目的：评估帕金森病(PD)患者的泪膜稳定性和角膜神经特征。

方法：横断面观察性研究。纳入72例PD患者和50名健康人(对照组)。根据Hoehn-Yahr(H-Y)量表测量疾病严重程度，并分为轻度PD组和中度PD组。使用OSDI问卷调查受试者的干眼症状，SchirmerⅠ试验测试泪液分泌量，眼表染色评分评估眼表损伤情况，并使用LipiView眼表面干涉仪、眼表综合分析仪对所有参与者进行全面的眼科检查，使用角膜共聚焦显微镜和自动化分析软件ACCMetrics分析角膜神经参数，及其与PD病程、疾病严重程度的相关性分析。

结果：PD患者OSDI评分显著升高，与对照组相比有差异(F=70.290，P<0.01)，且泪膜稳定性显著降低，非接触式泪膜破裂时间、角膜荧光素染色与对照组相比差异显著(均P<0.01)。PD患者评估泪液分泌的指标如SchirmerⅠ试验、泪河高度与对照组相比显著下降(均P<0.01)，而脂质分泌对应的指标如泪膜脂质层厚度、睑板腺缺失评分与对照组相比无明显差异。角膜神经分析提示，PD患者的角膜神经纤维密度、角膜神经分支密度、角膜神经纤维长度和角膜神经总分支密度与对照相相比均显著降低(均P<0.01)，眨眼频率显著延长(F=62.353，P<0.01)。相关性分析结果显示PD患者泪膜稳定性的变化与病程、H-Y评分显著相关。

结论：PD患者在患病早期即出现明显的干眼表现，包括泪膜稳定性的降低及角膜神经纤维密度的减少，并随着病情进展逐渐加重，神经退行性疾病相关性干眼需早期诊断并积极诊治。

METHODS: This cross-sectional observational study included 72 PD patients and 50 healthy controls. Disease severity was determined using the Hoehn-Yahr(H-Y)scale, dividing patients into mild and moderate PD groups. Dry eye symptoms were evaluated via the ocular surface disease index(OSDI)questionnaire, while tear secretion was quantified using the Schirmer I test. Ocular surface damage was assessed through staining scores, and comprehensive ocular examinations were performed utilizing the LipiView ocular surface interferometer and an ocular surface analyzer. Corneal nerve parameters were examined using corneal confocal microscopy in conjunction with automated analysis software ACCMetrics, with correlations drawn between these parameters, PD course, and severity.

RESULTS: PD patients exhibited significantly elevated OSDI scores, indicative of more pronounced dry eye symptoms compared to the control group(F=70.290, P<0.01). Tear film stability was markedly compromised, with significantly shorter tear film breakup time and increased corneal fluorescein staining, both showing statistically significant differences relative to controls(all P<0.01). Tear secretion indices, including Schirmer I test results and tear meniscus height, were significantly reduced in PD patients(all P<0.01), whereas lipid secretion indices, such as lipid layer thickness and meibomian gland dropout score, did not show significant variation. Corneal nerve analysis revealed significant reductions in corneal nerve fiber density, nerve branch density, fiber length, and total branch density in PD patients compared to controls(all P<0.01). Furthermore, blink frequency was markedly prolonged(F=62.353, P<0.01). Correlation analysis demonstrated a significant relationship between alterations in tear film stability and both disease duration and H-Y scores.

CONCLUSION: PD patients have obvious dry eye manifestations in the early stage of the disease, including the reduction of tear film stability and corneal nerve fiber density, and gradually aggravate with the progress of the disease. Neurodegenerative disease-related dry eye needs to be diagnosed early and actively treated.