目的：探索原发性翼状胬肉患者术前的眼部症状并分析其无症状性眼表异常的特点。方法：采取横断面研究方法，选取2022-08/10在厦门大学附属厦门眼科中心诊断为原发性翼状胬肉并拟行手术治疗的住院患者，进行主观症状评分[眼表疾病指数问卷量表(OSDI)]、六项客观检查(非侵入性泪膜破裂时间、Schirmer I试验、泪河高度、睑缘异常评分、睑板腺腺体缺失程度评分、泪膜脂质层厚度)以及眼前节相干断层扫描等检查。结果：共纳入患者178例178眼，其中男75例(42.1%)，女103例(57.9%)，平均年龄54.39±10.75岁，平均OSDI为11.47±9.69分，泪膜破裂时间为7.10±3.86 s，泪河高度为0.16±0.07 mm，泪液分泌量为14.39±7.29 mm/5 min，翼状胬肉平均厚度为504.74±175.87 μm。161眼(90.4%)存在睑缘异常，44眼(24.7%)睑板腺腺体缺失程度评分≥4分，52眼(29.2%)脂质层变薄。在六项客观检查中出现4项及以上异常的患眼比例为85.4%。根据翼状胬肉形态将患者分为四级：Ⅰ级10眼(5.6%)，Ⅱ级93眼(52.2%)，Ⅲ级60眼(33.7%)，Ⅳ级15眼(8.4%)。翼状胬肉分级越高，其泪膜破裂时间越短，睑缘异常的比例越高。根据OSDI评分结果将患者分为正常组(OSDI<13分，121眼，68.0%)和异常组(OSDI≥13分，57眼，32.0%)，两组患者睑板腺功能障碍患眼比例无差异(71.9% vs 71.9%，P=0.872)； 眼表检查异常项目数量有差异(4.11±0.85项 vs 4.91±0.99项，P<0.001)。结论：原发性翼状胬肉住院患者术前存在无症状性眼表异常。无眼部不适症状的翼状胬肉患者其睑板腺结构或功能异常的发生率与存在眼部不适症状者基本相当。临床医师应重视原发性翼状胬肉术前无症状患者的眼表异常。

AIM: To investigate the preoperative ocular symptoms and the characteristics of asymptomatic ocular surface abnormalities in hospitalized patients with primary pterygium.METHODS: Cross-sectional study. Hospitalized patients diagnosed with primary pterygium and scheduled to receive pterygium excision surgery at the Xiamen Eye Center of Xiamen University from August 2022 to October 2022 were enrolled. Ocular surface disease index questionnaire(OSDI), six examinations including non-invasive tear film break-up time, Schirmer I test, tear meniscus height, lid margin abnormality, meibomian gland dropout and tear film lipid layer thickness, and anterior segment optical coherence tomography(AS-OCT)were performed and statistically analyzed.RESULTS: A total of 178 cases(178 eyes), with a mean age of 54.39±10.75 years old, were recruited, including 75 males(42.1%)and 103 females(57.9%). The average values of ocular surface parameters in these patients included OSDI: 11.47±9.69, tear film break-up time: 7.10±3.86 s; tear meniscus height: 0.16±0.07 mm, Schirmer I test values: 14.39±7.29 mm/5 min, and pterygium thickness: 504.74±175.87 μm. Totally 161 eyes(90.4%)presented with abnormal lid margin, 44 eyes(24.7%)presented with meibomian gland dropout score ≥4, 52 eyes(29.2%)presented with low lipid layer thickness. In the 6 objective examinations, abnormalities in at least 4 of these tests were found in 85.4% of eyes. Pterygium morphology was classified into four grades: 10 eyes(5.6%)of grade Ⅰ, 93 eyes(52.2%)of grade Ⅱ, 60 eyes(33.7%)of grade Ⅲ, and 15 eyes(8.4%)of grade Ⅳ. In patients with a higher grade of pterygium, the tear film break-up time was lower, and the proportion of abnormal lid margin was also significantly higher(P<0.05). The patients were further divided into two subgroups, including 121 eyes(68.0%)with normal OSDI <13 in the normal group and 57 eyes(32.0%)with OSDI ≥13 in the abnormal group. No significant difference was found in the proportion of meibomian gland dysfunction between the two groups of patients(71.9% vs. 71.9%, P=0.872). In addition, there were differences in the number of abnormal objective examinations(4.11±0.85 vs. 4.91±0.99, P<0.001).CONCLUSIONS: Asymptomatic ocular surface abnormalities were present preoperatively in patients hospitalized for primary pterygium. A comparable high incidence of structural or functional meibomian gland dysfunction existed in pterygium patients with or without apparent ocular discomfort. More attention should be paid to the ocular surface abnormalities in those asymptomatic patients before primary pterygium surgery.

福建省卫生健康中青年骨干人才计划项目(No.2022GGB023); 福建省自然科学基金杰青项目(No.2020D029); 国家自然科学基金资助项目(No.81570816); 福建省“创新之星”人才计划(2021); 北京白求恩公益基金会干眼诊疗与研究科研项目(No.BJ-GY2021011J); 厦门市医工结合指导性项目(No.3502Z20214ZD2194,3502Z20214ZD2195,3502Z20214ZD2196)