Toda I, Shimazaki J, Tsubota K
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Ophthalmology. 1995 Feb;102(2):302-9. doi: 10.1016/s0161-6420(95)31024-x.
The authors' clinical experience has suggested that there is a form of dry eye with only decreased tear break-up time, which is associated with allergic conjunctivitis. The current study was performed to verify this hypothesis.
The authors recruited patients with two types of dry eye syndrome, those with only decreased tear break-up (BUT type) and those with positive vital staining (staining type). Individuals without any symptoms or signs served as controls. All subjects were compared regarding symptoms, Schirmer and tear clearance test results, conjunctival papillary formation, antigen-specific serum-IgE level (s-IgE), and goblet cell density of the palpebral conjunctiva. Antigen-induced allergic conjunctivitis was produced in guinea pigs, and histopathologic changes of the conjunctiva were examined.
Patients with the BUT-type dry eye syndrome were younger and their symptoms were as severe as the staining type. The Schirmer and tear clearance test results were better, and the papillary formation and s-IgE were observed more than in the BUT type. The average goblet cell density in the BUT-type syndrome was 625.4 +/- 193.2/mm2, which was significantly less than 1005.6 +/- 294.5/mm2 in the controls (P < 0.01). The average goblet cell density was significantly decreased in the allergic animals (10.40 +/- 1.11/0.2 mm) compared with that of the controls (16.21 +/- 0.26/0.2 mm) or the anti-allergic drug-treated group (13.69 +/- 0.30/0.2 mm) (P < 0.01).
These results support the authors' hypothesis that decreased break-up time is in part associated with the decreased goblet cell density caused by allergic conjunctivitis.
作者的临床经验表明，存在一种仅泪膜破裂时间缩短的干眼症形式，其与过敏性结膜炎相关。进行本研究以验证这一假设。
作者招募了两种类型干眼症综合征的患者，即仅泪膜破裂时间缩短的患者（BUT型）和活体染色阳性的患者（染色型）。无任何症状或体征的个体作为对照。比较了所有受试者的症状、泪液分泌试验和泪液清除试验结果、结膜乳头形成、抗原特异性血清IgE水平（s-IgE）以及睑结膜杯状细胞密度。在豚鼠中诱发抗原性过敏性结膜炎，并检查结膜的组织病理学变化。
BUT型干眼症综合征患者较年轻，其症状与染色型一样严重。泪液分泌试验和泪液清除试验结果更好，且乳头形成和s-IgE的观察结果比BUT型更明显。BUT型综合征中杯状细胞的平均密度为625.4±193.2/mm²，显著低于对照组的1005.6±294.5/mm²（P<0.01）。与对照组（16.21±0.26/0.2mm）或抗过敏药物治疗组（13.69±0.30/0.2mm）相比 , 过敏性动物的杯状细胞平均密度显著降低（10.40±1.11/0.2mm）（P<0.01）。
这些结果支持了作者的假设，即泪膜破裂时间缩短部分与过敏性结膜炎导致的杯状细胞密度降低有关。
