儿童急性结膜炎治疗后泪膜变化临床观察
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摘要
目的:探讨儿童急性结膜炎治疗后泪膜变化情况。方法:前瞻性队列研究。选择2016-01/2017-01抚顺眼病医院门诊就诊,经规范治疗在自然病程内痊愈的儿童急性结膜炎64例患者,均为单眼,首次就诊时检查未发病眼作为对照。排除其他影响泪膜的因素,分别于痊愈后3、7、14、30d行泪河高度测量、角膜荧光素染色(fluorescein staining,FL)、泪膜破裂时间(tear break up time,BUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt),并与未发病眼对照比较。结果:泪河高度对照组为0.43±0.18mm,患眼痊愈后3、7、14d分别为0.25±0.11、0.23±0.13、0.34±0.26mm,均低于对照组,差异有统计学意义(t=-24.364、-24.042、-8.398,均P<0.05),治愈后30d为0.44±0.06mm,与对照组比较,恢复至对照组水平,差异无统计学意义(t=1.987,P>0.05);未发病眼FL评分为1.27±0.96,患眼痊愈后第3、7、14d分别为2.13±0.75、5.56±2.28、4.21±0.91分,均高于对照组,差异有统计学意义(t=6.437、18.303、20.386,均P<0.05),治愈后30d为1.81±2.13分,与对照组比较,恢复至对照组水平,差异无统计学意义(t=1.44,P>0.05);对照组BUT为13.33±2.75s,患眼痊愈后第3、7、14d分别为5.46±0.9、6.34±1.75、7.72±1.77s,均低于对照组,差异有统计学意义(t=-50.731、-50.522、-38.706,均P<0.05),治愈后30d为12.07±2.23s,恢复至对照组水平,差异无统计学意义(t=-1.470,P>0.05)。发病眼SⅠt为14.07±3.84mm/5min,痊愈后第3、7、14d,SⅠt分别为8.03±1.79、11.28±2.33、12.59±2.56mm/5min,均高于对照组,差异有统计学意义(t=-20.892、-9.104、-6.710,均P<0.05),愈合后第30d为13.57±3.46mm,与对照组比较,恢复至对照组水平,差异无统计学意义(t=-0.969,P>0.05)。结论:儿童急性结膜炎痊愈后可出现短暂泪膜不稳定和可逆性干眼症;治疗儿童急性结膜炎时应合理用药,充分考虑药物对泪膜的副作用,必要时辅助人工泪液减少干眼症的发生。
AIM:To investigate tear film changes in children after acute conjunctivitis were treated.METHODS:A perspective cohort study was conducted.Sixty-four acute conjunctivitis cases(64 unilateral eyes)from January 2016 to January 2017 were investigated in this study.Other tear film factors which could affect the conditions of dry eye were excluded.The height of tear meniscus,fluorescein staining(FL),tear film break up time(BUT) and Schirmer Ⅰ test(SⅠ t) were checked and measured on both recovered eye and healthy eye of the patients at 3,7,14 and 30 d after recovery,respectively. RESULTS:The height of tear meniscus was 0.43 ±0.18 mm in healthy eyes,0.25±0.11 mm,0.23±0.13 mm,0.34 ± 0.26 mm in cured eyes at 3,7 and 14 d,all significantly lower than that in healthy eyes(t =-24.364,-24.042,-8.398,P<0.05),but that at 30 d(0.44±0.06 mm)was not different(t =1.987,P>0.05).FL scored 1.27±0.96 in healthy eyes,those of cured eyes were 2.13±0.75,5.56±2.28,4.21±0.91 at 3,7 and 14 d,significantly higher than that in healthy eyes(t = 6.437,18.303,20.386;P<0.05);but that at 30 d was 1.81±2.13 without difference(t =1.44,P>0.05).BUT was 13.33±2.75 s in healthy eyes,those of cured eyes were 5.46±0.9 s,6.34±1.75 s,7.72±1.77 s at 3,7 and 14 d,significantly lower than that in healthy eyes(t =-50.731,-50.522,-38.706;P<0.05);but that at 30 d was12.07±2.23 s without difference(t =-1.470,P>0.05).SⅠT was 14.07±3.84 mm/5 min in healthy eyes,those of cured eyes were 8.03±1.79,11.28±2.33,12.59±2.56 mm/5 min at3,7 and 14 d,significantly lower than that in healthy eyes(t =-20.892,-9.104,-6.710;P<0.05);but that at 30 d was13.57± 3.46 mm/5 min without difference(t =-0.969,P>0.05).CONCLUSION:The short-term tear film instability and reversible dry eye might be arisen in children after acute conjunctivitis recovery.Considering the drug side effects to the tear film and minimizing the unnecessary use of drugs,however,dry eye can be avoided during the treatment of acute conjunctivitis.At the same time,the artificial tears could function to reduce the occurrence of xerophthalmia.
AIM:To investigate tear film changes in children after acute conjunctivitis were treated.METHODS:A perspective cohort study was conducted.Sixty-four acute conjunctivitis cases(64 unilateral eyes)from January 2016 to January 2017 were investigated in this study.Other tear film factors which could affect the conditions of dry eye were excluded.The height of tear meniscus,fluorescein staining(FL),tear film break up time(BUT) and Schirmer Ⅰ test(SⅠ t) were checked and measured on both recovered eye and healthy eye of the patients at 3,7,14 and 30 d after recovery,respectively. RESULTS:The height of tear meniscus was 0.43 ±0.18 mm in healthy eyes,0.25±0.11 mm,0.23±0.13 mm,0.34 ± 0.26 mm in cured eyes at 3,7 and 14 d,all significantly lower than that in healthy eyes(t =-24.364,-24.042,-8.398,P<0.05),but that at 30 d(0.44±0.06 mm)was not different(t =1.987,P>0.05).FL scored 1.27±0.96 in healthy eyes,those of cured eyes were 2.13±0.75,5.56±2.28,4.21±0.91 at 3,7 and 14 d,significantly higher than that in healthy eyes(t = 6.437,18.303,20.386;P<0.05);but that at 30 d was 1.81±2.13 without difference(t =1.44,P>0.05).BUT was 13.33±2.75 s in healthy eyes,those of cured eyes were 5.46±0.9 s,6.34±1.75 s,7.72±1.77 s at 3,7 and 14 d,significantly lower than that in healthy eyes(t =-50.731,-50.522,-38.706;P<0.05);but that at 30 d was12.07±2.23 s without difference(t =-1.470,P>0.05).SⅠT was 14.07±3.84 mm/5 min in healthy eyes,those of cured eyes were 8.03±1.79,11.28±2.33,12.59±2.56 mm/5 min at3,7 and 14 d,significantly lower than that in healthy eyes(t =-20.892,-9.104,-6.710;P<0.05);but that at 30 d was13.57± 3.46 mm/5 min without difference(t =-0.969,P>0.05).CONCLUSION:The short-term tear film instability and reversible dry eye might be arisen in children after acute conjunctivitis recovery.Considering the drug side effects to the tear film and minimizing the unnecessary use of drugs,however,dry eye can be avoided during the treatment of acute conjunctivitis.At the same time,the artificial tears could function to reduce the occurrence of xerophthalmia.
引文
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2 Beal C,Giordano B.Clinical Evaluation of Red Eyes in Pediatric Patients.J Pediatr Health Care 2016;30(5):506-514
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10范玉香,赵俊华,冯雪艳,等.儿童干眼与过敏性结膜炎临床分析.中国实用眼科杂志2012;30(2):171-173
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13 Barabino S,Montaldo E,Solignani F,et al.Immune response in the conjunctival epithelium of patients with dry eye.Exp Eye Res 2010;91(4):524-529
14 Zhu L,Shen J,Zhang C,et al.Inflammatory cytokine expression on the ocular surface in the Botulium toxin B induced murine dry eye model.Mol Vis 2009;15(1):250-258
15 Enríquez-de-Salamanca A,Castellanos E,Stern ME,et al.Tear cytokine and chemokine analysis and clinical correlations in evaporativetype dry eye disease.Mol Vis 2010;16(5):862-873
16 Anderson NJ,Edelhauser HF.Toxicity of ocular Surgical solutions.Int Ophthalmol Clin 1999;39(2):91-106
17 Singh G,Kaur J.Iatrogenic dry eye:late effect of topical steroid formulations.Indian Med Assoc 1992;90(9):235-237
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19 Rose PW,Harnden A,Brueggemann AB,et al.Chloramphenicol treatment for acute infective conjunctivitis in children in primary care:a randomised double-blind placebo-controlled trial.Lancet 2005;366(9479):37-43
20 Ward JB,Siojo LG,Waller SG.A prospective,masked clinical trial of trifluridine,dexamethasone,and artificial tears in the treatment of epidemic keratoconjunctivitis.Cornea 1993;12(3):216-221
2 Beal C,Giordano B.Clinical Evaluation of Red Eyes in Pediatric Patients.J Pediatr Health Care 2016;30(5):506-514
3 Shukla D,Kumar A,Srivastava S,et al.Molecular identification and phylogenetic study of coxsackie virus A24 variant isolated from an outbreak of acute hemorrhagic conjunctivitis in India in 2010.Arch Virol2013;158(3):679-684
4 International Dry Eye Workshop(DEWS).The definition and classification of dry eye Disease:report of the Definition and Classification Subcommittee of the International Dry Eye Workshop 2007.Ocul Surf2007;5(2):75-92
5 Champey J,Corruble E,Gottenberg JE,et al.Quality of life and psychological status in patients with primary Sj9gren's syndrome and sicca symptoms without autoimmune features.Arthritis Rheum 2006;55(3):451-457
6 Li M,Gong L,Chapin WJ,et al.Assessment of vision-related quality of life in dry eye patients.Invest Ophthalmol Vis Sci 2012;53(9):5722-5727
7 Vander VR,Weaver MA,Lefebvre C,et al.The association between dry eye disease and depression and anxiety in a large population-based study.Am J Ophthalmol 2015;159(3):470-474
8 Wen W,Wu Y,Chen Y,et al.Dry eye disease in patients with depressive and anxiety disorders in Shanghai.Cornea 2012;31(6):686-692
9朱晓谦,刘海凤,宋建.急性细菌性结膜炎治疗前后的眼表改变.眼科新进展2011;31(9):851-853
10范玉香,赵俊华,冯雪艳,等.儿童干眼与过敏性结膜炎临床分析.中国实用眼科杂志2012;30(2):171-173
11 ChenY,Chauhan SK,Saban DR,et al.Interferon-γ-secreting NKpromtote induction of dry eye disease.Leukoc Biol 2011;89(6):965-972
12 Hattori T,Chauhan SK,Lee H,et al.Characterization of langerinexpressing dendritic cell subsets in the normal cornea.Invest Ophthalmol Vis Sci 2011;52(7):4598-4604
13 Barabino S,Montaldo E,Solignani F,et al.Immune response in the conjunctival epithelium of patients with dry eye.Exp Eye Res 2010;91(4):524-529
14 Zhu L,Shen J,Zhang C,et al.Inflammatory cytokine expression on the ocular surface in the Botulium toxin B induced murine dry eye model.Mol Vis 2009;15(1):250-258
15 Enríquez-de-Salamanca A,Castellanos E,Stern ME,et al.Tear cytokine and chemokine analysis and clinical correlations in evaporativetype dry eye disease.Mol Vis 2010;16(5):862-873
16 Anderson NJ,Edelhauser HF.Toxicity of ocular Surgical solutions.Int Ophthalmol Clin 1999;39(2):91-106
17 Singh G,Kaur J.Iatrogenic dry eye:late effect of topical steroid formulations.Indian Med Assoc 1992;90(9):235-237
18 Li C,Song Y,luan S,et al.Research on the stability of a rabbit dry eye model induced by topical application of the preservative benzalkonium chloride.PLoS One 2012;7(3):e33688
19 Rose PW,Harnden A,Brueggemann AB,et al.Chloramphenicol treatment for acute infective conjunctivitis in children in primary care:a randomised double-blind placebo-controlled trial.Lancet 2005;366(9479):37-43
20 Ward JB,Siojo LG,Waller SG.A prospective,masked clinical trial of trifluridine,dexamethasone,and artificial tears in the treatment of epidemic keratoconjunctivitis.Cornea 1993;12(3):216-221