Eyelid Diseases

眼睑疾病
  • 文章类型: Journal Article
    黄血病(XP)是皮肤黄色瘤的主要形式,因为它占95%以上的病例。它的特征是存在含有大量低密度脂蛋白(LDL)的泡沫细胞簇,它们位于皮肤的结缔组织中,肌腱,和筋膜。XP病变通常表现为独特的黄橙色黄斑,丘疹,或结节,主要位于上眼睑和内眼角。女性受影响的频率是男性的两倍,病变通常出现在35至55岁之间。XP的病理生理学涉及异常的脂质代谢,通常与高脂血症状态相关,如II型和IV型高脂血症。甲状腺功能减退,体重增加,和高脂肪饮食。尽管有各种治疗方法,当前的XP管理缺乏标准化,特别是由于有限的比较研究。为了解决这个差距,我们对2012年至2023年间发表的45项研究进行了广泛的文献综述,提供了当前XP治疗方式的最新概述.这种全面的分析将使研究人员和临床医生了解XP管理的不断发展。
    Xanthelasma palpebrarum (XP) is the predominant form of cutaneous xanthoma, as it accounts for greater than 95% of cases. It is characterized by the presence of foam cell clusters containing a large amount of low-density lipoprotein (LDL), which are located in the connective tissue of skin, tendons, and fascia. XP lesions commonly present as distinctive yellow-orange macules, papules, or nodules, and are primarily on the upper eyelids as well as the inner canthus. Women are affected twice as often as men, with lesions typically emerging between the ages of 35 and 55. The pathophysiology of XP involves abnormal lipid metabolism and is often associated with hyperlipidemic states like Type II and IV hyperlipidemia, hypothyroidism, weight gain, and fatty diet. Despite the availability of various treatment methods, current XP management lacks standardization, particularly due to limited comparative research. To address this gap, we conducted an extensive literature review of 45 studies published between 2012 to 2023, which provides an updated overview of current XP treatment modalities. This comprehensive analysis will inform researchers and clinicians on the evolving landscape of XP management.
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  • 文章类型: Journal Article
    在这篇评论中,我们的目的是调查性别特异性睑板腺功能障碍(MGD)患病率的文献,并确定女性还是男性患MGD的风险更大.
    在PubMed上使用以下术语进行搜索:(性别或性别或患病率)和(睑板腺)。
    确定了24项有关MGD患病率的相关研究,包括10项基于人群的研究和14项基于医院的研究。在基于人群的研究中,五项研究报告男性发病率较高,三项研究没有发现差异,一项研究观察到女性的发病率更高。在以医院为基础的研究中,10项研究报告没有差异,两个人在男性中发现了更高的比率,在女性中发现更高。在综述的文献中,在质量方面,研究之间存在相当大的差异,样本量,年龄范围,诊断标准。
    虽然大多数基于人群的研究表明男性患病率较高,大多数基于临床的研究没有显着差异。需要进行更大样本和标准化标准的进一步研究,以确定男性是否确实更容易受到MGD的影响。
    In this review, we aimed to investigate the literature on sex-specific prevalence of meibomian gland dysfunction (MGD) and to determine whether women or men are more at risk for MGD.
    A search was conducted on PubMed using the terms: (Sex OR Gender OR prevalence) AND (Meibomian gland).
    Twenty-four relevant studies on MGD prevalence were identified, including 10 population-based and 14 hospital-based studies. Among the population-based studies, five studies reported higher rates among men, three studies found no differences, and one study observed higher rates among women. In the hospital-based studies, 10 studies reported no difference, two found higher rates among men, and one found higher among women. In the reviewed literature, there was a considerable variation between studies in terms of quality, sample size, age ranges, diagnostic criteria.
    While most of the population-based studies suggest a higher prevalence among men, the majority of clinic-based studies show no significant difference. Further research with larger samples and standardized criteria is needed to determine whether men are indeed more susceptible to MGD.
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  • 文章类型: Journal Article
    这篇综述的目的是研究评估,诊断,与面神经麻痹相关的眼科并发症的处理,并讨论当前和未来的干预措施。面神经麻痹的眼科并发症包括眼睑,外翻,暴露性角膜病变,眼运动联合,鳄鱼的眼泪在初始诊断后不久,由熟练识别和管理面瘫并发症的眼科医生进行评估可以帮助识别和预防长期并发症。几种类型的分级量表用于评估,衡量严重程度,并追踪手术和患者报告的治疗结果.使用旨在润滑和遮盖眼睛的临时措施来管理Laghophymos或外翻,包括巩膜晶状体;然而,这些措施的获取和维护可能是昂贵且具有挑战性的。临时手术干预措施包括侧卧位修补术,加权眼睑植入物,外侧泪腺成形术,和其他收紧或抬起眼睑或周围组织的程序。由于医源性损伤或肿瘤引起的弛缓性面瘫的治疗需要神经修复或移植修复。慢性面瘫动态重建的最常见技术是区域和游离肌瓣转移。眼科并发症管理的未来方向旨在通过开发可以检测正常眼睛中的眨眼并使用刺激肌肉以诱导眼睑闭合的机制将信号传输到瘫痪的眼睛的系统来诱导眨眼和眼睛闭合。眨眼检测技术已经发展,一项研究表明,眨眼可以使用面神经zy支的电极来刺激。需要进一步的研究来开发一种自动眨眼并使其与正常眼睛同步的系统。
    The purpose of this review was to study the evaluation, diagnosis, and management of ophthalmic complications associated with facial nerve palsy and to discuss the current and future interventions. The ophthalmic complications of facial paralysis include lagophthalmos, ectropion, exposure keratopathy, ocular synkinesis, and crocodile tears. Evaluation by an ophthalmologist skilled in recognizing and managing complications of facial paralysis shortly after its initial diagnosis can help identify and prevent long-term complications. Several types of grading scales are used to evaluate, measure the severity, and track surgical and patient-reported treatment outcomes. Lagophthalmos or ectropion are managed using temporary measures aimed at lubricating and covering the eye, including scleral lenses; however, these measures can be expensive and challenging to acquire and maintain. Temporary surgical interventions include lateral tarsorrhaphy, weighted eyelid implants, lateral canthoplasty, and other procedures that tighten or lift the eyelid or surrounding tissues. Management of flaccid facial paralysis due to iatrogenic injury or neoplasm requires neurorrhaphy or graft repair. The most common techniques for dynamic reconstruction in chronic facial paralysis are regional and free muscle flap transfer. Future directions for the management of ophthalmic complications aim to induce blinking and eye closure by developing systems that can detect blinking in the normal eye and transmit the signal to the paralyzed eye using mechanisms that would stimulate the muscles to induce eyelid closure. Blink detection technology has been developed, and a study demonstrated that blinking can be stimulated using electrodes on the zygomatic branch of the facial nerve. Further studies are needed to develop a system that will automate blinking and synchronize it with that of the normal eye.
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  • 文章类型: Systematic Review
    瘢痕性下眼睑回缩是一个具有挑战性的条件。它涉及下眼睑的疤痕,这导致它缩回并暴露巩膜。这可能导致并发症,如干眼综合征和角膜融化。可能是外伤造成的,烧伤,或之前的眼睑手术。对眼睑解剖和退缩的详细评估和了解对于成功的手术计划至关重要。眼睑的动态和静态检查,包括测量下眼睑边缘反射距离(MRD2)和巩膜显示,对于确定适当的治疗方法也至关重要。
    使用Medline进行了系统评价,Scopus,和Cochrane数据库,其关键字与瘢痕性下眼睑退缩有关。2000年以后,出版物语言仅限于英语。共纳入29篇文章进行数据提取和分析。
    主要的手术技术包括骨结膜移植物,垫片,面部中间提升,外侧肌腱悬吊,尽管没有一个单一的程序被普遍公认为黄金标准。正在探索合成移植物和异种移植物等新创新技术在眼睑重建中的潜力。严重病例,定义为巩膜下显示大于2毫米,可能需要重建方法的组合。
    矫正瘢痕性下眼睑回缩是眼可塑性重建的主要挑战。手术方式应个体化,考虑到眼睑退缩的病理和病因。深入的知识和仔细的手术计划对于最佳结果至关重要。没有黄金标准技术,和术后结果,并发症,和管理取决于所使用的手术方法。
    UNASSIGNED: Cicatricial lower eyelid retraction is a challenging condition. It involves scarring of the lower eyelid, which causes it to retract and expose the sclera. This can lead to complications such as dry eye syndrome and corneal melting. It can be caused by trauma, burns, or previous eyelid surgery. Detailed assessment and understanding of eyelid anatomy and retraction are critical for successful surgical planning. Dynamic and static examinations of the eyelid including measurements of the lower eyelid margin reflex distance (MRD2) and scleral show are also essential to determine the appropriate treatment approach.
    UNASSIGNED: A systematic review was conducted using Medline, Scopus, and Cochrane databases with keywords related to cicatricial lower eyelid retraction. The publication language was limited to English after 2000. A total of 29 articles were included for data extraction and analysis.
    UNASSIGNED: The main surgical techniques include tarsoconjunctival grafts, spacers, midface lift, and lateral canthal tendon suspension, although no single procedure has been universally recognized as the gold standard. New innovations such as synthetic grafts and xenografts are being explored for their potential in eyelid reconstruction. Severe cases, defined as those with inferior scleral show greater than 2 mm, may require a combination of reconstruction methods.
    UNASSIGNED: Correcting cicatricial lower eyelid retraction is a major challenge in oculoplastic reconstruction. The surgical approach should be individualized, considering the pathologies and etiologies of lid retraction. In-depth knowledge and careful surgical planning are essential for best outcomes. There is no gold standard technique, and postoperative outcomes, complications, and management vary depending on the surgical approach used.
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  • 文章类型: Meta-Analysis
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  • 文章类型: Meta-Analysis
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  • 文章类型: Meta-Analysis
    背景:阻塞性睡眠呼吸暂停(OSA)与眼部疾病发展的关系尚不清楚。本系统综述和荟萃分析试图总结和分析文献中OSA与眼部疾病之间的关联。
    方法:PubMed,EMBASE,谷歌学者,网络科学,和Scopus数据库从1901年至2022年7月根据系统评价和荟萃分析(PRISMA)的首选报告进行搜索。我们的主要结果评估了OSA与发展眼睑松弛综合征(FES)的几率之间的关联,青光眼,非动脉炎性前部缺血性视神经病变(NAION),视网膜静脉阻塞(RVO),圆锥角膜(KC),特发性颅内高压(IIH),年龄相关性黄斑变性(AMD),和中心性浆液性脉络膜视网膜病变(CSR),通过95%置信区间计算的比值比。
    结果:纳入49项研究进行系统评价和荟萃分析。NAION的合并OR估计值最高[3.98(95%CI2.38,6.66)],其次是FES[3.68(95%CI2.18,6.20)],RVO[2.71(95%CI1.83,4.00)],企业社会责任[2.28(95%CI0.65,7.97)],KC[1.87(95%CI1.16,2.99)],青光眼[1.49(95%CI1.16,1.91)],IIH[1.29(95%CI0.33,5.01)],和AMD[0.92[95%CI0.24,3.58]除IIH和AMD外,所有观察到的关联均显著(p<0.001)。
    结论:OSA与NAION显著相关,FES,RVO,CSR,KC,和青光眼。临床医生应该被告知这些关联,以便尽早认识到,诊断,眼部疾病的治疗可以在高危人群中解决,早期转诊眼科服务是为了防止视力障碍。同样,眼科医生对患有上述任何疾病的患者应考虑筛查和转诊患者以评估可能的OSA.
    BACKGROUND: The association of obstructive sleep apnea (OSA) with development of eye diseases is unclear. This current systematic review and meta-analysis attempts to summarize and analyze associations between OSA and ocular disorders in the literature.
    METHODS: PubMed, EMBASE, Google Scholar, Web Of Science, and Scopus databases were searched from 1901 to July 2022 in accordance with the Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA). Our primary outcome assessed the association between OSA and the odds of developing floppy eyelid syndrome (FES), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), keratoconus (KC), idiopathic intracranial hypertension (IIH), age-related macular degeneration (AMD), and central serous chorioretinopathy (CSR) through odds ratio calculated at the 95% confidence interval.
    RESULTS: Forty-nine studies were included for systematic review and meta-analysis. The pooled OR estimate was highest for NAION [3.98 (95% CI 2.38, 6.66)], followed by FES [3.68 (95% CI 2.18, 6.20)], RVO [2.71(95% CI 1.83, 4.00)], CSR [2.28 (95% CI 0.65, 7.97)], KC [1.87 (95% CI 1.16, 2.99)], glaucoma [1.49 (95% CI 1.16, 1.91)], IIH [1.29 (95% CI 0.33, 5.01)], and AMD [0.92 [95% CI 0.24, 3.58] All observed associations were significant (p < 0.001) aside from IIH and AMD.
    CONCLUSIONS: OSA is significantly associated with NAION, FES, RVO, CSR, KC, and glaucoma. Clinicians should be informed of these associations so early recognition, diagnosis, and treatment of eye disorders can be addressed in at-risk groups, and early referral to ophthalmic services is made to prevent vision disturbances. Similarly, ophthalmologists seeing patients with any of these conditions should consider screening and referring patients for assessment of possible OSA.
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  • 文章类型: Meta-Analysis
    目的:评价口服多西环素抗生素与大环内酯类药物治疗睑板腺功能障碍(MGD)的疗效和安全性。
    方法:系统评价和荟萃分析。
    方法:我们对包括口服抗生素MGD治疗临床结果在内的所有同行评审的已发表研究进行了系统的电子数据库检索。在加权汇总分析中提取并评估了各个研究数据,包括总体征和症状评分,睑板腺分泌评分,泪液破裂时间(TBUT),荧光素染色评分及并发症发生率。
    结果:发现了两千九百三十三项研究,其中54人有资格进行系统审查,六项前瞻性研究最终被纳入分析,报告了来自三个国家的563例病例。受影响患者的年龄在12至90岁之间。总的来说,两种治疗方法均可改善MGD体征和症状。在汇总分析中,大环内酯类药物的总体征评分(合并标准化平均差(SMD)-0.51,95%置信区间(CI):-0.99至-0.03)睑板腺分泌评分(合并SMD-0.25,95CI:[-0.48,-0.03]),TBUT(SMD-0.31,95CI:[-0.50,-0.13])和荧光素染色评分(SMD-1.01,95CI:[-1.72,-0.29])。此外,虽然两种治疗方法均未出现严重并发症,大环内酯组的不良事件显著减少(合并比值比0.24,95%CI为0.16~0.34).
    结论:大环内酯类和四环素类都是MGD的有效治疗方法。在这项研究中,与四环素类药物相比,大环内酯类药物具有更好的疗效和安全性.
    OBJECTIVE: To review the efficacy and safety of oral doxycycline antibiotics versus macrolides in the treatment of meibomian gland dysfunction (MGD).
    METHODS: Systematic review and meta-analysis.
    METHODS: We performed a systematic search of electronic databases for all peer-reviewed published studies which included clinical outcomes of oral antibiotic MGD treatment. Individual study data were extracted and evaluated in a weighted pooled analysis, including total sign and symptom scores, meibomian gland secretion score, tear break-up time (TBUT), fluorescein staining score and rate of complications.
    RESULTS: Two thousand nine hundred and thirty-three studies were found, of which 54 were eligible for the systematic review, and six prospective studies were ultimately included for analysis, reporting on 563 cases from three countries. Age of affected patients ranged between 12 and 90 years. Overall, both treatment methods induced improvement in MGD signs and symptoms. In pooled analysis, macrolides were significantly superior in the total signs score (pooled standardized mean difference (SMD) -0.51, 95% confidence interval (CI): -0.99 to -0.03), meibomian gland secretion score (pooled SMD -0.25, 95%CI: [-0.48, -0.03]), TBUT (SMD -0.31, 95%CI: [-0.50, -0.13]) and fluorescein staining score (SMD -1.01, 95%CI: [-1.72, -0.29]). Moreover, while no severe complications were reported for both treatments, the macrolide group exhibited significantly less adverse events (pooled odds ratio 0.24 with a 95% CI of 0.16 to 0.34).
    CONCLUSIONS: Both macrolides and tetracyclines are effective treatments for MGD. In this study, macrolides exhibited better efficacy and safety profile compared to tetracyclines.
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  • 文章类型: Review
    目的:探讨强脉冲光(IPL)治疗眼睑炎症的相关临床转归及可能机制。背景:IPL装置主要应用于皮肤血管畸形,已在眼部疾病中使用了约20年。主要包括睑板腺功能障碍(MGD),眼睑炎,和眼酒渣鼻。最新发现:包括72项原始临床研究,MGD为57,4用于眼睑炎或眼睑炎相关性角膜结膜炎,酒渣鼻和11。干眼症状,(撕裂)分手时间(BUT),大多数患者的睑板结构和/或功能得到改善,而活性氧的产生是IPL介导的光生物调节的重要环节,可以影响许多信号通路来实现抗炎,抗感染,和前分化效应。结论:有证据表明,IPL是大多数MGD患者的有效治疗工具,但其他适应症需要更多的临床证据。
    Objective: To evaluate relevant clinical outcomes and conclude possible mechanisms of intense pulsed light (IPL) in eyelid inflammation. Background: IPL devices were primarily applied in cutaneous vascular malformations and have been used in ocular diseases for about 20 years, mostly including meibomian gland dysfunction (MGD), blepharitis, and ocular rosacea. Recent findings: Seventy-two original clinical researches were included, 57 for MGD, 4 for blepharitis or blepharitis-related keratoconjunctivitis, and 11 for rosacea. Dry eye symptoms, (tear) break-up time (BUT), and meibomian structure and/or functions were improved in most patients, but production of reactive oxygen species is an important link in the photobiomodulation mediated by IPL, which can influence numerous signal pathways to achieve anti-inflammatory, anti-infective, and prodifferentiation effects. Conclusions: The evidence suggests that IPL is an effective therapeutic tool for most patients with MGD, but more clinical evidence is needed for other indications.
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  • 文章类型: Meta-Analysis
    结论:睑板腺功能障碍降低了睑脂的质量和/或数量。已经提出了血脂异常与睑板腺功能障碍之间的关联,但这还没有估计。因此,这项研究评估了睑板腺功能障碍中血脂异常的几率。
    目的:使用meta分析评估血脂异常与睑板腺功能障碍之间的关系。
    方法:搜索了以下数据库:PubMed,谷歌学者,还有Scopus.包括评估血脂异常与睑板腺功能障碍之间关联的病例对照和队列研究。使用比值比评估该关联。用卡方统计量和不一致程度评估研究之间的异质性。使用纽卡斯尔-渥太华量表评估研究质量。系统评价在PROSPERO上注册(ID:CRD42022347982)。
    结果:系统评价包括3项病例对照和2项队列研究。睑板腺功能障碍患者出现高胆固醇血症和高甘油三酯血症的几率分别为5.45(95%CI:1.65~17.95)和3.28(95%CI:1.25~8.62),分别。睑板腺功能障碍患者血清低密度脂蛋白升高和高密度脂蛋白降低的几率分别为2.72(95%CI:1.24~5.98)和1.15(95%CI:0.74~1.79),分别。目前研究的局限性是性别的影响,年龄,和睑板腺功能障碍严重程度关于血脂异常和睑板腺功能障碍之间的关联没有评估。
    结论:目前的研究表明血脂异常与睑板腺功能障碍之间存在显著关联。这一发现表明睑板腺功能障碍的诊断可能需要血脂异常筛查。
    This study aimed to use meta-analysis to estimate the association between dyslipidemia and meibomian gland dysfunction.
    The following databases were searched: PubMed, Google Scholar, and Scopus. Case-control and cohort studies assessing the association between dyslipidemia and meibomian gland dysfunction were included. The association was assessed using odds ratios. Heterogeneity between studies was assessed with the χ2 statistic and degree of inconsistency. The quality of studies was assessed using the Newcastle-Ottawa Scale. The systematic review was registered on PROSPERO (ID: CRD42022347982).
    The systematic review included three case-control and two cohort studies. The odds of hypercholesterolemia and hypertriglyceridemia in meibomian gland dysfunction were 5.45 (95% confidence interval [CI], 1.65 to 17.95) and 3.28 (95% CI, 1.25 to 8.62), respectively. The odds of elevated serum low-density lipoprotein and reduced high-density lipoprotein in meibomian gland dysfunction were 2.72 (95% CI, 1.24 to 5.98) and 1.15 (95% CI, 0.74 to 1.79), respectively. The current study\'s limitation is that the effects of sex, age, and meibomian gland dysfunction severity on the association between dyslipidemia and meibomian gland dysfunction were not assessed.
    The current study suggests a significant association between dyslipidemia and meibomian gland dysfunction. This finding suggests that meibomian gland dysfunction diagnosis may call for dyslipidemia screening.
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