Dry Eye Syndromes

干眼综合征
  • 文章类型: Journal Article
    根据韩国干眼症指南制定委员会的文献综述,制定了新的韩国干眼症诊断和管理指南。韩国角膜疾病研究组以前的干眼症指南,对韩国干眼症协会(KDES)成员的调查,和KDES共识会议。干眼症的新定义也由KDES正式成员提出。KDES常规成员的新定义如下:“干眼症是一种以泪膜异常和眼部症状为特征的眼表疾病。”眼部症状和不稳定泪膜(泪液破裂时间<7s)的组合被认为是诊断干眼的重要组成部分。Schirmer试验和眼表染色被认为是辅助诊断标准。治疗指南包括根据房水缺乏占主导地位的简化逐步方法,蒸发占主导地位,和改变泪液分布亚型。新的韩国指南可以作为一个简单的,有效,在临床实践中诊断和管理干眼症的工具。
    New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: \"Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms.\" The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.
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  • 文章类型: English Abstract
    The number of contact lens wearers in China is increasing rapidly. Long-term contact lens wearing may induce or exacerbate tear film instability, and consequently affect the visual quality, ocular surface safety, and compliance of the wearers. To promote the safety and effectiveness of contact lens fitting, and to improve the visual quality and satisfaction of contact lens wearers, the Society of Contact Lens Safety Monitoring & Vision Health of Chinese Health Association has targeted to develop an expert consensus on the diagnosis and treatment of contact lens-associated dry eye. By referring to relevant literature and summarizing clinical experience, the clinical experts in corneal disease, pediatric ophthalmology and optometry have made repeated discussions to form this consensus, including the definition, pathological mechanisms, influencing factors, evaluation, prevention and treatment of contact lens-associated dry eye, for the reference of optometrists and ophthalmologists.
    我国接触镜配戴者数量日益增加。长期配戴各种类型的接触镜可能引起或加重泪膜稳态失衡,从而影响接触镜配戴者的视觉质量、眼表安全及依从性。中国健康管理协会接触镜安全监控与视觉健康专业委员会在参考国内外相关文献和总结临床实践经验的基础上,组织国内角膜病、小儿眼科及视光专业的专家,经过反复讨论、函审及修改,针对接触镜相关性干眼的定义、病理机制、影响因素、评估、预防与治疗等,形成共识性意见,以供眼视光医师在工作中参考使用,共同提高临床接触镜验配工作的安全性和有效性,进一步提升接触镜配戴者的视觉质量和满意度。.
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  • 文章类型: English Abstract
    Meibomian gland dysfunction (MGD) is a common ocular surface disease. In recent years, the meibomian gland-related examination and treatment technologies have evolved rapidly. In order to further optimize the diagnostic process of MGD in China and improve the treatment efficiency of MGD, the Chinese Branch of the Asian Dry Eye Society has organized relevant experts to discuss the clinical characteristics of MGD in China and the progress of research at home and abroad. Based on the expert consensus formed in 2017, the updated consensus opinions have been developed for clinical physicians to refer to in the diagnosis and management of MGD.
    睑板腺功能障碍(MGD)是临床常见的眼表疾病。近年来睑板腺相关检查和治疗技术发展迅速,为了进一步优化我国MGD的诊断流程,提高MGD的治疗效果,亚洲干眼协会中国分会等相关学术组织的专家,根据我国MGD的临床特点,结合近年国内外研究进展和临床实践经验,基于《我国睑板腺功能障碍诊断与治疗专家共识(2017年)》,针对MGD的检查方法、诊断标准和治疗方法进行讨论,形成新的共识性意见,以供临床医师在工作中参考。.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Practice Guideline
    干眼症(DED)眼的角膜穿孔难以管理,由于几个因素的相互作用,如不稳定的泪膜,表面炎症,以及影响伤口愈合过程的潜在全身性疾病,以及最终的结果。需要仔细的术前检查以确定潜在的病理,以及眼表和附件的状态,排除微生物性角膜炎,除了评估穿孔本身外,还下令进行适当的系统性检查。有几种手术选择,其中包括组织粘合剂,多层羊膜移植(AMT),榫补片移植(TPG),角膜补片移植(CPG),穿透性角膜移植术(PK)。程序的选择取决于大小,location,和穿孔的配置。在穿孔较小的眼睛中,组织粘合剂是有效的治疗方式,而AMT,TPG,和CPG是中等尺寸穿孔的可行选择。AMT和TPG在绷带接触镜片的放置可能是挑战的情况下也是优选的。大穿孔需要PK,额外的程序,如tarsorrhy,以保护眼睛免受相关的上皮愈合问题。在视觉潜能差的眼睛中考虑结膜瓣。考虑到在这些情况下延迟上皮化和再穿孔的机会,急性疾病的管理与改善泪液体积的措施结合进行。局部和全身免疫抑制的给药,当指示时,有助于改善结果。这篇综述旨在帮助临床医生在DED环境中建立同步的多方面治疗方法,以成功管理角膜穿孔。
    Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.
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  • 文章类型: Practice Guideline
    白内障手术是世界上最常见的眼科手术之一。发现干眼症(DED)在大多数白内障患者中共存,因为这两种疾病的年龄组重叠。术前评估DED对改善预后很重要。影响泪膜的预先存在的DED可能会影响生物特征。此外,对于DED患者,术中需要特别考虑,以减少并发症并改善术后结局.已知干眼症(DED)在顺利的白内障手术后发生,或者预先存在的DED也可能在白内障手术后恶化。在这些情况下,尽管视觉效果很好,由于令人痛苦的DED症状,患者不满意是常见的。这篇综述旨在总结术前,术中,以及在共存DED的情况下进行白内障手术时的术后注意事项。
    Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.
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  • 文章类型: Practice Guideline
    自体血清滴眼液提供润滑并促进上皮愈合。它们已成功用于治疗眼表疾病,如干眼病,几十年来持续的上皮缺损和神经营养性角膜病变。制备自体血清滴眼液的方法有很大差异,最终浓度和使用持续时间存在于已发表的文献中。在这次审查中,简化的准备建议,运输,描述了自体血清的储存和使用。总结了在房水缺乏的干眼症中使用这种方式的证据,以及基于专业知识的基本原理。
    Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.
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  • 文章类型: Practice Guideline
    睑板腺功能障碍(MGD)引起的蒸发性干眼(EDE)是眼科常见的临床问题之一。它是干眼病(DED)和眼病的主要原因。在EDE中,由睑板腺产生的脂质的数量或质量不足导致眼前泪膜的更快蒸发以及DED的症状和体征。尽管结合临床特征和特殊诊断测试结果进行诊断,该疾病的治疗可能具有挑战性,因为通常很难将EDE与DED的其他亚型区分开来.这是至关重要的,因为DED的治疗方法是通过识别潜在的亚型和原因来指导的。MGD的传统治疗包括热敷,盖子按摩,改善盖子卫生,所有旨在缓解腺体阻塞和促进泪液流出的措施。近年来,出现了新的EDE诊断成像模式和治疗方法,例如矢量热脉动和强脉冲光疗法。然而,众多的管理选择可能会混淆治疗眼科医生,这些患者需要定制的而不是通用的方法。这篇综述旨在提供一种简化的方法来诊断MGD引起的EDE,并为每位患者提供个性化治疗。该综述还强调了改变生活方式和适当咨询的作用,以便患者能够有现实的期望并享受更好的生活质量。
    Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.
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  • 文章类型: Practice Guideline
    干眼症(DED)是一个广泛的术语,包括一组不同的临床疾病。水缺乏性干眼(ADDE),DED的子类型,其特征在于泪腺的泪液产生减少。它可以在多达三分之一的DED患者中看到,并且可以与全身性自身免疫过程并存或继发于环境损害。由于ADDE可能是长期痛苦和严重视力障碍的来源,早期识别和适当的治疗是必要的。多种病因可以作为ADDE的基础,至关重要的是确定根本原因,不仅要改善眼部健康,还要改善受影响个体的整体生活质量和福祉。这篇综述讨论了ADDE的各种病因,强调了一种基于病理生理学的方法来评估潜在的贡献者,概述了各种诊断测试,并回顾治疗方案。我们介绍了当前的标准,并讨论了该领域正在进行的研究。通过这次审查,我们提出了一种治疗算法,该算法将有助于眼科医生诊断和管理ADDE患者.
    Dry eye disease (DED) is a broad term that includes a diverse group of clinical disorders. Aqueous-deficient dry eye (ADDE), a subtype of DED, is characterized by decreased tear production by the lacrimal gland. It can be seen in up to one-third of individuals with DED and can be comorbid with a systemic autoimmune process or occur secondary to an environmental insult. Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative. Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals. This review discusses the various etiologies of ADDE, highlights a pathophysiology-based approach for evaluating underlying contributors, outlines various diagnostic tests, and reviews treatment options. We present the current standards and discuss ongoing research in this field. Through this review, we propose a treatment algorithm that would be useful for an ophthalmologist in diagnosing and managing individuals with ADDE.
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  • 文章类型: Journal Article
    维生素D是一种类固醇激素,在人体生理中具有广泛的作用,不仅在维持钙稳态方面,而且在免疫调节方面,细胞分化,和扩散。维生素D的免疫调节作用是众所周知的,并且适用于眼表免疫细胞和结构细胞。维生素D在干眼症(DED)等眼表疾病中的作用,圆锥角膜(KC),术后结局受到了广泛和当之无愧的关注.维生素D补充剂在临床上以及在实验模型中都显示出改善DED。抗炎特性在诸如DED和KC的眼表病症的治疗中可能是至关重要的。维生素D具有抗炎和细胞外基质重塑特性,在角膜伤口愈合中起着多方面的作用。在这次审查中,我们讨论了如何利用现有的维生素D在这些疾病中的作用的基础和临床知识来治疗DED患者和接受屈光手术的患者.我们的目标是强调临床利用维生素D介导的天然免疫炎症调节与目前可用的标准护理策略相结合的重要性,以减少与眼表疾病相关的发病率和疾病持续时间。
    Vitamin D is a steroid hormone that has widespread role in human physiology, not only in the maintenance of calcium homeostasis but also in immunomodulation, cellular differentiation, and proliferation. The immunomodulatory effects of vitamin D are well known and are applicable to the ocular surface immune cells and structural cells. The role of vitamin D in ocular surface conditions such as dry eye disease (DED), keratoconus (KC), and post-surgical outcomes has received widespread and well-deserved attention. Vitamin D supplementation is shown to improve DED clinically as well as in experimental models. The anti-inflammatory properties may be crucial in the treatment of ocular surface conditions such as DED and KC. Vitamin D plays a multifaceted role in corneal wound healing with its anti-inflammatory and extracellular matrix remodeling properties. In this review, we discuss how to approach patients with DED and those undergoing refractive surgery with the available basic and clinical knowledge on the role of vitamin D in these conditions. We aim to highlight the importance of clinically harnessing vitamin D-mediated natural immuno-inflammatory modulation in combination with currently available standard of care strategies to reduce the morbidity and disease duration associated with ocular surface diseases.
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