摘要目的:通过裂隙灯显微镜和非侵入式眼表分析仪评价异常瞬目患儿干眼的状况.方法:系列病例研究.选取2017-2018年于南京医科大学附属眼科医院门诊收治的85例(170眼)3～13岁眼表正常的异常瞬目患儿.采用裂隙灯显微镜行眼前节检查、Keratograph-D眼表综合分析仪测量非侵入性泪河高度(NTMH)、非侵入性首次泪膜破裂时间(NITBUTf)、非侵入性平均泪膜破裂时间(NITBUTav)、睑板腺缺失评分等分析儿童异常瞬目的原因.数据采用t检验、单因素方差分析、秩相关进行分析.结果:85例患者NTMH值为(0.19±0.05)mm;NITBUTf值为(7.5±5.3)s;NITBUTav值为(8.6±5.6)s;睑板腺缺失面积评分为(0.7±0.8)分.睑板腺拍照中78眼睑板腺均无缺失,62眼睑板腺缺失面积<1/3,27眼睑板腺缺失面积为1/3～2/3,3眼睑板腺缺失面积>2/3.46眼伴睑板腺腺体形态异常.77例(91％)被诊断为干眼,8例(9％)正常.其中水液缺乏型干眼占10例(13％);蒸发过强型干眼占25例(32％);混合型干眼占42例(55％).性别与NTMH无相关性,但与NITBUTf和NITBUTav均有显著相关性(r=0.31、0.32,P<0.001).年龄与NTMH和NITBUTf无明显相关性,但与NITBUTav有相关性(r=0.19,P<0.017).异常瞬目的病程与NTMH、NITBUTf和NITBUTav均呈显著负相关(r=-0.61、-0.37、-0.40,P<0.001).结论:干眼可能是导致眼表正常的儿童异常瞬目的主要原因,非侵入式眼表综合分析仪是一种非接触、无创、可重复性强的快速检查手段,在异常瞬目患儿眼表状况评估中具有很高的应用价值.

abstractsObjective: To evaluate the dry eye status of children with abnormal blinking using a slit lamp and non-invasive ocular surface analyzer. Methods: In this cross-sectional study, 85 patients with abnormal blinking (170 eyes), aged 3 to 13 years old, who had a normal ocular surface and were admitted to the Nanjing Medical University Affiliated Eye Hospital from 2017 to 2018 were selected. The slit lamp was used for anterior segment examination, and the Keratograh-D ocular surface analyzer was used to measure noninvasive tear meniscus height (NTMH), noninvasive tear film break-up time (NITBUTf), average noninvasive tear film break-up time (NITBUTav), and the degree of meibomian gland loss to analyze thecauses of abnormal blinking in children. Data were analyzed using t-test, ANOVA and rank correlation analysis. Results: The NTMH value of the 85 patients was 0.19±0.05 mm; NITBUTf was 7.5± 5.3 s, and NIBUTav was 8.6±5.6 s. The degree of meibomian gland loss was 0.7±0.8. In meibomian gland photography, 78 had no missing meibomian glands; in 62 eyes meibomian gland loss was less than 1/3;in 27 eyes meibomian gland loss was more than 1/3 and less than 2/3; in 3 eyes meibomian gland loss was greater than 2/3. The morphology of the meibomian glands in 46 eyes was abnormal. Among the 85 children with abnormal blinking, 77 (91％) were diagnosed with dry eye and 8 (9％) were normal. Tear deficiency accounted for 10 cases (13％); excessive evaporation dry eye accounted for 25 cases (32％); and mixed tear deficiency and evaporation accounted for 42 cases (55％). There was no significant correlation between gender and NTMH, but there was a significant correlation between gender and both NIBUTf and NIBUTav (r=0.31, 0.32, P<0.001). There was no significant cor-relation between age and both NTMH and NITBUTf, but there was a slight positive correlation between age and NIBUTav (r=0.19, P<0.017). The course of abnormal blinking was negatively correlated with NTMH, NITBUTf and NITBUTav (r=-0.61, -0.37, -0.40, P<0.001). Conclusion: Dry eye is the main cause of abnormal blinking in children with normal ocular surfaces. The ocular surface analyzer is a non-contact, non-invasive and repeatable rapid exami-nation method, which is highly valuable in evaluating eye surface conditions in children with abnormal blinking.