Ong Tone Stephan, Elbaz Uri, Silverman Earl, Levy Deborah, Williams Sara, Mireskandari Kamiar, Ali Asim
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Cornea. 2019 May;38(5):581-586. doi: 10.1097/ICO.0000000000001902.
To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools.
Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining.
No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found.
There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.
使用常见诊断工具比较系统性红斑狼疮（SLE）患儿与健康儿童干眼疾病（DED）的症状和体征。
前瞻性、观察性、单中心队列研究。从加拿大多伦多病童医院招募了34名SLE患儿和15名健康受试者。受试者使用加拿大干眼评估（CDEA）问卷、泪膜渗透压、裂隙灯检查、泪膜破裂时间、角膜荧光素染色、Schirmer试验1和结膜丽丝胺绿染色进行主观和客观干眼评估。
SLE患儿与健康儿童在症状方面未发现差异（CDEA评分6.4±5.4 vs. 3.8±3.2；P = 0.09）。SLE患儿角膜染色比健康儿童更普遍（58.8% vs. 20.0%；P = 0.01），且SLE患儿角膜荧光素染色平均得分更高（1.7±1.7 vs. 0.2±0.4；P = 0.002）。两组在泪液渗透压、两眼间泪液渗透压差异、泪膜破裂时间、Schirmer试验1或丽丝胺绿染色评分方面未观察到统计学显著差异。在健康儿童中，CDEA评分与角膜荧光素染色评分弱相关（r = 0.53，P = 0.04）。在SLE患儿中，未发现CDEA评分与任何诊断测试结果之间存在相关性。
SLE患儿DED的症状和体征之间存在不一致。角膜荧光素染色对这些患儿DED的诊断至关重要。
