McMonnies Charles W
School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia.
Clin Exp Optom. 2016 Jul;99(4):366-72. doi: 10.1111/cxo.12343. Epub 2016 Jun 16.
Eye rubbing is commonly associated with keratoconus and may contribute to disease onset and progression. Verbal counselling to avoid rubbing may not be successful and adverse consequences of rubbing, which occurs on contact lens removal may be more serious. This study examines the prevalence of 'removal-relief' rubbing and its potential consequences.
Rubbing histories were recorded for contact lens wearing normal and keratoconic patients as well as for normal non-contact lens wearers. Analogue scaled responses were used to identify and compare abnormal rubbing habits.
Contact lens wearing patients (both with and without keratoconus) reported significantly more rubbing before contact lens insertion (p < 0.05) compared to non-contact lens wearers. Eye rubbing after contact lens removal ('removal-relief' rubbing) was found to be significantly more prevalent among contact lens-wearing keratoconic patients compared to contact lens-wearing non-keratoconic patients (p < 0.001 in both cases).
Rubbing-related trauma occurring before contact lens insertion may predispose the cornea to wound healing activities and greater levels of adverse response to contact lens wear. Such adverse responses could predispose the cornea to greater trauma, which occurs in response to rubbing on removal of contact lenses. Strong counselling to avoid eye rubbing is often not an adequate form of management for a significant number of patients with keratoconus. Evidence of relapses indicates the need for better methods of counselling and for them to be repeated regularly. Apart from keratoconus, any other keratectasia, corneal disease or wound healing (including post-surgical) may increase susceptibility to corneal rubbing trauma. Such cases also appear to warrant counselling on avoidance of rubbing.
揉眼通常与圆锥角膜相关，可能促使疾病发生和发展。通过言语劝告来避免揉眼可能并不成功，而且在摘除隐形眼镜时揉眼所产生的不良后果可能更严重。本研究调查了“摘除-缓解”性揉眼的发生率及其潜在后果。
记录了佩戴隐形眼镜的正常人和圆锥角膜患者以及不佩戴隐形眼镜的正常人的揉眼史。使用模拟量表反应来识别和比较异常的揉眼习惯。
与不佩戴隐形眼镜者相比，佩戴隐形眼镜的患者（包括有和没有圆锥角膜的患者）在插入隐形眼镜前报告的揉眼次数明显更多（p < 0.05）。与佩戴隐形眼镜的非圆锥角膜患者相比，佩戴隐形眼镜的圆锥角膜患者在摘除隐形眼镜后揉眼（“摘除-缓解”性揉眼）的情况明显更普遍（两种情况均为p < 0.001）。
在插入隐形眼镜前发生的与揉眼相关的创伤可能使角膜易于出现伤口愈合活动以及对隐形眼镜佩戴产生更高水平的不良反应。这种不良反应可能使角膜更容易受到创伤，而这种创伤是在摘除隐形眼镜时因揉眼而发生的。对于大量圆锥角膜患者而言，单纯通过强烈劝告来避免揉眼往往并非充分的治疗方式。复发的证据表明需要更好的劝告方法并定期重复进行。除圆锥角膜外，任何其他角膜扩张、角膜疾病或伤口愈合情况（包括手术后）都可能增加角膜受到揉眼创伤的易感性。这类情况似乎也需要进行关于避免揉眼的劝告。
