睑缘炎、睑板腺功能障碍与干眼症

睑板腺通过分泌睑脂组成泪膜脂质层 ,防止泪液过度蒸发 ,促进泪膜稳定性。睑缘炎和睑板腺功能障碍破坏正常的睑脂分泌 ,使泪液蒸发过强 ,是蒸发过强型干眼症的最常见原因。目前对睑板腺和泪膜脂质层功能评价的认识尚不足。本文就睑缘和睑板腺的功能特点和临床评价、睑缘炎和睑板腺功能障碍与干眼症的关系以及治疗进展进行综述     

睑缘炎所致泪膜损害23例

目的探讨睑缘炎对泪膜的损害作用。方法对23例严重睑缘炎患者进行详细裂隙灯检查、泪膜破裂时间、泪液分泌试验测定及角膜上皮荧光素染色。观察经药物治疗后上述各项的改变。结果23例患者睑缘充血、不规则,睫毛根部及睑板腺开口处黄色分泌物及痂皮附着,泪膜破裂时间缩短,角膜弥漫着色,泪液分泌试验在正常范围。结论睑缘炎引起脂质分泌减少及成分异常,破坏泪膜稳定性,导致蒸发过强型干眼。     

0. 02% 氟米龙联合玻璃酸钠治疗中度干眼的临床研究

目的观察0．02％氟米龙滴眼液联合玻璃酸钠滴眼液治疗中度干眼的临床疗效。方法将2012年6月-2012年10月在复旦大学附属眼耳鼻喉科医院眼科门诊诊断为中度干眼的41例（41眼）患者随机分成A、B2组,A组给予0．02％氟米龙联合玻璃酸钠滴眼液,B组单独应用玻璃酸钠滴眼液,观察2组患者在用药前、治疗14d后及治疗28d后的眼表疾病指数OSDI评分、结膜充血评分、角膜荧光素染色评分、泪膜破裂时间（BUT）、基础泪液分泌试验（SIt）及睑板腺分泌物评分。结果用药28d后,A组和B组干眼患者在OSDI评分、结膜充血评分、角膜荧光素染色评分、BUT、SIt及睑板腺分泌物评分上均有明显改善（P〈0．05）;A组比B组更有助于结膜充血评分及睑板腺分泌物评分的改善（P〈0．05）。结论氟米龙联合玻璃酸钠滴眼液能减轻眼表的炎性充血,改善睑板腺功能。     

睑缘炎、睑板腺功能障碍与干眼症

睑板腺通过分泌睑脂组成泪膜脂质层，防止泪液过度蒸发，促进泪膜稳定性。睑缘炎和睑板腺功能障碍破坏正常的睑脂分泌，使泪液蒸发过强，是蒸发过强型干眼症的最常见原因。目前对睑板腺和泪膜脂质层功能评价的认识尚不足。本就睑缘和睑板腺的功能特点和临床评价、睑缘炎和睑4板腺功能障碍与干眼症的关系以及治疗进展进行综述。     

眼表综合分析仪在儿童早期前睑缘炎临床分析中的应用

目的利用眼表综合分析仪对儿童早期前睑缘炎患者的眼表情况进行观察,分析其临床特点。方法描述性研究。选取2015年7月至2016年5月就诊于山西省眼科医院门诊,经裂隙灯显微镜检查确诊为早期前睑缘炎的儿童患者40例（80眼）,年龄4~14岁。对患儿睑缘炎体征进行评分,利用眼表综合分析仪检查其泪膜破裂时间（BUT）、泪河高度,并进行眼表充血、睑板腺缺失及角膜荧光素钠染色评分,对所得数据进行Spearman秩相关分析。结果80眼中,58眼（72%）BUT缩短;50眼（62%）泪河高度下降;15眼（19%）发生角膜上皮点状缺损;25眼（31%）睑板腺缺失范围＞1/3。睑缘炎体征评分与BUT、泪河高度、角膜荧光染色评分及睑板腺缺失评分不相关;睑板腺缺失评分与BUT呈负相关（r=-0.253,P=0.024）,与角膜荧光染色评分呈正相关（r=0.563,P＜0.001）。结论儿童早期前睑缘炎患者泪膜稳定性下降,同时合并睑板腺缺失的患者易继发干眼。     

眼表综合分析仪评价干眼患者相关指标的临床分析

目的 评价眼表综合分析仪在干眼患者中的应用价值。方法 横断面研究。选择70例（135眼）干眼患者作为研究对象。检查指标包括眼表疾病指数（OSDI）评分、泪液分泌试验（SⅠT）、睑板腺分泌物性质检查,以及利用眼表综合分析仪系统--Keratograph 5M进行泪河高度测量、泪膜破裂时间（BUT）测定以及睑板腺检查。Keratograph 5M与传统检查方法之间的相关性、干眼患者睑板腺状况评分与OSDI评分及BUT的相关性用Pearson相关及线性回归进行分析,Keratograph 5M分析眼表状况的重测信度用组内相关系数评价。结果 70例（135眼）患者OSDI评分为（15.8±3.4）分,SⅠT为（6.0±7.7）mm,泪河高度为（0.27±0.13）mm,BUT为（7.9±5.5）s。睑板腺分泌物评分为（3.3±1.4）分,睑板腺缺失面积评分为（3.4±1.6）分。测得的BUT时间越短,SⅠT越短（r=0.474,P＜0.01）;泪河高度越低,SⅠT越短（r=0.432,P＜0.01）。睑板腺分泌物评分、睑板腺照相评分与OSDI评分呈正相关（r=0.673、0.752,P<0.05）,与BUT呈负相关（r=-0.638、-0.603,P<0.05）。眼表综合分析仪的检查结果具有较好的重测信度（ICC值在0.84~0.89之间）。结论 眼表综合分析仪能够直观地评价干眼患者眼表状况,是一种非接触性、无创、可重复性强的快速检查手段,具有实际临床应用价值。     

睑缘炎患者睑板腺形态变化及其与干眼的关系

背景 睑缘炎是一种常见的眼表疾病,常累及睑板腺体,而睑板腺体所分泌的脂质是泪膜的重要组成成分之一.泪膜稳定性的破坏可导致干眼相关症状,可以说睑缘炎是干眼发病的因素之一,但二者之间的关系有待进一步研究. 目的 使用非接触式红外线睑板腺观察仪观察睑缘炎患者睑板腺腺体的形态,并与干眼相关检查进行相关性分析. 方法 采用病例观察的设计方法对睑缘炎患者睑板腺形态改变与干眼症的关系进行研究.选取2010年9月至2011年4月于河南省眼科研究所眼科门诊依据PPP标准诊断为睑缘炎的患者83例83眼,取得患者的知情同意后,在裂隙灯下行眼前节检查睑缘畸形评分、泪液分泌( Schirmer Ⅰ)试验、泪膜破裂时间(BUT)、角膜荧光素染色评分及结膜充血评分,采用泪膜干涉仪行泪膜形态分级,采用非接触式红外线睑板腺摄像仪行睑板腺腺体缺失分级,对睑缘炎睑板腺腺体缺失分级与上述检查结果的关系进行评估.结果 不同年龄组不同性别间睑缘炎的频数分布差异无统计学意义(x2=2.69,P=0.75).睑缘炎患者的睑板腺腺体缺失分级与年龄星弱的正相关(r=0.58,P=0.00),但与性别无明显相关性(r=-0.09,P=0.99);患者睑板腺体缺失与睑缘畸形评分及结膜充血评分均呈弱的正相关(r=0.64,P=0.00;r=0.50,P=0.00);与泪膜影像分级及角膜染色评分均呈弱的正相关(r=0.23,P=0.04;r=0.50,P=0.00),与BUT呈弱的负相关(r=-0.32,P=0.00),但与Schirmer Ⅰ试验结果无明显相关性(r=-0.05,P=0.69).不同年龄组男性和女性的睑板腺缺失分级评分差异无统计学意义(Z=-0.09,P=0.93).结论 睑缘炎可引起蒸发过强型干眼,且患者的睑板腺体随年龄的增长缺失程度加重.非接触式红外线睑板腺观察仪作为一种有效、快速、无刺激地观察睑板腺体形态的仪器,可作为一项常规检查来辅助诊断睑缘炎.     

睑板腺脂质在干眼症发病机制中的作用

干眼症是眼科常见病,根据病因可分为泪液分泌不足和泪液蒸发过强两种类型。位于泪膜最外层的脂质层由睑板腺分泌,具有维持泪膜稳定和防止泪液蒸发的作用。脂质层的组成成分以及组织结构对它的稳定性有很大影响,睑板腺功能障碍患者由于脂质层功能紊乱,造成泪膜稳定性下降及眼表的破坏,引起蒸发过强型干眼症。（国际眼科纵览,2014, 38：316-319）     

干眼患者睑板腺状况的分析

目的 探讨临床诊断为干眼症患者的睑板腺状态。方法 非干预性、观察性研究。2010年3至12月在北京大学第三医院眼科诊断为干眼的194例（388只眼）作为研究对象。其中男性69例（138只眼）,女性125例(250只眼),总体年龄范围7～ 85岁,平均年龄（44±18）岁,男性平均年龄(39±18)岁,女性平均年龄(47±17)岁。检查指标包括主观症状评分、泪液分泌试验、泪膜破裂时间(BUT)及角膜荧光染色情况,同时利用非接触红外线睑板腺照相系统进行睑板腺检查。结果 观察的194例（388只眼）主观症状平均(5.47±2.14)分,SIaT值为(5.58±4.22) mm,BUT为(3.09±2.34)s,角膜荧光素染色评分(4.10±3.79)分。睑板腺照相评分为1分占3.09％（12只眼）,2分占9.28％（36只眼）,3分占20.10％（78只眼）,4分占26.03％（101只眼）,5分占21.91％（85只眼）,6分占19.59％（76只眼）。结论 睑板腺功能障碍是干眼症的重要病因之一。非接触红外线睑板腺照相系统可以客观评价睑板腺形态。     

γ-亚麻酸治疗兔蒸发过强型干眼的实验研究

目的观察γ-亚麻酸治疗实验性蒸发过强型干眼的疗效。方法烧灼兔睑板腺开口制成蒸发过强型干眼模型，将30只兔随机分为对照组和治疗组2组。对照组不给予任何药物；治疗组给予γ-亚麻酸灌胃治疗，用药前后定期进行Schirmer Ⅰ试验、角膜虎红染色，并观察泪膜破裂时间、泪液中白细胞介素-6（IL-6）质量浓度的变化。用药5周后，免疫组织化学方法检测细胞间黏附分子-1（ICAM-1）在角膜、结膜中的表达。结果治疗组兔Schirmer Ⅰ试验滤纸湿长、泪膜破裂时间较对照组增加（P〈0．01）、角膜虎红染色分值下降（P〈0．01）、泪液中IL-6质量浓度下降（P〈0．01）。ICAM-1在治疗组角膜、结膜上皮无表达或弱表达，在对照组有表达，两者差异有统计学意义（P〈0．01）。结论1-亚麻酸通过对抗细胞因子的作用减轻蒸发过强型干眼眼表的炎症反应，对干眼有治疗作用。     

Disposable eyelid-warming device for the treatment of meibomian gland dysfunction

PURPOSE: To assess the clinical efficacy of a newly developed disposable eyelid-warming device (Eye Warmer) for the treatment of meibomian gland dysfunction (MGD). METHODS: The Eye Warmer was applied for 5 minutes to 44 eyes of 22 patients who exhibited decreased tear break-up time (BUT) and dry-eye symptoms. Its efficacy was assessed on the basis of BUT and dry-eye symptoms in the short-term study. In the therapeutic study, the Eye Warmer was applied to 34 eyes of 17 MGD patients with decreased BUT and dry-eye symptoms for 5 minutes once a day for 2 weeks. The 16 eyes of 8 patients served as untreated controls. We examined tear film lipid layer interference patterns, BUT, meibomian gland secretion, and dry-eye symptoms in both groups before and after the treatment. RESULTS: BUT and dry-eye symptoms significantly improved after the treatment in both the short-term and the therapeutic study (P<.01). The incidence of normal tear lipid layer in the treated group was significantly higher after treatment (28 eyes [82.4%]) than before (19 eyes [55.9%]) (P=.036). The incidence of meibomian gland obstruction was significantly decreased after treatment (14 eyes [41.2%]) compared to before treatment (26 eyes [76.5%]) (P=.006). CONCLUSIONS: Warming the eyelids with the Eye Warmer improved the stability and uniformity of the tear lipid layer in MGD patients by melting the meibomian gland lipid. Our study demonstrates the usefulness of the Eye Warmer for the treatment of MGD.     

Meibomian gland dysfunction in chronic blepharitis

We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.     

物理治疗睑板腺功能障碍的疗效观察

目的:探讨睑板腺开口挑排等物理治疗睑板腺功能障碍(meibomian gland dysfunction,MGD)的疗效。方法:回顾性分析2012-01/12我院收治的MGD患者52例100眼的临床资料,根据临床表现及体征确诊为MGD,随机分为两组,A组(物理治疗组)26例50眼患者给予局部清洗、热敷、睑板腺开口挑排、妥布霉素地塞米松眼膏及人工泪液等综合治疗,B组(对照组)26例50眼患者仅用人工泪液和妥布霉素地塞米松眼膏药物治疗,比较两组治疗前后患者自觉症状、角膜荧光素染色(FL)、泪液分泌和泪膜破裂时间。结果:A组自觉症状好转24例47眼,好转率94%,B组自觉症状好转14例27眼,好转率54%,两组间差异有统计学意义(P<0.01);两组间泪液分泌治疗后无明显统计学差异(P>0.05);泪膜破裂时间(BUT)A组治疗后明显好转,治疗后2,4wk两组间比较有统计学意义(P<0.01);角膜荧光素染色(FL),治疗后2,4wk两组之间有统计学意义(P<0.05)。结论:MGD是一种可致眼表炎症及损伤的慢性疾病,睑板腺开口挑排等物理治疗睑板腺功能障碍疗效确切,患者满意度高。     

The features of dry eye disease in a Japanese elderly population.

PURPOSE: The purpose of this study is to assess the features of dry eye disease in a Japanese elderly population. METHODS: One hundred thirteen left eyes of 113 pensioners (50 males, 63 females; mean age, 67.5 +/- 5.7 years) aged over 60 years were recruited in this study. The subjects underwent careful slit-lamp examinations of the conjunctiva, ocular surface, and the eye lids. Tear film breakup time (BUT) examinations, Schirmer test-I, and fluorescein staining of the ocular surface and transillumination of the eyelids were also performed. Dry eye symptomatology was assessed with a symptom questionnaire. Japanese Dry Eye Diagnostic Criteria were used in this study. RESULTS: Ocular tiredness, irritation, dryness, and foreign body sensation were the most frequently reported symptoms by the patients. A total of 73.5% of the eyes had definite dry eyes. A total of 39.8% of the eyes had a Schirmer test reading <5 mm. Mean Schirmer test value was 9.4 +/- 7.8 mm. The mean BUT score was 4.0 +/- 2.8 seconds. A total of 76.9% of the eyes had positive fluorescein staining of the cornea. Meibomian gland dysfunction and conjunctivochalasis were found as frequent factors in relation to dry eye disease with meibomian grand dropout showing positive correlation with tear instability. CONCLUSION: Qualitative and quantitative disorders of the tear film were far more common than recognized in this population of elderly subjects, meibomian gland dysfunction being the most common associate of the tear film disorder and dry eye status. Conjunctivochalasis (conjunctival laxity), although commonly associated with dry eye disease in the elderly, was observed not to be related to age or gender in this study.     

In vivo confocal microscopy in blepharitis

BACKGROUND: Dysfunction of the meibomian glands with inflammation and obstruction has been suggested to be an important factor in the pathogenesis of chronic blepharitis. Few objective tests are, however, available to examine the meibomian glands directly. PATIENTS AND METHODS: Nineteen patients with anterior blepharitis, meibomitis, meibomian gland dysfunction or severe keratoconjunctivitis sicca associated with blepharitis as well as 10 patients with normal lid margins were examined with the HRTII/RCM in vivo confocal microscope. Scans of the tear film, the tarsal conjunctiva, the hair follicles and the meibomian glands were analysed by a masked observer. RESULTS: Patients with normal lid margins exhibited a minimal round cell infiltrate in the tarsal conjunctival epithelium and largely normal ducts of the meibomian glands lined with a multilayered epithelium as well as normal gland acini. In patients with anterior blepharitis, blepharitis associated with autoimmune peripheral ulcerative keratitis and blepharitis in the context of severe dry eye, confocal microscopy disclosed normal meibomian glands. In 12 patients with blepharitis/meibomitis or meibomian gland dysfunction, profound pathology was visible with dilatation and obstruction of the meibomian gland ducts. In 15 of 19 patients with blepharitis/meibomitis, but not in meibomian gland dysfunction, an intense inflammation was observed in the tarsal conjunctival epithelium and stroma. In one patient, demodex folliculorum was evident in vivo. In patients with normal lid margins as well as in patients with blepharitis, hair follicles appeared within normal limits. CONCLUSIONS: In vivo confocal microscopy allowed the examination of the tear film, the tarsal conjunctiva, the lid margin including the lash follicles and the meibomian glands. In patients with meibomian gland disease pathological changes could be visualised and documented objectively. The presence of an inflammatory infiltrate permitted us to differentiate between meibomitis and meibomian gland dysfunction. Changes of the lash follicles do not seem to play an important role in blepharitis. Thus, in vivo confocal microscopy represents an objective technique in the classification and follow-up of patients with blepharitis.     

糖尿病周围神经病变患者干眼的临床特征分析

目的:探讨糖尿病周围神经病变(DPN)患者泪膜功能的改变及干眼症状特征。方法:病例对照研究。选取存在泪膜异常的2型糖尿病(T2DM)患者59例59眼,以是否存在DPN分为T2DM组31例31眼和DPN组28例28眼,另选择符合泪膜异常标准且无糖尿病的患者33例33眼作为无T2DM组。对三组患者进行眼表疾病指数(OSDI)量表评分、泪膜破裂时间(BUT)、角结膜荧光素钠染色(FL)评分、泪液分泌试验(SchirmerⅠ)、红外线睑板腺照相。结果:各组间BUT结果有差异(F=9.43,P<0.01),无T2DM组、T2DM组和DPN组两两比较均有差异(P<0.05);各组间SchirmerⅠ及FL阳性率比较无差异(P>0.05);各组间睑板腺缺失评分有差异(χ2=8.433,P<0.05),T2DM组与无T2DM组比较无差异(P>0.05),DPN组与无T2DM组、T2DM组比较均有差异(P<0.05);各组间OSDI量表评分比较有差异(P<0.05),两两比较,T2DM组与无T2DM组比较无差异(P>0.05),DPN组与无T2DM组、T2DM组比较均有差异(P<0.05)。结论:合并DPN的T2DM患者较不伴发DPN的T2DM患者及无T2DM患者BUT更短、睑板腺缺失更重,但干眼症状更不明显,应密切关注和随访DPN患者的眼表异常。     

【In Press】Cinical efficacy of combined topical 0.05% cyclosporin A and 0.1% sodium hyaluronate in the dry eyes with meibomian gland dysfunction

AIM: To investigate the efficacy of combined topical 0.05% cyclosporin A (CsA, Restasis®, Allergan pharmaceuticals, USA) and 0.1% sodium hyaluronate treatment in dry eyes with meibomian gland dysfunction. METHODS: In this retrospective analysis, 53 patients (106 eyes) with meibomian gland dysfunction (MGD) were enrolled and performed lid warm massage for 10min daily and be instilled preservative free sodium hyaluronate 0.1% eye drops 4 times daily. Patients were divided into subjects treated with topical 0.05% cyclosporine A and preservative free sodium hyaluronate vehicle (CsA group, n=74 eyes) and subjects treated with the preservative free sodium hyaluronate vehicle (control group, n=32 eyes). They were evaluated at baseline and at 1, 2, and 3mo for subjective symptoms and objective signs including tear break-up time, schirmer test, corneal staining score, lid margin telangiectasia, meibomian gland secretion, and conjunctival injection. RESULTS: In the short-term treatment, CsA group showed a statistically significant improvement in the ocular surface disease index (P<0.001), tear film break-up time (P=0.004), schirmer test score (P=0.008) and lid margin telangiectasia (P=0.021) by repeated measure ANOVA. Additionally, mean changes from baseline in ocular surface disease index (P<0.001), tear film breakup time (P=0.001), schirmer test score (P=0.029), corneal staining score (P=0.047), eyelid margin telangiectasia (P=0.002), conjunctival injection (P=0.030) were improved better in CsA group than in the control group at 3mo. However, there was no significant difference between the two groups in meibomian gland secretion (P=0.67). CONCLUSIONS: In dry eyes with meibomian gland dysfunction, 0.05% cyclosporin A improves the tear film stability as well as subjective ocular discomfort, and is effective in controlling lid margin inflammation.