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TFOS DEWS二期定义与分类报告 TFOS DEWS II Definition and Classification Report

Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F

期刊名称:The Ocular Surface




摘要:TFOS DEWSⅡ分类与定义小组的目标是建立一个循证学定义以及当代对干眼症进行分类的系统。新定义表明干眼症具有多因素特征,是一种以泪膜稳态丧失为中心病理生理改变的疾病。眼部症状作为一个广泛的术语,包含眼部不适、视觉干扰、定义中的特征,泪膜不稳定的重要病因学,高渗性,眼表炎症及损伤,这些是在定义中包含的重要因素。根据最新数据来看,神经感觉异常也首次在定义中被提及。在干眼症分类中,最近的证据支持一个基于病理生理学来分类的方案。在这个方案中,泪液缺乏型和蒸发型干眼症被作为一个连续统一体,每一个因素均在诊断和管理中被考虑。方案的中心内容是对有症状和体征干眼症的阳性诊断,这直接指向对恢复内环境稳定的管理,该方案还考虑了多种相关的表现形式,如非显性疾病,包括无症状的眼表体征,包含有感觉异常存在的神经营养状态,以及无明显眼部体征的症状,如神经性疼痛,这种分类方法并非意图推翻临床评估及判断,但应该有助于指导临床管理及研究。


The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.


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