Heigle T J, Pflugfelder S C
Department of Ophthalmology, University of Miami School of Medicine, Florida, USA.
Cornea. 1996 Mar;15(2):135-8. doi: 10.1097/00003226-199603000-00005.
The purpose of this study was to determine whether corneal epithelial defects and epitheliopathy in patients with unilateral dysfunction of the ophthalmic division of the trigeminal nerve (neurotrophic keratitis) is associated with reduced aqueous tear production. Sensation of the skin, cornea, and nasal mucosa, aqueous tear production by Schirmer 1 testing, nasal-lacrimal reflex, and exposure zone rose bengal staining were evaluated in the affected and fellow eyes of subjects with neurotrophic keratitis (n = 5), eyes of subjects who had recent herpes zoster ophthalmicus (HZO) and who did not develop neurotrophic keratitis (n = 4), and normal controls (n = 10). Sensation in the brow and upper lid skin and nasal mucosa was absent on the affected side of patients with neurotrophic keratitis, but was intact in all other groups. Corneal sensation and Schirmer 1 test values were significantly reduced (p < or = 0.05) in eyes with neurotrophic keratitis compared with the other groups. The nasal-lacrimal reflex was absent on the involved side of subjects with neurotrophic keratitis but was intact in subjects with HZO without keratopathy, and in normal controls (p < 0.008). Rose bengal keratitis staining scores were significantly increased in eyes with neurotrophic keratitis compared with the other groups (p < 0.05). We conclude that neurotrophic keratitis is associated with reduced cutaneous, nasal mucosal, and corneal sensation on the affected side, as well as marked reduction in aqueous tear production with loss of the nasal-lacrimal reflex. It is possible that the corneal epithelial pathology in neurotrophic keratitis is due in part to aqueous tear deficiency.
本研究的目的是确定三叉神经眼支单侧功能障碍患者（神经营养性角膜炎）的角膜上皮缺损和上皮病变是否与泪液分泌减少有关。对神经营养性角膜炎患者（n = 5）的患眼和健眼、近期患有带状疱疹性眼炎（HZO）但未发生神经营养性角膜炎的患者（n = 4）的眼睛以及正常对照组（n = 10）的眼睛进行了皮肤、角膜和鼻粘膜的感觉、Schirmer 1试验测量的泪液分泌、鼻泪反射以及暴露区孟加拉玫瑰红染色评估。神经营养性角膜炎患者患侧的眉部和上睑皮肤以及鼻粘膜感觉缺失，但在所有其他组中均正常。与其他组相比，神经营养性角膜炎患者的角膜感觉和Schirmer 1试验值显著降低（p≤0.05）。神经营养性角膜炎患者受累侧的鼻泪反射缺失，但在无角膜病变的HZO患者和正常对照组中正常（p < 0.008）。与其他组相比，神经营养性角膜炎患者的眼睛孟加拉玫瑰红角膜炎染色评分显著增加（p < 0.05）。我们得出结论，神经营养性角膜炎与患侧皮肤、鼻粘膜和角膜感觉减退有关，以及泪液分泌显著减少并伴有鼻泪反射丧失。神经营养性角膜炎中的角膜上皮病变可能部分归因于泪液缺乏。
