甲状腺功能亢进合并非浸润性突眼患者的眼表分析

Ocular surface evaluation in hyperthyroidism patients with simple exophthalmos

摘要:

目的 观察甲状腺功能亢进合并非浸润性突眼患者的眼表状况，总结其眼表损伤的临床特征。方法 采用横断面观察性研究。选取2017年1月—2018年6月天津市第四中心医院接诊的甲状腺功能亢进合并非浸润性突眼患者63例作为观察组，同时纳入年龄、性别匹配的健康体检者30例作为对照组。研究对象接受眼表疾病指数（OSDI）问卷调查、结膜充血和角膜荧光素钠染色评分（FL）、泪膜破裂时间（BUT）和泪液分泌试验（SchirmerⅠ试验）检查、眼球突出体征（眼球突出度、睑裂高度、眼睑闭合不全程度和上睑退缩程度）测量及瞬目检查，使用Image J图像分析系统计算眼表面积（OSA）。比较两组各指标之间的差异。结果 观察组眼球突出度、睑裂高度、上睑退缩程度均较对照组增加（P <0.05）；观察组不全瞬目次数、OSDI评分、结膜充血评分、FL、OSA均高于对照组（P <0.05）；观察组BUT较对照组缩短（P <0.05）。观察组眼睑闭合不全程度、SchirmerⅠ试验与对照组比较，差异无统计学意义（P >0.05）。观察组眼球突出度、睑裂高度、上睑退缩程度与OSA呈正相关（r_s =0.816，r =0.546和r_s =0.723，均P <0.05）；OSA与BUT呈负相关（r =-0.339，P =0.007）、与FL呈正相关（r_s =0.378，P =0.002）。上睑退缩与不全瞬目呈正相关（r_s =0.457，P =0.022）；不全瞬目与结膜充血呈正相关（r_s =0.434，P =0.002），但与BUT和FL无相关性（r =-0.082和r_s =0.013，均P >0.05）。结论 甲亢合并非浸润性突眼患者由于眼表暴露面积增大和不全瞬目次数增加，容易继发蒸发过强型干眼，导致眼表损伤。

Abstract:

Objective To observe the ocular surface condition of hyperthyroidism patients with simple exophthalmos, and to summarize the clinical characteristics of ocular surface injuries.Methods In this cross-sectional observational study, sixty-three hyperthyroidism patients, who were presenting with simple exophthalmos and came to our clinic from January 2017 to June 2018, were included as observation group. At the same time, thirty age and gender matched healthy subjects were selected as control group. All the subjects were asked to fill in Ocular Surface Disease Index (OSDI) questionnaire, and underwent conjunctival hyperemia and corneal fluorescein staining examinations, tear break-up time (BUT) and tear secretion test (Schirmer Ⅰ test), signs of exophthalmos (including exophthalmos, palpebral fissure height, degree of lagophthalmos and degree of upper eyelid retraction) measurements, and blink rate examination. Ocular surface area (OSA) was calculate using Image J. Differences of these indexes between observation group and control group were compared.Result Exophthalmos, palpebral fissure height, and degree of upper eyelid retraction in the observation group were higher than those in the control group, differences between two groups were statistically significant (P < 0.05). The number of incomplete blinks, OSDI scores, CH, FL, and OSA in the observation group were significantly higher than those in the control group, and difference between two groups were statistically significant (P < 0.05). BUT in the observation group was significantly shorter than that in the control group, and difference between two groups was statistically significant (P < 0.05). There were no significant differences in degree of lagophthalmos and Schirmer Ⅰ test between the observation group and the control group (P > 0.05). In the observation group, exophthalmos, palpebral fissure height, and degree of upper eyelid retraction were positively correlated with OSA (r_s = 0.816, r = 0.546 and r_s = 0.723, respectively, all P < 0.05); and OSA is negatively correlated with BUT (r = -0.339, P = 0.007), positively correlated with FL (r_s = 0.378, P = 0.002). The degree of upper eyelid retraction was positively correlated with the incomplete blink rate (r_s = 0.457, P = 0.022); The incomplete blink rate was positively correlated with conjunctival hyperemia scores (r_s = 0.434, P = 0.002), but no significant correlation showed between BUT and FL (r = -0.082 and r_s = 0.013, respectively, all P > 0.05).Conclusion Due to their increase of ocular surface exposure area and incomplete blink rates, hyperthyroidism patients with simple exophthalmos are prone to secondary evaporative dry eye.