Fujishima H, Toda I, Shimazaki J, Tsubota K
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Br J Ophthalmol. 1996 Nov;80(11):994-7. doi: 10.1136/bjo.80.11.994.
Differential diagnosis of allergic conjunctivitis or dry eye is sometimes very difficult to diagnose by symptoms and clinical examination alone, especially in older patients. It was hypothesised that clinically allergic patients who were serum antigen specific IgE negative were candidates for dry eye.
Sixty patients were studied prospectively who were clinically diagnosed with allergic conjunctivitis by their itchy sensation and papilla formation of conjunctiva. They consisted of 30 serum antigen specific IgE positive and 30 IgE negative patients, with no significant differences in age. Dry eye examination and serum total IgE were performed on these two groups.
No significant differences were seen between the two groups with regard to age (p = 0.76) and sex ratio. The antibody negative group had lower Schirmer's test scores (p = 0.002), lower tear clearance (p = 0.0001), lower tear function index (p = 0.0001), and lower serum total IgE (p = 0.04) than the antibody positive group.
This study suggests that the evaluation of serum antigen specific IgE and tear dynamics are important for the differential diagnosis of patients with allergic conjunctivitis and dry eye. Clinically diagnosed allergic conjunctivitis with negative serum antigen specific and total IgE can be one form of dry eye.
仅通过症状和临床检查有时很难鉴别诊断过敏性结膜炎或干眼症，尤其是在老年患者中。据推测，血清抗原特异性IgE阴性的临床过敏性患者可能是干眼症患者。
前瞻性研究了60例临床诊断为过敏性结膜炎的患者，这些患者有眼痒症状和结膜乳头形成。他们由30例血清抗原特异性IgE阳性和30例IgE阴性患者组成，年龄无显著差异。对这两组患者进行了干眼症检查和血清总IgE检测。
两组在年龄（p = 0.76）和性别比例方面无显著差异。抗体阴性组的泪液分泌试验评分较低（p = 0.002），泪液清除率较低（p = 0.0001），泪液功能指数较低（p = 0.0001），血清总IgE也低于抗体阳性组（p = 0.04）。
本研究表明，血清抗原特异性IgE和泪液动力学评估对过敏性结膜炎和干眼症患者的鉴别诊断很重要。临床诊断为过敏性结膜炎但血清抗原特异性和总IgE均为阴性可能是干眼症的一种形式。
