目的：应用共焦显微镜观察不同程度的泪液生成不足型和蒸发过强型干眼患者的角膜细胞学变化。

方法：本研究采用回顾性系列病例研究。选择临床上根据患者病史、症状、角结膜体征及相关仪器检查确诊为蒸发过强型干眼患者33例65眼和泪液生成不足型干眼患者28例55眼。应用三维断层角膜地形图及眼前节分析系统(Sirius系统)对所有干眼患者的严重程度进行分级。应用共焦显微镜对其角膜上皮层(表层上皮细胞层、翼状上皮细胞层和基底上皮细胞层)、朗格汉斯细胞(树突状细胞)、基质层(浅基质和深基质)、内皮层的细胞密度、形态进行观察和分析。

结果：共焦显微镜显示泪液生成不足型和蒸发过强型干眼患者角膜上皮层的细胞数量随干眼的严重程度增加而减少，差异有统计学意义(P<0.01)。两种类型干眼角膜上皮各层细胞大小不均，排列欠规则。泪液生成不足型干眼的角膜上皮下神经纤维直径变细，排列不规则，随着干眼严重程度的增加其弯曲度逐渐增大、分支增多。蒸发过强型干眼朗格汉斯细胞的活化程度与干眼的严重程度成正比，差异有统计学意义(P<0.01)。干眼患者角膜浅基质层细胞数量和深基质层细胞数量变化差异无统计学意义(P>0.05)。两种类型干眼患者的角膜内皮细胞数量无明显变化，差异无统计学意义(P>0.05)。

结论：应用Sirius系统可对两种类型干眼的严重程度进行非接触无创检查并分类，共焦显微镜观察分类后的两种干眼类型患者的角膜各层细胞密度及形态存在变化。

METHODS: Retrospective case series was adopted with three-dimensional corneal topography and anterior segment analysis system(Sirius system). A total of 33 typical dry eye patients(total 65 eyes)with deficient aqueous production and 28 typical dry eye patients(total 55 eyes)with over evaporation were selected from optical center of the First Affiliated Hospital of Harbin Medical University from December 2016 to June 2017, which were grading according to dry eye degrees. The corneal epithelial cell(surface epithelial cell, pterygoid epithelial cell, basal epithelial cell), Langerhans cell(dendritic cell), stroma(deep stromal layer and superficial stromal layer), the density and form of endothelial cells were observed and analyzed with the confocal microscope.

RESULTS: Confocal microscope showed that the number of corneal epithelial cells decreased with the increasing of dry eye severity in patients with tear deficiency and evaporative. The results were statistically significant(P<0.01). The sizes of each layer of corneal epithelium cells were uneven, and the arrangement was irregular. The diameter of corneal sub-epithelial nerve fiber of deficient aqueous production dry eye became thinner with irregular arrangement. With the increase in severity of dry eye, the degree of curvature and branches gradually increased. The activation degree of Langerhans cells of evaporative dry eye was directly proportional to the severity of dry eye(P<0.01). There was no significant changes in the number of superficial stromal cells in the two types of dry eye(P>0.05). The number of deep stromal cells in the two types of dry eye had no relations with the severity of dry eye(P>0.05). There was no significant changes in the number of corneal endothelial cells in the two types of dry eye(P>0.05).

CONCLUSION: The Sirius system can be used for non-contact and non-invasive examination and classification. And there is changes of the density and morphology in each layers of cornea cells of two types of dry eye with the confocal microscope.