血泪是指因各种原因导致眼部流出血性泪液的症状，其病因和临床表现复杂多样，往往涉及多学科多专业。不同病因引起的血泪，无论是临床表现，还是诊治方法均差异很大。为了向临床医生提供可参考的血泪临床诊疗流程，中国医师协会眼科医师分会泪器病专业委员会及中国中西医结合学会眼科专业委员会泪器病学组组织有关专家以临床实践经验为基础，经过认真讨论建立本共识，对血泪的病因、临床特征及诊疗流程提出指导性意见。

Bloody tears refers to the symptoms of blooding tears flowing from the eye due to various reasons. Its etiology and clinical manifestations are complex and diverse, often involving multiple disciplines and specialties. In order to provide clinicians with a reference for the clinical diagnosis and treatment process of bloody tears, Lacrimal Diseases Professional Committee of Ophthalmologist Branch of Chinese Medical Doctor Association and Lacrimal Diseases Group of Ophthalmic Professional Committee of Chinese Association of Integrated Medicine organized relevant experts to establish this consensus based on clinical practice after serious discussion, and put forward guiding opinions on the etiology, clinical characteristics, and diagnosis and treatment process of bloody tears.

目的：评估Smart plug泪小管塞治疗水液缺乏型干眼的长期并发症。方法：收集汕头国际眼科中心2011至2016年门诊确诊的水液缺乏型干眼患者300例(600眼)，进行Smart plug泪小管塞治疗，随访观察术后临床并发症，中位随访时间为术后3年(术后1~5年)。结果：3例患者(3眼)术后患有泪小管炎(0.5%)，发病时间为术后1~3(中位2)年，取出泪小管塞后并给予局部抗生素滴眼液治愈。2例患者 (4眼)因植入上下泪小管塞后流泪症状不能耐受，单纯取出下泪小管塞后症状缓解(0.7%)；4例患者(8眼)因只植入下泪小管塞症状未能明显好转，1个月后再次植入上泪小管塞(1.3%)；291例患者干眼主观症状改善，有效率为97.5%，长期随访未发现并发症。结论：虽然Smart plug泪小管塞治疗水液 缺乏型干眼具有明确的疗效，但Smart plug泪小管塞植入后的长期并发症不容忽视，需要长期观察。

Objective: To evaluate the long-term complication associated with the use of the Smart plug in the treatment of aqueous tear deficiency dry eye. Methods: A total of 300 patients (600 eyes) were collected in Joint Shantou International Eye Center from 2011 to 2016, all the patients accepted the treatment with Smart plug, and were followed up for clinical complications. The median follow-up time was postoperative 3 years (1–5 years after surgery). Results: Three patients (3 eyes) developed canaliculitis, the rate was 0.5%. The median time from Smart plug insertion to the onset of canaliculitis was 2 (1–3) years, leaving the Smart plug and resolved the application of topical antibiotics. Two patients (4 eyes) could not suffer from implantation of the upper and lower Smart plug, removed the below, the ratio was 0.7%; 4 patients (8 eyes) need upper Smart plug insertion after implantation of the lower one month later, the rate was 1.3%; 291 cases of dry eye improved by long-term followup, the effective rate was 97.5%. Conclusion: Although the Smart plug is effective in the treatment of aqueous tear deffciency dry eye, the later complications of Smart plug insertion cannot be neglected and need the long-term follow-up.

      液相芯片技术是一种利用混悬在液相中的分类编码微球作为反应及信号检测载体，集合流式细胞技术、激光技术、数字信号处理技术及传统化学技术为一体的新型生物分子检测技术。它充分利用发展成熟的流式细胞术检测原理，对目标分子（如核酸、蛋白质等）进行高通量分析。目前已在生物医学研究中得到了广泛的应用。现就其技术原理、特点及其在泪液细胞因子检测中的应用作简要介绍。

Liquichip (Multiplexed microsphere-based flow cytometric assays) is a new biomolecular detection technology using encoded microspheres suspended in liquid as reaction and detection carrier, which is an integration of flow cytometry, laser technology, digital signal processing and traditional chemical technology. It is a high-throughput analyzer for the target molecular (e.g. nucleic acid and protein) based on the principles of flow cytometry. Liquichip is now widely used in biomedical analyses. This article briefly reviews the principle and characteristic of liquichip and its application in tear cytokine analysis.

目的: 探讨泪膜改变对 Goldmann 压平眼压计测量值的影响。

方法: 将 68 例(136 只眼) 受检者随机分为 2 组, 每组 34 例。随机选择一只眼作为实验眼, 另一只眼作为对照眼。A 组的实验眼采用右旋糖苷 70 滴眼液滴眼, B 组的实验眼采用粘弹剂 Viscoat 滴眼。采用 Goldmann 眼压计测量 2 次眼压, 比较滴眼前、后测量值的差异。

结果: A 组对照眼第 1、2 次的眼压测量值分别为(14.44±2.68) mmHg(1 mmHg = 0.133 KPa) 、(14.47 ± 2.69) mmHg, 两次眼压测量值的差异无统计学意义(t = - 0.329, P = 0.744) 。实验眼滴右旋糖苷 70 滴眼液前、后的眼压测量值分别为(14.41 ±2 .63) mmHg、(12.94 ± 2.59) mmHg, 两次眼压测量值的差异有统计学意义 (t = 13.949, P = 0.000) 。B 组对照眼第 1、2 次的眼压测量值分别为(14.29 ± 2.96) mmHg、(14.35 ± 3.12) mmHg, 两次眼压测量值的差异无统计学意义(t = - 0.466, P = 0.644) 。实验眼滴 Viscoat 前、后的眼压测量值分别为 (14.53 ± 3.13) mmHg、(11.18 ± 3.07) mmHg, 两次眼压测量值的差异有统计学意义( t = 22.126, P = 0.000) 。两组的实验眼滴眼后的眼压均呈一致性的下降。

结论: 泪膜的改变可以使 Goldmann 压平眼压计的测量值产生偏差。

Purpose: To explore the effect of tear film changes on the intraocular pressure (IOP) measurement by Goldmann applantion tonometer.

Methods: Sixty-eight normal subjects were randomly divided into two groups (Gruop A and B) , 34 in each group. One eye of each subject by random selection was given Dextran (in Group A) and Viscoat (in Group B) , respectively. And the fellow eyes were used as controls. IOP was measured in all subjects twice using Goldmann applantion tonometer. And the difference between first and second measurements was compared.

Result: In the control eyes of Group A, the average IOP of first and second measurements were (14.44 ± 2.68) mmHg (1 mmHg= 0.133 KPa) and (14.47 ± 2.69) mmHg, there was no difference between the two measurements (t =- 0.329, P = 0.744) . In eyes given Dextran, the average IOP of two measurements were (14.41 ± 2.63) mmHg and (12.94 ± 2.59) mmHg, there was significant difference between the two mea-surements (t =13.949, P= 0.000) . In control eyes of Group B, the average IOP of first and second measurements were (14.53 ± 3.13) mmHg and (11.18 ± 3.07) mmHg, and there was no difference between the two measurements (t = -0.466, P = 0.644) . In eyes given Viscoat, the average IOP of two measurements were (14.53 ± 3.13) mmHg and (11.18 ± 3.07) mmHg, and there was significant difference between the two measurements (t = 22.126, P = 0.000) . After being given Dextran or Viscoat, the IOP values decreased consistently in both Group A and Group B.

Conclusions: The change of tear film components can affect IOP values by Goldmann applantion tonometer.

目的：探讨泪液中前列腺素E2(prostaglandin E2，PGE2)水平与干眼严重程度的关系。方法：选取干眼患者60例，并接受眼表疾病指数(Ocular Surface Disease Index，OSDI)问卷调查及眼科检查，包括泪膜破裂时间(tear film breakup time，BUT)、角膜荧光素染色评分(corneal fuorescein staining score，CFLS)、泪液分泌试验(Schirmer I试验)。使用酶联免疫吸附测定(ELISA)测量泪液中PGE2的水平。分析泪液PGE2水平与干眼临床症状相关指标的关系。结果：干眼患者泪液中的PGE2水平为(446.39±139.34) pg/mL。干眼患者泪液中PGE2水平与OSDI评分呈正相关(r=0.458，P<0.001)。泪液PGE2水平与BUT(r=0.164，P=0.354)、CFLS评分(r=0.265，P=0.086)、Schirmer I试验(r=?0.076，P=0.460)均无明显相关性。应用线性回归分析表明，泪液PGE2水平与OSDI评分呈正相关(95%CI：7.04~20.18，t=4.01，P<0.001)。结论：泪液中PGE2的水平与OSDI评分呈正相关，与BUT、CFLS评分、Schirmer I试验均无明显相关性。

Objective: To investigate the relationship between the level of prostaglandin E2 (PGE2) in tears and the severity of dry eye. Methods: Sixty patients with dry eye were selected and investigated with the Ocular Surface Disease Index (OSDI) questionnaire and ophthalmic examination, including tear film break-up time (BUT), corneal fluorescein staining score (CFLS) and tear secretion test (Schirmer I test). The level of PGE2 in tears was measured by enzyme-linked immunosorbent assay (ELISA). The relationship between the level of PGE2 in tears and related indexes of dry eye clinical symptoms was analyzed. Results: The average level of PGE2 in tears of patients with dry  eye was (446.39±139.34) pg/mL. The level of PGE2 in tears of patients with dry eye was positively correlated with the OSDI score (r=0.458, P<0.001). PGE2 levels were not significantly correlated with BUT (r=0.164, P=0.354),Schirmer I score (r=?0.076, P=0.460), and CFLS score (r=0.265, P=0.086). Linear regression analysis showed that the level of PGE2 in tears was positively correlated with OSDI score (95% CI: 7.04–20.18, t=4.01, P<0.001).Conclusion: The level of PGE2 in tears is positively correlated with OSDI score, but has no significant correlation with BUT, the CFLS score and Schirmer I test.

目的：研究短时间内大量摄入咖啡因对健康成年人眼表泪膜动力学的影响。方法：受试者为12名健康的成年人(20~30岁)，没有既往眼表疾病史。受试者在恒定的常规条件下摄入5.0 mg/kg咖啡因(取咖啡粉剂按浓度预调)。在摄入咖啡因前后2 h进行泪膜参数评估和泪液收集。受试者接受了泪河高度、泪膜破裂时间、Schirmer I试验、眼压和平均脂质层厚度的测量。结果：摄入大量咖啡因后，泪河高度、泪膜破裂时间和眼压的检测值显著增加，而平均脂质层厚度的检测值与摄入咖啡因之前相比显著下降。摄入咖啡因后，Schirmer试纸收集的泪液量改变无明显统计学意义，未观察到咖啡因对泪液分泌的影响中的性别差异。结论：在大量摄入咖啡因后，眼表泪液动力学发生显著改变且咖啡因可以刺激健康的非干眼受试者的泪液分泌。

Objective: To investigate the effects of high caffeine intake in a short period on tear film dynamics in healthy adults. Methods: The participants were 12 healthy adults (20–30 years old) with no history of ocular surface disease. Participants were given 5.0 mg/kg caffeine (preset the coffee powder according to the concentration)under constant routine conditions. Tear film parameters were assessed and tear collection was performed 2 h before and after caffeine intake. The tear meniscus height, non-invasive tear break-up time, Schirmer I test, intraocular pressure and average lipid layer thickness were all measured after a large amount of caffeine intake. Results: The tear meniscus height, non-invasive tear break-up time and intraocular pressure were significantly increased after caffeine intake, while the average lipid layer thickness was significantly lower than that before caffeine intake. The amount of  tear fluid collected by Schirmer’s I test paper was not statistically significant, and there was no gender difference in the effects of caffeine on tear secretion. Conclusion: After high caffeine intake, ocular tear dynamics are significantly altered and caffeine can stimulate tear secretion in healthy, non-dry-eyed subjects.

泪膜的不同组成成分通过相互作用共同维持眼球表面的湿润，从而维持眼部健康。当这些组成成分出现病理性改变，将会不同程度的影响泪膜稳态，从而导致干眼的发生。而瞬目运动一定程度上影响着泪膜组成成分的分布，随着对干眼相关机制研究的逐步深入，以泪膜为导向的诊断(tear-film-oriented diagnosis，TFOD)的新概念被提出，并被逐渐被接受。我们可以通过泪膜破裂方式来确定眼球表面所缺乏的组成成分，并在此基础上对干眼进行诊断，从而定向补充泪膜缺失成分，重新恢复泪膜稳态。本文将着重分析瞬目、泪膜形成及泪膜破裂机制之间的关系，从而进一步明确泪膜定向诊断的新概念及发展方向。

Different components of the tear film work together to maintain the wettability of the ocular surface, thus maintaining eye health. When the pathological changes of these components occur, the tear film homeostasis will be affected to varying degrees, leading to dry eye. Blinking movement affects the distribution of tear film components to some extent. With the continuous development of research and understanding of the concept and mechanism of dry eye, new concepts of tear-film-oriented diagnosis (TFOD) have been gradually proposed and widely accepted. We can determine the components lacking on the surface of the eye through the tear film  breakup patterns (BUPs). On this basis, dry eye is diagnosed, so as to replenish the lacking components of tear film directionally and restore the stability of tear film. This paper will focus on analyzing the relationship between blinking, tear film formation and tear film break-up mechanism, so as to further clarify the new concept and development direction of tear-film oriented diagnosis.

    泪膜是覆盖于眼球表面的一层液体薄膜，从内而外分为黏液层、水液层和脂质层，每层成分的改变都会导致泪膜不稳定，进而导致干眼的发生。在研究泪膜破裂方式及相关泪液成分改变的基础上，学者Yokoi及其团队分别在2012年和2013年提出了有关干眼治疗和诊断的新概念，称为泪膜导向治疗(tear film-oriented therapy，TFOT)和泪膜导向诊断(tear film-oriented diagnosis，TFOD)，就是根据泪膜破裂模式(tear film break-up pattern，TFBUP)的不同，推断出相应的泪膜成分改变，补充不足的泪膜成分，这种诊疗方法目前正逐渐被接受。本文对不同泪膜破裂方式与泪膜成分改变的关系做了汇总分析，旨在为干眼的诊断和治疗提供更为科学实用的指导方案。

    Tear film is a layer of fluid film covering the surface of eye global, which is divided into mucus layer, aqueous layer and lipid layer from inside to outside. The change of each layer composition will lead to tear film instability, resulting in the occurrence of dry eye. On the basis of numerous studies on the correlation between tear composition and tear film break-up patterns, Yokoi and his team proposed new concepts on the diagnosis and treatment of dry eye called tear film-oriented therapy (TFOT) and tear film-oriented diagnosis (TFOD) in 2012 and 2013. That is according to different tear film break-up patterns (TFBUP), so changes in tear film composition can be deduced and supplemented, and this diagnosis and treatment method is gradually being accepted. In this paper, we summarized and analyzed the relationship between different tear film break-up patterns and changes in tear film composition to provide a more scientific and convenient guidance program for the diagnosis and treatment of dry eye.