方法：横断面研究。选取2019-07/12在我院诊治的老年干眼患者154例267眼，143眼为右眼，124眼为左眼。其中男71例，女83例，年龄68～90(平均73.40±4.13)岁。应用角膜地形图仪对患者进行最早发生泪膜破裂位置的测量，破裂位置以仪器观察的角膜方位按逆时针顺序分为4个区域，分别对应右眼的鼻上、颞上、颞下、鼻下4个区域和左眼的颞上、鼻上、鼻下、颞下4个区域。记录哪个区域泪膜最先出现破裂，同时记录最早破裂位置距角膜中心的距离。

结果：右眼出现泪膜首先破裂最多的区域为鼻下(28.7%)，然后是颞下(27.3%)、鼻上(20.3%)、颞上(11.2%)，同时出现2～3个区域泪膜破裂占12.6%。左眼出现泪膜首先破裂最多的区域也为鼻下(31.5%)，然后是颞下(25.0%)、鼻上(23.4%)、颞上(11.3%)，同时出现2～3个区域泪膜破裂占8.9%。双眼之间泪膜破裂区域构成比的比较无差异(χ²=1.443，P=0.837)。双眼鼻下方泪膜破裂位置距角膜中心距离均以>1.5～2mm和>2～2.5mm为主。

结论：老年干眼患者泪膜的破裂位置有一定的规律，双眼泪膜首次破裂均以角膜鼻下方为主，双眼没有显著性差异。

METHODS: Cross-sectional study. The 154 elderly patients with dry eyes in our hospital from July 2019 to December 2019 were included, with 143 right eyes, 124 left eyes, and 71 patients were males, 83 patients were females, aged 68-90(mean: 73.40±4.13)years old. The location of the earliest tear film breakup was investigated by using corneal topographer. The cornea was separated to four sectors to record the earliest tear film breakup location by anticlockwise order. The sector corresponding to the right eye was nasal superior, temporal superior, temporal inferior and nasal inferior respectively. And it corresponding to the left eye was temporal superior, nasal superior, nasal inferior and temporal inferior respectively. Then the sector which was the earliest tear film breakup location was recorded. At the same time, the distance which was from the earliest tear film breakup location to the centre of cornea was recorded too.

RESULTS: The highest constituent ratio of area of right eye was nasal inferior(28.7%), then was temporal inferior(27.3%), nasal superior(20.3%), temporal superior(11.2%), and the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 12.6%. The constituent ratio of the earliest tear film breakup area of left eye also was nasal inferior(31.5%), then was temporal inferior(25.0%), nasal superior(23.4%), temporal superior(11.3%), the constituent ratio of earliest tear film breakup occurred in 2-3 areas at the same time was 8.9%. There was no difference in the constituent ratio of tear film breakup area between two eyes(χ²=1.443, P=0.837). The distance from the earliest tear film breakup area of the nasal inferior quadrant to the centre of cornea was mostly the zone from 1.5-2mm and 2-2.5mm in both eyes.

CONCLUSION: There is a certain regularity in the characteristics of tear film breakup area in elderly patients with dry eyes, and the earliest tear film breakup area of both eyes is mainly occurred in nasal inferior, and there is no significant difference between two eyes.