目的:描述一种实用的方法来治疗儿童眼睑结膜炎,基于已发表的证据和临床经验。
方法:作者使用德尔菲共识方法探索了一个机构的四名高级临床医生的首选管理模式,以就常用治疗的适应症和剂量时间表达成一致。创建了四个迭代,通过在线调查平台分发电子问卷。最初的问题是基于最近的系统评价和临床经验。每一轮之后,主持人总结了答复,并将其反馈给专家参与者,以及完成下一轮问题的邀请。
结果:典型和特定的眼睑,角膜,结膜疾病特征影响管理决策,治疗针对这些组织中的具体发现,而不是整体疾病严重程度.活动性角膜炎被认为是高效能类固醇的主要适应症,全身性抗生素,可能还有全身性免疫调节剂.全身性抗生素的其他适应症是慢性活动性睑缘炎和复发性麻烦性cha症。口服抗生素因其抗炎和抗微生物特性而被使用。关于饮食调整的作用几乎没有共识,局部润滑剂,并偏爱口服或局部抗生素。
结论:眼睑和眼表的详细临床评估允许有针对性的治疗。需要研究以阐明疾病机制并优化治疗策略。[J.眼睛斜视.2017;54(3):156-162。].
OBJECTIVE: To describe a pragmatic approach to the medical management of blepharokeratoconjunctivitis in children, based on published evidence and clinical experience.
METHODS: The authors used the Delphi
consensus method to explore the preferred management patterns of four senior clinicians at one institution to reach agreement on indications and dosage schedules for commonly used treatments. Four iterations were created, with electronic questionnaires distributed via an online survey platform. Initial questions were based on recent systematic reviews and clinical experience. After each round, a facilitator summarized the responses and fed these back to the expert participants, together with an invitation to complete the next round of questions.
RESULTS: Typical and specific eyelid, corneal, and conjunctival disease features influenced management decisions, and treatments were targeted toward specific findings in these tissues rather than to overall disease severity. Active keratitis was considered the main indication for high potency steroids, systemic antibiotics, and possibly systemic immunomodulators. Other indications for systemic antibiotics were chronic active blepharitis and recurrent troublesome chalazia. Oral antibiotics were used for their anti-inflammatory and antimicrobial properties. There was little agreement on the role of dietary modification, topical lubricants, and preference for oral or topical antibiotics.
CONCLUSIONS: Detailed clinical assessment of eyelids and ocular surface allows targeted treatment. Research is needed to clarify disease mechanisms and to optimize treatment strategies. [J Pediatr Ophthalmol Strabismus. 2017;54(3):156-162.].