目的：探讨斜视手术对泪膜的影响和术后干眼症的发生情况。

方法：选取2018-09/2019-09我院就诊并行手术治疗的共同性斜视患者58例66眼，按手术方式分组，1组(25例33眼)手术方式为单眼一条水平直肌切断； 2组(33例33眼)手术方式为单眼两条水平直肌切断。分别在术前1d，术后3d，1、2、3wk先采用sirius眼前节分析系统进行泪膜检查， 测量非侵入式泪膜破裂时间(NIBUT)，再行基础泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)和角膜荧光素检查。根据干眼临床诊疗专家共识分别诊断两组患者干眼症发生率。

结果：手术前后两组患者SⅠt无差异(P>0.05)。术后3d，1、2wk时1组BUT值高于2组(P<0.05)，但术后3wk时两组之间BUT无差异(P>0.05)； 1组术后2wk时BUT值恢复至术前水平，2组术后3wk时BUT值恢复至术前水平。两组患者手术前后采用sirius眼前节分析系统测量的NIBUT值与传统方法测量的BUT值均无差异(P>0.05)。1组患者术后2、3wk时干眼症发生率最低(24%、18%)，2组患者术后3wk时干眼症发生率最低(15%)，且术后2wk时，2组患者干眼症发生率明显高于1组(52% vs 24%，P<0.05)。

结论：斜视术后SⅠt无明显变化，手术对泪膜的影响主要体现在BUT方面，累及肌肉条数少者泪膜受影响相对小，恢复快，且随着时间的延长，干眼症发生率逐渐下降。

METHODS: A total of 66 eyes of 58 patients admitted and underwent surgery in our hospital between September 2018 to September 2019 with concomitant strabismus were enrolled. The patients were divided into two groups based on surgical methods: Group 1 included 25 cases(33 eyes)who underwent a single horizontal rectus cut; Group 2 included 33 cases(33 eyes)who underwent both horizontal rectus cut in. The noninvasive tear film break-up time(NIBUT)was examined with sirius anterior analysis system at the time of 1d preoperatively and 3d, 1wk, 2wk and 3wk after operation. In addition, the tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescein examination were tested. The patients were diagnosed with dry eye in both groups according to the consensus of clinical experts specialized in the diagnosis and treatment of dry eye.

RESULTS: There were no statistically significant differences when compared to SⅠt between the two groups before and after surgery(P>0.05). The BUT of group 1 was higher than group 2 at postoperative 3d, 1wk and 2wk(P<0.05), while there was no difference between the two groups at 3wk postoperative(P>0.05); BUT returned to baseline by 2wk after surgery in group 1 and by 3wk after surgery in group 2. There were no differences between the NIBUT measured by sirius anterior segment analysis system and the BUT measured by traditional method before and after operation(P>0.05). The lowest incidence of dry eye was found at postoperative 2wk and 3wk in group 1(24%, 18%). The lowest incidence of dry eye was found at postoperative 3wk in group 2(15%). Besides, the incidence of dry eye in group 2 was higher than that in group 1 at postoperative 2wk(52% vs 24%, P<0.05).

CONCLUSION: There was no obvious influence on the SⅠt after strabismus surgery; the surgical effect on tear film was mainly reflected in BUT. The fewer muscles operated, the lesser tear film was affected and the tear film was recovered faster. The incidence of dry eye decreased as time went by.