背景:围绝经期妇女经常遇到原发性获得性鼻泪管阻塞(PANDO),导致泪液流动停滞并导致各种眼部不适症状。然而,对绝经后PANDO患者睑板腺的改变知之甚少。因此,这项研究调查了绝经后PANDO患者睑板腺和眼表的变化。
方法:这项前瞻性研究纳入了60只伴PANDO的绝经后妇女(PANDO组)的60只眼和30只不伴PANDO的绝经后妇女(对照组)的30只眼。PANDO组进一步细分为不完全和完全PANDO组,根据鼻泪管阻塞的程度.使用眼表疾病指数问卷评估患者的症状。使用5M角膜描记器评估睑板腺和眼表。其他眼科检查包括泪液破裂时间,角膜荧光素染色,睑板腺表达,和我测试的Schirmer.分析鼻泪管阻塞程度与其他指标的相关性。
结果:不完全PANDO组的上眼睑损失率大于对照组(p=0.023)。对照组的上眼睑睑板腺变形比完整的PANDO组更严重(p=0.022)。非侵入性撕裂半月板高度更大,而PANDO组的角膜荧光素染色强度低于对照组(均p<0.05)。鼻泪管阻塞程度与非侵入性泪液半月板高度和眼表疾病指数评分呈正相关(分别为p<0.001和p<0.001)。角膜荧光素染色和上眼睑睑板腺变形与鼻泪管阻塞程度呈负相关(分别为p=0.01和p=0.007)。
结论:绝经后PANDO患者睑板腺表现出显著的形态学变化。PANDO不全的绝经后妇女睑板腺丢失应引起更多关注,因为它对于识别PANDO患者的睑板腺损伤至关重要。
BACKGROUND: Primary acquired nasolacrimal duct obstruction (PANDO) is frequently encountered in perimenopausal women, causing tear flow stagnation and resulting in a variety of ocular discomfort symptoms. However, little is known about the alterations in the meibomian gland in postmenopausal women with PANDO. Hence, this
study investigated the changes in the meibomian gland and ocular surface in postmenopausal women with PANDO.
METHODS: This prospective
study included 60 eyes of 60 postmenopausal women with PANDO (PANDO group) and 30 eyes of 30 postmenopausal women without PANDO (control group). The PANDO group was further subdivided into incomplete and complete PANDO groups, based on the degree of nasolacrimal duct obstruction. The patients\' symptoms were evaluated using the ocular surface disease index questionnaire. The meibomian gland and ocular surface were assessed using the Keratograph 5 M. Other ophthalmologic examinations included the tear break-up time, corneal fluorescein staining, meibomian gland expression, and Schirmer I test. The correlations between the degree of nasolacrimal duct obstruction and other metrics were analyzed.
RESULTS: The loss ratio of the upper eyelid was greater in the incomplete PANDO group than in the control group (p = 0.023). Meibomian gland distortion of the upper eyelid was more severe in the control group than in the complete PANDO group (p = 0.022). The non-invasive tear meniscus height was greater, whereas the intensity of corneal fluorescein staining was lower in the PANDO group than in the control group (all p < 0.05). The degree of nasolacrimal duct obstruction was positively associated with the non-invasive tear meniscus height and ocular surface disease index scores (p < 0.001 and p < 0.001, respectively). Corneal fluorescein staining and meibomian gland distortion of the upper eyelid were negatively correlated with the degree of nasolacrimal duct obstruction (p = 0.01 and p = 0.007, respectively).
CONCLUSIONS: Postmenopausal women with PANDO exhibit significant morphological changes in the meibomian gland. More attention should be paid to meibomian gland loss in postmenopausal women with incomplete PANDO, as it is crucial for identifying meibomian gland impairments in patients with PANDO.