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TFOS DEWS二期医源性报告 TFOS DEWS II iatrogenic report

JAP G, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS

期刊名称:The Ocular Surface




摘要:干眼可因各种医源性干预因素导致。越来越多的患者追求眼部护理或眼部美容手术,同时对干眼症病理生理学机制有更好的理解,导致了TFOS DEWS Ⅱ中存在一份关于医源性干眼症报告的需求。局部用药导致干眼症是由于药物作用于眼球表面的过敏性、毒性以及免疫炎症反应所引起。防腐剂,比如苯扎氯铵,可能进一步加重干眼症。多系统药物也可能导致继发于多种机制的干眼症。此外,佩戴隐形眼镜可以导致干眼症或可能与之相关。然而,最具代表性的情况之一是手术过程导致的干眼症,例如角膜屈光术、LASIK视力矫正术、角膜移植术,由于手术的内部机制(比如角膜神经切断),或者甚至是术后局部药物的使用。白内障手术、眼睑手术、肉毒毒素的应用以及整容手术也被认为是医源性干眼症的危险因素,这可能会导致病人的不满、视觉障碍以及不良术后反应。这份报告还提出了未来解决医源性干眼症的方向,包括对危险因素进行更深入的流行病学研究,研发毒性更小的药物和防腐剂,以及减少眼部侵入性手术的新技术。在外科手术前对早期干眼症的发现,致力于建立适当的治疗方法,以及加大对药物、防腐剂、手术程序的规范和监督力度应该被考虑在内。


Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.


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