Corneal epitheliopathy of dry eye induces hyperesthesia to mechanical air jet stimulation
Corneal epitheliopathy of dry eye induces hyperesthesia to mechanical air jet stimulation
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DOI：
10.1016/s0002-9394(03)00897-3
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发表时间：
2004-01-01
影响因子：
4.2
通讯作者：
Pflugfelder, SC
中科院分区：
文献类型：
--
作者：
De Paiva, CS;Pflugfelder, SC
目的：用改良的贝尔蒙特气体感受器评价正常受试者、干眼症患者、干眼症患者和非干眼症患者LASIK术后角膜感觉。设计：回顾性、临床为基础的病例对照研究。方法：对20名正常受试者、20名干眼患者、20名lasik术后无干眼患者和6名lasik术后干眼患者进行评估。使用改进的贝尔蒙特气体感受器测量角膜感觉，该感受器使用两种不同的刺激来评估角膜表面的机械和多模态受体。机械感受器被评估2秒脉冲空气射流的可变强度。多模态感受器是通过用2秒脉冲空气喷射不同浓度的二氧化碳来刺激角膜来测量的，二氧化碳是一种与角膜表面接触后转化为碳酸的气体。主要的结局指标是测定角膜感觉。结果：各组平均+/-标准差（+/- SD）年龄相似。正常组平均机械阈值为61.50 +/- 20.07 ml/min (n = 20)，干燥组平均机械阈值为34.60 +/- 21.09 ml/min (n = 20, P < 0.05)， lasik后组平均机械阈值为99.50 +/- 47.40 ml/min (n = 20, P < 0.01)， lasik后合并干燥性角膜炎患者平均机械阈值为50.00 +/- 15.49 ml/min （n = 06, P < 0.05）。CO2引起不适的百分比在所有组中相似（P < 0.05）。无性别差异（P < 0.05）。机械刺激阈值与角膜荧光素染色严重程度呈显著负相关。结论：改良的Belmonte非接触式角膜感受器是一种能够评估不同类型角膜感觉受体的精密仪器。干眼症患者对该仪器的空气喷射刺激过敏，这似乎是由于角膜上皮屏障功能的改变。LASIK术后出现深度感觉减退，与干眼相似，术后出现干眼致敏。这些发现为干眼症患者对环境压力，特别是气流的过敏提供了新的见解。
PURPOSE: To evaluate corneal sensation in different groups: normal subjects, dry eye patients, and patients with and without dry eye after laser in situ keratomileusis (LASIK) using the modified Belmonte gas esthesiometer.DESIGN: A retrospective, clinic-based, case control study.METHODS: We evaluated 20 normal subjects, 20 dry eye patients, 20 post-LASIK patients without dry eye, and six post-LASIK patients with dry eye. The corneal sensation was measured with the modified Belmonte gas esthesiometer that uses two different stimuli to assess mechanical and polymodal receptors on the corneal surface. Mechanoreceptors were assessed by 2 second pulsed air jets of variable intensity. Polymodal receptors were measured by stimulating the corneal with 2-second pulsed air jets of varying concentrations of CO2, a gas that is converted to carbonic acid on contact with the corneal surface. The main outcome measure was determining corneal sensation.RESULTS: The mean +/- standard deviation ( +/- SD) age was similar in all groups. The mean mechanical threshold was 61.50 +/- 20.07 ml/min in the normal group (n = 20), 34.60 +/- 21.09 ml/min in the dry group (n = 20, P < .05 vs normal), 99.50 +/- 47.40 ml/min in the post-LASIK group (n = 20, P < .01 vs normal), and 50.00 +/- 15.49 ml/min in the post-LASIK patients with keratitis sicca (n = 06, P < .05 vs post-LASIK). The percentage of CO2 to elicit discomfort was similar in all groups (P > .05). No sex-related differences were noted (P > .05). There was a significant inverse correlation between the threshold of mechanical stimulation and the severity of corneal fluorescein staining.CONCLUSIONS: The Belmonte modified noncontact esthesiometer is a sophisticated instrument that can assess different types of corneal sensory receptors. Patients with dry eye were hypersensitive to the air jet stimulus of this instrument, and this appears to be due to altered corneal epithelial barrier function. Profound hypoesthesia was observed after LASIK and similar to dry eye, post-LASIK patients with dry eye were sensitized. These findings provide new insight into the hypersensitivity to environmental stresses, particularly air drafts experienced by dry eye patients.