首頁 > 期刊首頁 > 美中國際眼科雜志 > 2002年1期 > 幹眼癥
幹眼癥
Dry Eeyes: Diagnosis and Management
- doi：
- 摘要：
- 幹眼癥是一種常見眼表疾病,病人至訴有幹澀感、畏光燒灼感、視物模糊、視力波動、不適感、異物感和易視疲勞等癥狀.以下臨床檢查有助于診斷:淚膜破裂時間,淚液分泌實驗和診斷染色(熒光素和虎紅染色),很多多實驗室檢查都有助于診斷,但由于儀器不足及費用過高,臨床上并不常采用.現今的治療有淚液成分的替代治瘵及保留淚液,但并不治本,而祗是緩解癥狀.用人工淚液和潤滑劑替代淚液以提高表面濕度,增加潤滑度及提高視銳度是目前應用最廣的療法.大多數制劑含防腐劑和表面毒性,長期使用,會導致并發癥.采用防腐性自由淚液是過去10年促進淚液替代的最重要方法.淚小黠封閉衍是保留淚液最有效最實用的瘵法,由硅膠、特氟隆和HEMA制作的淚小黠栓子植入垂直小管或水平小管.因為淚小黠栓子會游移及導致潛伏性并發癥,此法祗用于持續注入人工淚液臨床改善不明顯的病人.經常用口服制劑來促進淚液分泌,但因其潛在副作用,而且一旦腺體被廣泛破壞,剌激也產生不了很多淚液.紅腫腺體的刺激會在表面釋放炎癥的淚液,使病情惡化,慢性免疫介導的炎癥過程是導致幹眼癥發生的主要因素.局部環孢菌素A和局部用甲強龍有一定瘵效.性激素與淚液產生的關系復雜,全身性雌激素療法對幹眼癥病人有益.局部維生素A對伴有磷狀組織燮形和角質化的病人治療有效.自家血液療法對并有嚴重SPK及持續上皮缺陷的幹眼癥病人療效顯著,眼瞼中層注射毒桿菌毒素可以降低淚液的流失.雖然最近幹眼癥的治療主要是針對癥狀的,但對免疫介導病因學的了解日益提高,針對此方面的治瘵也益增多.
- Abstract：
- Dry eye is a commonly encountered clinical condition in day to day practice. The patient presents with symptoms which in-cludes awareness, tearing, burning, blurring of vision, fluctuating vision, irritation, foreign body sensation and tired eyes. The clinical tests which are helpful in the diagnosis include tear film breakup time, Schirmer's test and diagnostic dye staining (Fluorescein & Rose bengal). Various laboratory tests have been reported useful in the diagnosis, but these tests are not usually performed because of the non-availability of the instruments and the cost involved. Current treatment of dry eyes is largely palliative, that is to provide symptomatic relief. Treatment includes replacing or conserving tears. The tear replacement by artificial tears and lubricants is currently the most widely used therapy for dry eyes. The goals of treatment are to increase the humidity at the surface, to increase lubrication and to improve visual acuity. Most of these preparations contain preservatives and surface toxicity when used on long term is an important complication. Introduction of preservative free tears is the most important contribution in the formulation of the tear substitutes in the last decade or so. Punctal occlusion is one of the most useful and practical therapies for conserving tears. Punctal plugs made up of silicone, Teflon and HEMA are inserted into either the horizontal canaliculus or into the vertical canaliculus. These are considered only in patients showing no clinical improvement with frequent instillation of artificial tears, as they can migrate and can cause potential complications. Stimulation of tear production are usually done by oral medications. They are not usually considered because of the potential side effects and whenever the glands are extensively damaged, stimulation will not produce much tears. Stimulation of the inflamed gland can deliver pro-inflammatory tears on the surface, worsening the disease. Chronic immune-mediated inflammation process appears to play an essential role in pathogenesis of dry eyes. Topical cyclosporine A and topical methylprednisolone have been tried with encouraging results. The relationship between sexual hormones and tear production appears complex. Systemic estrogen therapy has been reported to be useful in patients with dry eyes. Topical Vitamin A has been useful in patients with squamous metaplasia and keratinization. Autologous serum has been found useful in dry eye patients with severe SPK's and persistent epithelial defects. Injection of Botulinum toxin into the medial aspect of the lids has been found to decrease the lacrimal drainage. Though presently the treatment of dry eyes is mainly symptomatic, with increasing understanding of the immune-mediated pathogenesis, treatment aimed at this aspect of the disease is encouraging.
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