儿童轻度过敏性结膜炎中干眼的研究及治疗

A study of dry eyes in children with mild allergic conjunctivitis and the treatment

目的探讨儿童轻度过敏性结膜炎中干眼发生的原理及不同方案疗效,为过敏性结膜炎的治疗提供指导依据。方法回顾性分析4~10岁轻度过敏性结膜炎患儿(观察组)101例及健康儿童(对照组)100例。过敏性结膜炎患儿检测过敏原。比较2组泪膜破裂时间(tear film breakup time,BUT)、角膜荧光素染色(fluorescein,FL)评分、泪河高度(tear meniscus height,TMH),分析BUT、FL评分、TMH与病程的相关性。观察组根据治疗方案中是否有人工泪液分为A组42例和B组59例,比较A、B组治疗前后BUT、FL评分、TMH。结果观察组BUT短于对照组;FL评分高于对照组(P<0.01);2组TMH差异无统计学意义(P>0.05)。观察组过敏性结膜炎BUT与病程呈负相关(r=-0.439,P<0.01),FL评分与病程呈正相关(r=0.396,P<0.01),TMH与病程无相关性(r=0.043,P>0.05)。治疗后,A、B组BUT长于治疗前,FL评分低于治疗前,A组TMH高于治疗前;A组BUT长于B组,FL评分低于B组,TMH高于B组,差异有统计学意义(P<0.05)。结论儿童过敏性结膜炎通过降低双眼泪膜稳定性,破坏角膜上皮完整性,造成干眼症状,而对泪液分泌无显著影响。病程越长泪膜稳定性越低,角膜上皮破坏越严重。联合人工泪液治疗过敏性结膜炎效果更佳。

Objective To investigate the principle of dry eye in children with mild allergic conjunctivitis and the effect of different therapies,and provide guidance for the treatment of allergic conjunctivitis.Methods Retrospective analysis was performed on 101 children(observation group)and 100 healthy children(control group)aged 4-10 years with mild allergic conjunctivitis.Children with allergic conjunctivitis were tested for allergens.The relationship of tear film breakup time(BUT),corneal fluorescein(FL)score,tear meniscus height(TMH)between two groups was analyzed.And the correlation between BUT,FL score,TMH and course of disease was analyzed.The observation group was divided into group A(42 cases of children)and group B(59 cases of children)according to the presence of artificial tears in the treatment plan.BUT,FL score and TMH of group A and B were compared before and after treatment.Results The observation group BUT shorter than the control group.The FL score was higher than the control group(P<0.01).There was no significant difference in TMH between two groups(P>0.05).In the observation group,BUT was negatively correlated with course of disease(r=-0.439,P<0.01),FL score was positively correlated with course of disease(r=0.396,P<0.01),TMH was not correlated with course of disease(r=0.043,P>0.05).After treatment,BUT was longer,FL score was lower in group A and B.TMH was higher than before in group A;and in group A,BUT was longer,FL score was lower,TMH was higher than group B,the difference was statistically significant(P<0.05).Conclusion Allergic conjunctivitis in children can reduce the stability of tear film in both eyes,destroy the integrity of corneal epithelium and cause dry eye symptoms,but it has no significant effect on tear secretion.The longer course of the disease causes the lower stability of tear film which leads the greater damage of corneal epithelium.Anti-allergy combined with artificial tear treatment of allergic conjunctivitis is more effective.