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干眼是一种泪液和眼表的多因素性疾病,可引起眼部不适、视觉障碍、泪膜不稳定和眼表损害,并伴有泪膜渗透性升高和眼表炎症。目前研究表明,炎症在干眼的发病和病理损害中起着重要作用。本文从炎症与泪液渗透压、眼表黏蛋白表达、角结膜上皮结构及功能、泪腺及睑板腺结构和功能等方面对炎症造成干眼眼表和泪液功能损害的可能机制进行综述。 相似文献
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睑板腺功能障碍(MGD)是临床常见的眼表疾病,以睑板腺终末导管的阻塞和/或睑板腺分泌物质或量的改变为特征,导致脂质向泪膜的排出减少,引起泪液蒸发过强。睑缘和睑板腺的炎症是引起睑板腺阻塞,进而导致MGD的直接原因,可引起眼表功能的异常。MGD的诊断主要依靠临床症状与体征,其症状与干眼的症状相似,因此无诊断特异性。体征主要包括睑缘形态的变化、睑板腺分泌异常和睑板腺缺失。MGD的治疗方法包括热敷、清洁睑缘、促进睑板腺的分泌、抗菌、抗炎治疗及润滑眼表,中度、重度MGD患者可给予必要的抗炎治疗,常用的抗炎药物有糖皮质激素、非甾体类抗炎药及免疫抑制剂。临床医师在进行眼部疾病的检查时应重视睑板腺的功能状态,尤其在角膜屈光手术及内眼手术前更应重视MGD的筛查,以免术后引起严重的眼表并发症,有效规避医疗风险。 相似文献
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目的 分析干眼的病因,为干眼症的诊断提供重要依据.方法 回顾126例干眼病例的临床资料,对干眼的症状、泪膜破裂时间、泪液分泌、角膜荧光素染色、睑板腺功能检查、裂隙灯检查及眼表损害等进行分析.结果 126例患者中泪膜破裂时间均异常(100%),泪液分泌试验低于正常83例(65.87%),角膜荧光染色异常者13例(10.32%),睑板腺开口阻塞30例(23.81%).结论 干眼症状与多种因素有关,了解干眼相关因素积极寻找干眼症的病因,为临床诊断提供主要依据,减少误诊的发生. 相似文献
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JuttaHorwath-Winter AndreaBerghold OttoSchmut IngridFloegel VerenaSolhdju ElizabethBodner GeroldSchwantzer Eva-MariaHaller-Schober陆遥 李子良 《美国医学会眼科杂志(中文版)》2004,16(3):146-150
目的:在干眼综合征患者进行治疗的8年观察期中,评估临床病程中的主观症状、泪液功能因素和眼表面形态。方法:对眼部不舒适的97例患者(78例女性和19例男性),根据他们的典型症状和泪膜破裂时间缩短少于10s,临床诊断为干眼综合征。继续检查发现9例患者有水液层不足,32例患者有睑板腺功能障碍,30例患者有水液层不足合并睑板腺功能障碍,12例患者有水液层不足伴有Sjogren综合征,14例患者有水液层不足、睑板腺功能障碍伴有sjogren综合征。初次诊断后对患者进行了12—94个月(平均随访时间为40个月)的随访评估。主要结果测定:根据干眼泪膜破裂时间划分的不同小组在1—8年(平均3.3年)的随访后,将不加表面麻醉剂的Schirmer试验(Schirmer1)、荧光素和孟加拉玫瑰红染色、印记细胞学和主观干眼综合征状及泪液替代剂的使用情况与基础水平进行比较。结果:水液层功能不全合并sjogren综合征,以及水液层不足、睑板腺功能障碍合并Sjogren综合征与其他干眼综合征组比,在基础水平上泪膜功能和眼表面测试结果表示出更明显的病理学异常和更严重的主观症状。在泪液替代剂的使用频率上未观察到任何区别。在随访时,将泪膜破裂时间、Schirmer Ⅰ试验结果和改善的角膜荧光素染色情况与基础数值进行比较,而孟加拉玫瑰红染色和结膜表面的印记细胞学结果基本保持不变,主观症状和人工泪液的使用频率减少。结论:在长达8年的观察中,干眼综合征在适当的治疗后可得到改善或稳定。尽管没有患者得到彻底治愈,但主诉和人工泪液的使用频率都减少了。 相似文献
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目的:比较眼睑加热联合眼睑按摩与人工泪液对办公室干眼的疗效.方法:本研究纳入办公室工作人员干眼患者60例60眼,并随机分为2组.对照组给予人工泪液治疗,试验组给予蒸汽润眼仪联合眼睑按摩治疗.所有受检者均在治疗前、治疗后2、4wk按照以下顺序进行检查:眼表疾病指数问卷表、泪膜破裂时间、角膜荧光素染色、Schirmer I试验与睑板腺分泌功能评估.结果:入选60例60眼干眼患者中,48例48眼患者(对照组23例23眼,试验组25例25眼)患有睑板腺功能障碍.4wk的治疗过程中,眼表疾病指数评分(F分组=41.63,P<0.01)、泪膜破裂时间(F分组=60.47,P<0.01)与睑板腺分泌物性质评分(F分组=12.12,P<0.01),实验组疗效均优于对照组.角膜荧光素染色(F分组=1.79,P>0.05)、泪液分泌量(F分组=0.17,P>0.05)与睑板腺管通畅率评分(F分组=0.68,P>0.05),两组间差异无统计学意义.结论:睑板腺功能障碍是我国办公室干眼的重要病因,眼睑加热联合眼睑按摩对办公室工作人员干眼疗效优于人工泪液. 相似文献
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目的 探讨水液缺乏型干眼和混合型干眼患者睑板腺形态及功能差异。方法 选取四川大学华西医院2018年9月至12月眼科门诊收治的干眼患者67例(67眼),其中水液缺乏型干眼患者32例32眼(水液缺乏型组),混合型干眼患者35例35眼(混合型组)。分别统计两组患者眼表疾病指数问卷调查表得分,采用LipiViewⅡ眼表面干涉仪测量患者泪膜脂质层厚度、不完全瞬目比例,拍摄并记录两组患者上、下睑睑板腺缺失率(MGDR),并进行睑板腺缺失严重程度的评估,检测或记录患者泪膜破裂时间、角膜荧光素染色(FL)评分、泪液分泌试验。结果 水液缺乏型组和混合型组患者眼表疾病指数评分分别为(26.59±17.16)分和(29.31±15.77)分,差异无统计学意义(t=0.676,P=0.501)。水液缺乏型组患者上睑MGDR和FL评分均高于混合型组患者,差异均有统计学意义(均为P<0.05);两组患者泪膜脂质层厚度、不完全瞬目比例、下睑MGDR、泪膜破裂时间、泪液分泌试验结果相比,差异均无统计学意义(均为P>0.05)。水液缺乏型组患者上睑睑板腺缺失严重程度分级较混合型组增高(P<0.05),下睑睑板腺缺失严重程度分级两组差异无统计学意义(P>0.05)。水液缺乏型组患者上、下睑MGDR与FL评分均无相关性(r=0.281,P=0.119;r=0.012,P=0.947)。混合型组上睑MGDR与FL评分呈正相关性(r=0.399,P=0.018),下睑MGDR与FL评分无相关性(r=0.077,P=0.660)。结论 水液缺乏型干眼患者存在睑板腺缺失和萎缩,较混合型干眼患者上睑睑板腺萎缩更严重,角膜损伤更加明显。 相似文献
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An overview on dry eye disease diagnosis: options for new non-invasive testing technologies 下载免费PDF全文
This literature review intends to provide an overview of the new non-invasive testing technologies and their role in the diagnosis of dry eye disease (DED). Including imaging technologies of tear volume, tear film stability, meibomian glands morphology and function, corneal morphology, biomarkers and ocular surface temperature, as well as tear osmolarity, optical quality, blinking test and so on. New testing technologies can provide an indirect and objective assessment of the ocular surface, tear condition and visual quality. Testing technologies, such as tear volume, meibography and tear osmolarity have been widely recognized and applied in clinical practice, showing higher specificity and sensitivity than traditional tests. Others, such as strip meniscometry, interferometer, light scattering technology, double-pass system, blinking test and so on, are currently in the stage of clinical research and improvement, and may translate to routine clinical detection techniques in the future. The new non-invasive testing technologies can non-invasively evaluate the ocular surface and tears, and measure the changes of components related to the disease, which play an important role in the diagnosis, classification, clinical management and curative effect evaluation of DED. 相似文献
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Abdelrahman M. Elhusseiny Ali A. Khalil Reem H. El Sheikh Mohammad A. Bakr Mohamed Gaber Eiss Yasmine M. El Sayed 《国际眼科》2019,12(10):1618-1628
We reviewed the literature for different diagnostic approaches for dry eye disease (DED) including the most recent advances, contradictions and promising diagnostic tools and technique. We performed a broad literature search for articles discussing different methods for diagnosis of DED including assessment of tear osmolarity, tear film stability, ocular biomarkers and others. Articles indexed in PubMed and google scholar were included. With the growing cosmetic industry, environmental pollution, and booming of digital screens, DED is becoming more prevalent. Its multifactorial etiology renders the diagnosis challenging and invites the emergence of new diagnostic tools and tests. Diagnostic tools can be classified, based on the parameter they measure, into tear film osmolarity, functional visual acuity, tear volume, tear turnover, tear film stability, tear film composition, ocular biomarkers and others. Although numerous methods exist, the most accurate diagnosis can be reached through combining the results of more than one test. Many reported tests have shown potential as diagnostic/screening tools, however, require more research to prove their diagnostic power, alone or in combination. Future research should focus on identifying and measuring parameters that are the most specific to DED diagnosis. 相似文献
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James S. Wolffsohn Reiko Arita Robin Chalmers Ali Djalilian Murat Dogru Kathy Dumbleton Preeya K. Gupta Paul Karpecki Sihem Lazreg Heiko Pult Benjamin D. Sullivan Alan Tomlinson Louis Tong Edoardo Villani Kyung Chul Yoon Lyndon Jones Jennifer P. Craig 《The ocular surface》2017,15(3):539-574
The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious. 相似文献
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《Seminars in ophthalmology》2013,28(3):84-93
Dry eye (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation. DED is a common clinical problem and is among the most frequent diagnoses in ophthalmology. It substantially affects quality of life because of the constant ocular discomfort and decrease in visual function. This review discusses the etiology, classification, diagnosis procedures, clinical, and surgical treatments of dry eye. 相似文献
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Role of lymphotoxin alpha as a new molecular biomarker in revolutionizing tear diagnostic testing for dry eye disease 下载免费PDF全文
Chao-Ran Li 《国际眼科》2023,16(11):1883-1889
Dry eye disease (DED), primarily classified as multifactorial ocular surface disorder, afflicts tens of millions of individuals worldwide, adversely impacting their quality of life. Extensive research has been conducted on tear film analysis over the past decades, offering a range of tests to evaluate its volume, health, and integrity. Yet, early diagnosis and effective treatment for DED continue to pose significant challenges in clinical settings. Nevertheless, by recognizing key phenomena in DED such as ocular surface inflammation, hyperosmolarity, and tear film instability, this article provides a comprehensive overview of both traditional and recently developed methods for diagnosing and monitoring DED. The information serves as a valuable resource not only for clinical diagnosis but also for further research into DED. 相似文献
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Mark D.P. Willcox Pablo Argüeso Georgi A. Georgiev Juha M. Holopainen Gordon W. Laurie Tom J. Millar Eric B. Papas Jannick P. Rolland Tannin A. Schmidt Ulrike Stahl Tatiana Suarez Lakshman N. Subbaraman Omür Ö. Uçakhan Lyndon Jones 《The ocular surface》2017,15(3):366-403
The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. 相似文献
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Glenn C. Cockerham Sonne Lemke Catherine Glynn-Milley Lars Zumhagen Kimberly P. Cockerham 《The ocular surface》2013,11(1):25-34
The pathophysiology of neurotrauma is reviewed and an original study investigating the prevalence of dry eye disease in a sample of veterans with traumatic brain injury (TBI) is presented. Fifty-three veterans with TBI were evaluated by history of injury, past ocular history, and medication use. Ocular Disease Surface Index (OSDI), ocular examination, cranial nerve evaluation, tear osmolarity, tear film break-up time (TFBUT), ocular surface staining and tear production testing were performed. A matched comparison group underwent similar testing. TBI causes were blast (44) or non-blast (9). TBI subjects scored significantly worse on the OSDI (P<.001), and ocular surface staining by Oxford scale (P<.001) than non-TBI subjects. Scores for tear film breakup (P=.6), basal tear production less than 3 mm (P=.13), and tear osmolarity greater than 314 mOsm/L (P=.15) were all higher in TBI subjects; significantly more TBI subjects had at least one abnormal dry eye measure than comparisons (P<.001). The OSDI related to presence of dry eye symptoms (P<.01). These effects were present in both blast and non-blast TBI. Seventy percent of TBI subjects were taking at least one medication in the following classes: antidepressant, atypical antipsychotic, anticonvulsant, or h1-antihistamine. There was no association between any medication class and the OSDI or dry eye measures. Reduced corneal sensation in 21 TBI subjects was not associated with OSDI, tear production, or TFBUT, but did correlate with reduced tear osmolarity (P=.05). History of refractive surgery, previous contact lens wear, facial nerve weakness, or meibomian gland dysfunction was not associated with DED. In summary, we found a higher prevalence of DED in subjects with TBI, both subjectively and objectively. This effect is unrelated to medication use, and it may persist for months to years. We recommend that patients with TBI from any cause be evaluated for DED using a battery of standard testing methods described in a protocol presented in this article. Further research into the pathophysiology and outcomes of DED in neurotrauma is needed. 相似文献
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Christophe Baudouin Pasquale Aragona Elisabeth M. Messmer Alan Tomlinson Margarita Calonge Kostas G. Boboridis Yonca A. Akova Gerd Geerling Marc Labetoulle Maurizio Rolando 《The ocular surface》2013,11(4):246-258
Dry eye disease (DED), a multifactorial disease of the tears and ocular surface, is common and has a significant impact on quality of life. Reduced aqueous tear flow and/or increased evaporation of the aqueous tear phase leads to tear hyperosmolarity, a key step in the vicious circle of DED pathology. Tear hyperosmolarity gives rise to morphological changes such as apoptosis of cells of the conjunctiva and cornea, and triggers inflammatory cascades that contribute to further cell death, including loss of mucin-producing goblet cells. This exacerbates tear film instability and drives the cycle of events that perpetuate the condition. Traditional approaches to counteracting tear hyperosmolarity in DED include use of hypotonic tear substitutes, which have relatively short persistence in the eye. More recent attempts to counteract tear hyperosmolarity in DED have included osmoprotectants, small organic molecules that are used in many cell types throughout the natural world to restore cell volume and stabilize protein function, allowing adaptation to hyperosmolarity. There is now an expanding pool of clinical data on the efficacy of DED therapies that include osmoprotectants such as erythritol, taurine, trehalose and L-carnitine. Osmoprotectants in DED may directly protect cells against hyperosmolarity and thereby promote exit from the vicious circle of DED physiopathology. 相似文献
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The NZB/NZW F1 hybrid mouse has been reported to contract a disease similar to Sj?gren's syndrome in man. We studied lacrimal gland morphology, corneal morphology, and tear osmolarity in this mouse as a function of age. Lacrimal glands of hybrid mice contained abnormal periductal infiltrates of lymphocytes and plasma cells. Maximum infiltration of the lacrimal gland occurred in the 29-week-old female hybrid mouse and was estimated to involve 12% of the gland, but was insufficient to alter tear osmolarity relative to DBA and Balb/c control mice. Nevertheless, both NZB/NZW F1 hybrid mice and DBA and Balb/c control mice had tear osmolarity and corneal surface morphology similar to that reported for keratoconjunctivitis sicca in man. Although the NZB/NZW F1 hybrid mouse may provide a valuable model for the study of lacrimal gland infiltration, since its tear osmolarity and ocular surface remain normal for a mouse, its usefulness as a model for ocular surface disease in human keratoconjunctivitis sicca may be more limited than previously thought. 相似文献
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干眼是指由泪液的质、量和动力学异常等原因导致的泪膜稳定性下降或眼表微环境失衡,造成多种眼部不适甚至视功能障碍。其发病机制复杂,目前治疗尚局限于缓解症状,保护视功能。针刺治疗干眼有效,但作用机制尚未完全明确。蛋白质组学技术能系统全面反映蛋白质的功能、结构以及相互作用关系,将蛋白质组学技术应用于针刺治疗干眼的研究,不仅可从不同病因病程揭示干眼蛋白质水平的动态变化,寻找潜在生物标志物,还能系统挖掘针刺治疗干眼的调控机制,为针刺治疗的理论研究和针刺作用的基础研究提供依据。本文旨在探讨蛋白质组学在干眼临床和基础研究中的潜在应用价值,为干眼的诊疗及针刺机制研究提供科学有效的思路。 相似文献