目的：探讨儿童急性结膜炎治疗后泪膜变化情况。

方法：前瞻性队列研究。选择2016-01/2017-01抚顺眼病医院门诊就诊，经规范治疗在自然病程内痊愈的儿童急性结膜炎64例患者，均为单眼，首次就诊时检查未发病眼作为对照。排除其他影响泪膜的因素，分别于痊愈后3、7、14、30d行泪河高度测量、角膜荧光素染色(fluorescein staining，FL)、泪膜破裂时间(tear break up time，BUT)、基础泪液分泌试验(Schirmer Ⅰ test，SⅠt)，并与未发病眼对照比较。

结果：泪河高度对照组为0.43±0.18mm，患眼痊愈后3、7、14d分别为0.25±0.11、0.23±0.13、0.34±0.26mm，均低于对照组，差异有统计学意义(t=-24.364、-24.042、-8.398，均P<0.05)，治愈后30d为0.44±0.06mm，与对照组比较，恢复至对照组水平，差异无统计学意义(t=1.987，P>0.05)； 未发病眼FL评分为1.27±0.96，患眼痊愈后第 3、7、14d分别为2.13±0.75、5.56±2.28、4.21±0.91分，均高于对照组，差异有统计学意义(t=6.437、18.303、20.386，均P<0.05)，治愈后30d为1.81±2.13分，与对照组比较，恢复至对照组水平，差异无统计学意义(t=1.44，P>0.05)； 对照组BUT为13.33±2.75s，患眼痊愈后第3、7、14d分别为5.46±0.9、6.34±1.75、7.72±1.77s，均低于对照组，差异有统计学意义(t=-50.731、-50.522、-38.706，均P<0.05)，治愈后30d为12.07±2.23s，恢复至对照组水平，差异无统计学意义(t=-1.470，P>0.05)。发病眼SⅠt为14.07±3.84mm/5min，痊愈后第3、7、14d，SⅠt分别为8.03±1.79、11.28±2.33、12.59±2.56mm/5min，均高于对照组，差异有统计学意义(t=-20.892、-9.104、-6.710，均P<0.05)，愈合后第30d为13.57±3.46mm，与对照组比较，恢复至对照组水平，差异无统计学意义(t=-0.969，P>0.05)。

结论：儿童急性结膜炎痊愈后可出现短暂泪膜不稳定和可逆性干眼症； 治疗儿童急性结膜炎时应合理用药，充分考虑药物对泪膜的副作用，必要时辅助人工泪液减少干眼症的发生。

METHODS: A perspective cohort study was conducted. Sixty-four acute conjunctivitis cases(64 unilateral eyes)from January 2016 to January 2017 were investigated in this study. Other tear film factors which could affect the conditions of dry eye were excluded. The height of tear meniscus, fluorescein staining(FL), tear film break up time(BUT)and Schirmer Ⅰ test(SⅠt)were checked and measured on both recovered eye and healthy eye of the patients at 3, 7, 14 and 30d after recovery, respectively.

RESULTS: The height of tear meniscus was 0.43±0.18mm in healthy eyes, 0.25±0.11mm, 0.23±0.13mm, 0.34±0.26mm in cured eyes at 3, 7 and 14d, all significantly lower than that in healthy eyes(t= -24.364, -24.042, -8.398,P<0.05), but that at 30d(0.44±0.06mm)was not different(t=1.987, P>0.05). FL scored 1.27±0.96 in healthy eyes, those of cured eyes were 2.13±0.75, 5.56±2.28, 4.21±0.91 at 3, 7 and 14d, significantly higher than that in healthy eyes(t=6.437, 18.303, 20.386; P<0.05); but that at 30d was 1.81±2.13 without difference(t=1.44, P>0.05). BUT was 13.33±2.75s in healthy eyes, those of cured eyes were 5.46±0.9s, 6.34±1.75s, 7.72±1.77s at 3, 7 and 14d, significantly lower than that in healthy eyes(t=-50.731, -50.522, -38.706; P<0.05); but that at 30d was 12.07±2.23s without difference(t=-1.470, P>0.05). SⅠT was 14.07±3.84mm/5min in healthy eyes, those of cured eyes were 8.03±1.79, 11.28±2.33, 12.59±2.56mm/5min at 3, 7 and 14d, significantly lower than that in healthy eyes(t=-20.892, -9.104, -6.710; P<0.05); but that at 30d was 13.57±3.46mm/5min without difference(t=-0.969, P>0.05).

CONCLUSION: The short-term tear film instability and reversible dry eye might be arisen in children after acute conjunctivitis recovery. Considering the drug side effects to the tear film and minimizing the unnecessary use of drugs, however, dry eye can be avoided during the treatment of acute conjunctivitis. At the same time, the artificial tears could function to reduce the occurrence of xerophthalmia.