Daniel Moritz Claudius, O'Gallagher Michael, Hingorani Melanie, Larkin Daniel F, Tuft Stephen, Dahlmann-Noor Annegret
J Pediatr Ophthalmol Strabismus. 2017 May 1;54(3):156-162. doi: 10.3928/01913913-20161013-04. Epub 2016 Dec 16.
To describe a pragmatic approach to the medical management of blepharokeratoconjunctivitis in children, based on published evidence and clinical experience.
The authors used the Delphi consensus method to explore the preferred management patterns of four senior clinicians at one institution to reach agreement on indications and dosage schedules for commonly used treatments. Four iterations were created, with electronic questionnaires distributed via an online survey platform. Initial questions were based on recent systematic reviews and clinical experience. After each round, a facilitator summarized the responses and fed these back to the expert participants, together with an invitation to complete the next round of questions.
Typical and specific eyelid, corneal, and conjunctival disease features influenced management decisions, and treatments were targeted toward specific findings in these tissues rather than to overall disease severity. Active keratitis was considered the main indication for high potency steroids, systemic antibiotics, and possibly systemic immunomodulators. Other indications for systemic antibiotics were chronic active blepharitis and recurrent troublesome chalazia. Oral antibiotics were used for their anti-inflammatory and antimicrobial properties. There was little agreement on the role of dietary modification, topical lubricants, and preference for oral or topical antibiotics.
Detailed clinical assessment of eyelids and ocular surface allows targeted treatment. Research is needed to clarify disease mechanisms and to optimize treatment strategies. [J Pediatr Ophthalmol Strabismus. 2017;54(3):156-162.].
基于已发表的证据和临床经验，描述一种针对儿童睑角膜结膜炎进行药物治疗的实用方法。
作者采用德尔菲共识法，探讨一家机构的四位资深临床医生的首选治疗模式，以就常用治疗方法的适应证和用药方案达成一致。通过在线调查平台分发电子问卷，共进行了四轮。初始问题基于近期的系统评价和临床经验。每轮之后，主持人总结回答内容，并将其反馈给专家参与者，同时邀请他们完成下一轮问题。
典型和特定的眼睑、角膜及结膜疾病特征影响治疗决策，治疗针对这些组织的特定表现，而非整体疾病严重程度。活动性角膜炎被视为强效类固醇、全身用抗生素以及可能的全身免疫调节剂的主要适应证。全身用抗生素的其他适应证为慢性活动性睑缘炎和复发性难治性睑板腺囊肿。口服抗生素因其抗炎和抗菌特性而被使用。在饮食调整、局部润滑剂的作用以及对口服或局部用抗生素的偏好方面，几乎没有达成一致意见。
对眼睑和眼表进行详细的临床评估可实现针对性治疗。需要开展研究以阐明疾病机制并优化治疗策略。[《小儿眼科与斜视杂志》。2017；54(3)：156 - 162。]
