Lemp Michael A
Department of Ophthalmology, Georgetown University School of Medicine, 4000 Cathedral Avenue NW, Washington, DC 20016, USA.
Am J Ophthalmol. 2008 Sep;146(3):350-356. doi: 10.1016/j.ajo.2008.05.016. Epub 2008 Jul 2.
To present evidence from the literature and scientific meetings to support fundamental changes in concepts regarding the prevalence, pathogenesis, definition, diagnosis, management of dry eye disease (DED) and the prospects for the development of new therapies.
Analysis and clinical perspective of the literature and recent presentations.
Review and interpretation of literature.
The tear film and ocular surface form an integrated physiologic unit linking the surface epithelia and secretory glands via a neural network. This sensory-driven network regulates secretory activity in quantity and composition, supporting the homeostasis of the system. The tear film forms a metastable covering between blinks, subserving clear vision, and maintains the health and turnover of the ocular surface cells. Disturbance of intrinsic factors such as increasing age; hormonal balance; systemic or local autoimmune disease, or both; systemic drugs or extrinsic factors including topical medications; environmental stress; contact lens wear; or refractive surgery result in a final common pathway of events at the tear film and ocular surface, resulting in DED. Diagnosis of DED and the design of clinical trials for new drugs have been hampered by a lack of correlation between signs and symptoms and flawed endpoints; successful new drug applications likely will require new approaches, such as the use of objective biomarkers for disease severity.
Recent advances in our knowledge of the causation of DED open opportunities for improving diagnosis and disease management and for developing new, more effective therapies to manage this widely prevalent and debilitating disease state.
展示来自文献和科学会议的证据，以支持在干眼疾病（DED）的患病率、发病机制、定义、诊断、管理以及新疗法开发前景等概念方面的根本性变革。
对文献和近期报告的分析及临床视角。
对文献进行综述和解读。
泪膜和眼表通过神经网络形成一个整合的生理单元，将表面上皮和分泌腺连接起来。这个由感觉驱动的网络调节分泌活动的数量和成分，维持系统的稳态。泪膜在眨眼之间形成一个亚稳态覆盖物，有助于清晰视力，并维持眼表细胞的健康和更新。内在因素如年龄增长、激素平衡、全身性或局部自身免疫性疾病（或两者兼有）、全身性药物，或外在因素包括局部用药、环境压力、佩戴隐形眼镜或屈光手术等的干扰，会导致泪膜和眼表出现一系列最终的共同事件，从而引发DED。DED的诊断以及新药临床试验的设计一直受到症状与体征缺乏相关性以及终点存在缺陷的阻碍；成功的新药应用可能需要新的方法，例如使用客观生物标志物来评估疾病严重程度。
我们对DED病因认识的最新进展为改善诊断和疾病管理以及开发新的、更有效的疗法来治疗这种广泛流行且使人衰弱的疾病状态提供了机会。
