Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation
Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation
复制标题
DOI：
10.1097/00003226-199801000-00007
复制
发表时间：
1998-01-01
期刊：
影响因子：
2.8
通讯作者：
Reis, BL
中科院分区：
文献类型：
--
作者：
Pflugfelder, SC;Tseng, SCG;Reis, BL
目的.确定哪些主观评估和客观测试具有临床实用性，可作为与干燥综合征相关的水性泪液缺乏（ATD）、非干燥综合征ATD、与酒渣鼻相关的炎性睑板腺疾病（MGD）和萎缩性MGD相关的眼刺激的诊断工具。方法. 40例眼刺激成人和10例正常眼表成人参加了一项非随机、非盲临床试验。对症状进行评价。测试包括生物显微镜检查;泪膜完整性、产生和清除的评价;荧光素和玫瑰红染色;和血清自身抗体筛选。结果各组之间的症状相似，干燥组的症状最严重。ATD组和MGD组的泪液破裂时间明显快于对照组。ATD组Schirmer评分显著低于MGD组和对照组。ATD和萎缩性MGD组的泪液清除延迟。仅ATD出现静电复印机栅格失真。干燥综合征组鼻泪管反射消失更明显，荧光素清除更慢，眼表荧光素和虎红染色更明显。与干燥相关ATD和对照组相比，MGD组有更多的睑板腺口化生和腺泡脱落。Schirmer评分与虎红染色、角膜荧光素染色和网格畸变呈负相关。虎红染色与网格变形和鼻泪管反射丧失相关，但与MGD无关。结论主观评估和客观诊断测试作为泪膜疾病的诊断工具具有临床实用性。ATD与眼表疾病相关。包括一个算法，总结这些测试的诊断效用。
Purpose. To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjogren's syndrome-related aqueous tear deficiency (ATD), non-Sjogren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. Methods. Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear-film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. Results. Symptoms were similar among groups and most severe in the Sjogren's group. Fluorescein tear break-up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjogren's group had greater loss of nasolacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjogren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. Conclusion. Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.