Heiligenhaus A, Koch J M, Kruse F E, Schwarz C, Waubke T N
Universitäts-Augenklinik Essen.
Ophthalmologe. 1995 Feb;92(1):6-11.
Artificial tears often fail in dry eye patients. Our goal was to establish a diagnostic approach that involves alternatives that are more effective for the treatment. We examined 110 patients with dry eyes not stabilized by artificial tears: medical history, visual acuity, slit lamp examination, rose bengal stains and fluorescein stains, Schirmer test, break-up time (BUT), dye tests, impression cytology, and lid transillumination. This allowed disturbances of the three layers of the tear film (lipid, aqueous, mucin) to be differentiated. Cellular damage of the ocular surface was evaluated and scored by slit lamp examination, rose bengal staining, and impression cytology. Only 8% of the patients with "sicca syndrome" had exclusive aqueous deficiencies amenable to artificial tears. In contrast, lipid deficiencies (chronic blepharitis) were determined most frequently (78%). Twenty-six percent had disturbances in two or more layers of the tear film. The diagnostic strategy of differentiating disturbances of the layers of the tear film offers a more specific approach to the treatment of dry eyes.
人工泪液在干眼症患者中常常效果不佳。我们的目标是建立一种诊断方法，其中包括采用更有效的替代治疗方法。我们检查了110例使用人工泪液后病情未得到稳定控制的干眼症患者：收集了他们的病史、视力、裂隙灯检查、孟加拉玫瑰红染色和荧光素染色、泪液分泌试验、泪膜破裂时间（BUT）、染料试验、印迹细胞学检查以及睑透照检查。这使得能够区分泪膜三层（脂质层、水液层、黏蛋白层）的异常情况。通过裂隙灯检查、孟加拉玫瑰红染色和印迹细胞学检查对眼表的细胞损伤进行评估和评分。只有8%的“干燥综合征”患者仅存在适合使用人工泪液治疗的水液缺乏。相比之下，脂质缺乏（慢性睑缘炎）最为常见（78%）。26%的患者存在两层或更多层泪膜异常。区分泪膜各层异常情况的诊断策略为干眼症的治疗提供了一种更具针对性的方法。
