提高对睑板腺功能障碍的认识重视睑板腺功能障碍相关性干眼的药物治疗

摘要

Meibomian gland dysfunction (MGD)is a common ocular surface disease in clinic and characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.Meibomian gland obstruction may decrease superficial lipid element of the tear film,resulting in evaporative dry eye.Inflammation of lid margin and meibomian gland may result in conjunctival and corneal disease.Diagnosis of MGD depends on symptom and sign.Symptom of MGD is similar to dry eye,so MGD is nonspecific in diagnosis.Signs of MGD include the changes in morphology of lid margin,quantification of meibum expressibility/quality and dropout of meibomian gland.The managing regimes for MGD are warm,clean compresses and lid massage to increase secretion of meibomian,meanwhile,anti-infection and anti-inflammation and artificial lubricants also are available.Antiinflammation is essential for moderate to severe cases,and the treating medicines include steroid,nonsteroidal antiinflammatory drugs (NSAIDs)and immunosuppressive agents.Evaluation of meibomian gland function is very important when ophthalmologist check ocular surface with slit-lamp,especially for the patients going to perform refractive and intro-operation,so that avoid severe ocular surface complications and evade medical risks.%睑板腺功能障碍(MGD)是临床常见的眼表疾病,以睑板腺终末导管的阻塞和/或睑板腺分泌物质或量的改变为特征,导致脂质向泪膜的排出减少,引起泪液蒸发过强.睑缘和睑板腺的炎症是引起睑板腺阻塞,进而导致MGD的直接原因,可引起眼表功能的异常.MGD的诊断主要依靠临床症状与体征,其症状与干眼的症状相似,因此无诊断特异性.体征主要包括睑缘形态的变化、睑板腺分泌异常和睑板腺缺失.MGD的治疗方法包括热敷、清洁睑缘、促进睑板腺的分泌、抗菌、抗炎治疗及润滑眼表,中度、重度MGD患者可给予必要的抗炎治疗,常用的抗炎药物有糖皮质激素、非甾体类抗炎药及免疫抑制剂.临床医师在进行眼部疾病的检查时应重视睑板腺的功能状态,尤其在角膜屈光手术及内眼手术前更应重视MGD的筛查,以免术后引起严重的眼表并发症,有效规避医疗风险.