State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Ocular Surface Center, Sun Yat-sen University, Guangzhou, China.
Ophthalmology. 2011 Dec;118(12):2487-92. doi: 10.1016/j.ophtha.2011.05.035. Epub 2011 Aug 27.
To report ocular surface findings in eyes manifesting senile sunken upper eyelids.
Cross-sectional comparative case series.
A study group of 38 eyes of 38 patients with sunken upper eyelids was compared with a control group of 26 age- and gender-matched patients without sunken upper eyelids.
Patient records were retrieved and compared between the 2 groups and among different severities of sunken upper lids.
Ocular surface deficits were measured by symptoms, eyelid blinking and closure, Bell's phenomenon, apposition of lids and puncta to the globe, conjunctiva inflammation and chalasis, corneal epithelial breakdown by fluorescein and Rose Bengal staining, and the fluorescein clearance test.
Ocular irritation or pain was less common, but tearing and mucous buildup were more common in the study group than the control group, and it tended to be worse in the morning. Incomplete blinking, incomplete closure, abnormal Bell's phenomenon, lid/punctum ectropion, and delayed tear clearance were more frequently detected in the study group than the control group and were more evident in severely affected eyes. Incomplete blinking was significantly correlated with incomplete closure, whereas abnormal Bell's phenomenon was significantly correlated with early morning symptoms. Conjunctivochalasis was less common in the study group than the control group. Corneal epithelial breakdown was more common in the study group than the control group, and was more severe in severely affected eyes.
Sunken upper eyelids are associated with ocular surface morbidity characterized by corneal epithelial breakdown because of an array of ocular surface deficits leading to exposure and desiccation, not only during the day but also in the night. Recognition of this potential risk factor will help to understand pathogenesis and formulate effective therapies in complex ocular surface diseases.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
报告表现为老年性上睑凹陷的眼部的眼表面发现。
横断面对比病例系列。
一组 38 例 38 只上睑凹陷的患者眼与一组 26 例年龄和性别匹配的无上睑凹陷的患者对照。
检索患者记录并比较两组之间以及不同程度的上睑凹陷之间的记录。
通过症状、眼睑眨眼和闭合、Bell 现象、眼睑和泪小点与眼球的贴附、结膜炎症和睑裂、荧光素和孟加拉玫瑰红染色的角膜上皮破裂以及荧光素清除试验来测量眼表面缺陷。
研究组比对照组眼部刺激或疼痛较少见，但流泪和黏液积聚更为常见，且早晨更为严重。研究组中不完全眨眼、不完全闭合、异常 Bell 现象、眼睑/泪小点外翻以及泪液清除延迟的发生率高于对照组，且在重度受累眼更为明显。不完全眨眼与不完全闭合显著相关，而异常 Bell 现象与清晨症状显著相关。研究组中结膜松弛的发生率低于对照组。研究组中角膜上皮破裂的发生率高于对照组，且在重度受累眼中更为严重。
上睑凹陷与眼部表面疾病相关，其特征是由于一系列眼表面缺陷导致的角膜上皮破裂，不仅在白天，而且在夜间都会导致暴露和干燥。认识到这种潜在的危险因素将有助于理解发病机制并制定复杂眼表面疾病的有效治疗方案。
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