meibomian gland dropout,corneal fluorescein staining and expression of meibum were visualized by meibography and slit lamp microscope. Results OSDI in long time VDT group and short time VDT group were 28. 15 ± 11. 28,22. 93 ± 9. 75,tear film break-up time were（ 5. 84 ± 1. 95） s,（ 4. 75 ± 1. 59） s,corneal fluorescein staining score were 3. 08 ± 1. 70,2. 21 ± 2. 02,meibomian gland dropout degree were 2. 50 ± 1. 11,1. 89 ± 0. 91,and meibum expression assessment score were 2. 11 ± 0. 80,1. 75 ± 0. 86（ all P〈0. 05）. The tear river height in long time VDT group and short time VDT group were（ 0. 19 ± 0. 04） mm and（ 0. 20 ± 0. 04） mm（ P = 0. 069）. BUT in severe symptomatic group and mild to moderate symptomatic group were（ 4. 68 ± 1. 77） s,（ 5. 61 ±1. 81） s,corneal fluorescein staining score were 3. 50 ± 1. 50,2. 10 ± 2. 01,meibomian gland dropout degree were 2. 48 ± 1. 01,2. 05 ± 1. 03,and meibum expression assessment score were 2.23 ± 0. 62,1. 80 ± 0. 90（ all P〈0. 05）,while the tear river height were（ 0. 19 ± 0. 05） mm,（ 0. 20 ± 0. 04） mm（ P = 0. 428）. Meibomian gland dropout degree was positively correlated with OSDI score（ r = 0. 222,P = 0. 026） and corneal fluorescein staining score（ r =0. 241,P = 0. 016）. Meibum expression was positively correlated with OSDI score（ r = 0. 205,P = 0. 041） and corneal fluorescein staining score（ r = 0. 311,P = 0. 002）. Conclusion There is no significant correlation between tear volume and degree of ocular surface symptoms in VDT dry eye patients. Meibomian gland dropout and increased difficulty of meibum expression might be important factors in causing dry eye discomfort.