目的:据报道,一些全身性药物与干眼病(DED)有关,然而,它们与DED体征和症状严重程度的相关性尚未得到很好的研究.为了评估这些关联,我们对DRy眼科评估和管理(DREAM)研究的数据进行了二次分析.
方法:使用泪液破裂时间(TBUT)评估参与者(N=535)的DED体征,Schirmer测试,角膜荧光素染色,结膜lisamine绿色染色,睑板腺功能障碍(MGD),以及使用眼表疾病指数(OSDI)的泪液渗透压和DED症状。我们从6种DED体征中得出复合体征严重程度评分,并将参与者报告的全身药物分为抗抑郁药,抗组胺药,阿司匹林,皮质类固醇,利尿剂,非甾体抗炎药,质子泵抑制剂,他汀类药物,维生素D3和糖尿病药物,高血压,甲状腺功能减退,偏头痛,和癫痫。使用广义线性模型比较药物使用者和非使用者之间的DED症状和体征评分,调整与DED严重程度相关的因素。
结果:与非用户相比,抗组胺药使用者的TBUT较低(p=0.01),OSDI评分较高(p=0.02);阿司匹林使用者的TBUT较低(p=0.02);皮质类固醇使用者的TBUT较低(p=0.02),较低的Schirmer考试成绩(p=0.03),角膜荧光素染色较高(p=0.01),较高的综合严重程度评分(p=0.01),OSDI评分较高(p=0.03);癫痫发作药物使用者的综合严重程度评分较高(p=0.02);维生素D3使用者的TBUT较低(p=0.001),MGD较高(p=0.03);利尿剂使用者的MGD较低(p=0.03).
结论:某些全身用药可能与更严重的DED相关。这可以指导DED患者的处方实践。
OBJECTIVE: Some systemic medications are reported to be associated with dry eye disease (DED), yet their associations with the severity of DED signs and symptoms are not well studied. To evaluate these associations, we performed a secondary analysis of data from the DRy Eye Assessment and Management (DREAM)
Study.
METHODS: Participants (N = 535) were assessed for DED signs using tear break-up time (TBUT), Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining, meibomian gland dysfunction (MGD), and tear osmolarity and DED symptoms using the Ocular Surface Disease Index (OSDI). We derived a composite signs severity score from the 6 DED signs and categorized participant-reported systemic medications into antidepressants, antihistamines, aspirin, corticosteroids, diuretics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors, statins, vitamin D3, and medications for diabetes mellitus, hypertension, hypothyroidism, migraine, and seizure. Generalized linear models were used to compare DED symptom and sign scores between medication users and non-users, with adjustment for factors associated with DED severity.
RESULTS: Compared to non-users, antihistamine users had lower TBUT (p = 0.01) and higher OSDI score (p = 0.02); aspirin users had lower TBUT (p = 0.02); corticosteroid users had lower TBUT (p = 0.02), lower Schirmer test scores (p = 0.03), higher cornea fluorescein staining (p = 0.01), higher composite severity score (p = 0.01), and higher OSDI score (p = 0.03); seizure medication users had higher composite severity score (p = 0.02); vitamin D3 users had lower TBUT (p = 0.001) and greater MGD (p = 0.03); and diuretic users had less MGD (p = 0.03).
CONCLUSIONS: Certain systemic medications may be associated with more severe DED. This may guide prescription practices in patients with DED.