目的：研究长期使用氯氮平对泪膜稳定性和眼表组织结构的影响。方法：病例对照研究。选取2021-03/12期间接受氯氮平治疗3.45±0.72a的诊断为精神分裂症患者45例(组1)。选取45例健康受试者作为对照组(组2)，他们的人口统计学特征与第1组相似。使用OSDI问卷调查患者的干眼症状，SchirmerⅠ试验检测泪液分泌量，眼表染色评分评估眼表损伤情况，并采用LipiView眼表面干涉仪、眼表综合分析仪、角膜共聚焦显微镜和裂隙灯照相系统对所有患者进行全面的眼科检查。结果：裂隙灯照相显示：组1角膜基质可见弥漫性灰白色点状混浊，伴晶状体前囊中央褐色星状混浊。两组OSDI评分分别为38.00(31.50，48.50)、15.00(9.00，19.50)分。Schirmer试验：组1为5.27±2.18mm/5min，组2为15.62±3.05mm/5min。角膜荧光素染色评分：组1为4.00(2.50，5.00)分，组2为1.00(0.00，1.50)分。结膜丽丝胺绿染色评分组1、组2分别为9.00(6.50，10.00)、3.00(2.00，3.50)分。LipiView检测泪膜脂质层厚度(LLT)，提示组1、组2结果相似，分别为75.91±15.51、77.24±12.11nm； 睑板腺缺失评分也有类似的结果，组1、组2分别为1.37±0.26、1.29±0.31分。组1泪河高度平均为0.13±0.06mm，低于组2的0.23±0.04mm。非接触式泪膜破裂时间(NIBUT)组1、组2分别为6.04±2.62、11.4±2.74s。其中，两组间OSDI评分、Schirmer试验、眼表染色评分、泪河高度和NIBUT均有差异(P<0.05)。角膜共聚焦显微镜提示组1角膜神经纤维密度下降伴基质层炎症细胞浸润、色素沉着。结论：抗精神病药物氯氮平可诱发干眼，同时伴有角膜色素沉着等一系列眼表损伤，使用这类药物的患者应该由眼科医生进行常规检查。

AIM: To study the effects of long-term use of clozapine on tear film stability and ocular surface tissue structure.METHODS: Case-control study was conducted on 45 patients(group 1)who were diagnosed with schizophrenia and treated with clozapine for 3.45±0.72a between March 2021 and December 2021. Another 45 healthy subjects(group 2)served as controls, whose demographic characteristics were similar to those of group 1. Patients' dry eye symptoms were investigated using OSDI questionnaire, tear secretion was detected by the Schirmer I test, ocular surface damage was assessed by the ocular surface staining score, and comprehensive ophthalmic examination was performed on all patients through LipiView ocular surface interferometer, ocular surface integrated analyzer, corneal confocal microscope and slit lamp photographic system.RESULTS: Slit-lamp photography showed diffuse grayish-white spot-like opacification in the corneal stroma of group 1, accompanied by brown star-like opacification in the center of the anterior capsule of the lens. OSDI scores were 38.00(31.50, 48.50)and 15.00(9.00, 19.50)in the two groups respectively. Schirmer test showed that the group 1 was 5.27±2.18mm/5min, while group 2 was 15.62±3.05mm/5min. Corneal fluorescein staining score: 4.00(2.50, 5.00)for group 1 and 1.00(0.00, 1.50)for group 2. The lissamine green staining score for the conjunctiva was 9.00(6.50, 10.00)and 3.00(2.00, 3.50)for the two groups, respectively. LipiView detected lipid layer thickness(LLT), suggesting that the results of group 1 and group 2 were similar, respectively 75.91±15.51 and 77.24±12.11nm; and the results were similar for the lid gland deficiency score, with 1.37±0.26 and 1.29±0.31 points, respectively. The mean tear meniscus height in group 1 was 0.13±0.06mm, which was lower than 0.23±0.04mm of group 2. Non-invasive breakup time(NIBUT)was 6.04±2.62 and 11.4±2.74s in group 1 and group 2 respectively. OSDI score, Schirmer Ⅰ test, ocular surface staining score, tear meniscus height and NIBUT were significantly different between the two groups(P<0.05). Confocal corneal microscopy suggested decreased corneal nerve fiber density with stromal layer inflammatory cell infiltration and pigmentation in group 1.CONCLUSION: The antipsychotic drug clozapine can induce dry eye with a range of ocular surface injuries such as corneal pigmentation, and patients who taking such drugs should be routinely examined by an ophthalmologist.