Ocular Technology Group-International, London, UK.
School of Life and Health Sciences, Aston University, Birmingham, UK; Midland Eye, Solihull, UK; Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK.
Cont Lens Anterior Eye. 2019 Apr;42(2):147-154. doi: 10.1016/j.clae.2018.11.008. Epub 2018 Nov 27.
The symptom severity of patients with dry eye disease (DED) varies over a 24-hour period. It is typically worse upon waking than later in the morning and deteriorates towards the evening. Substantial differences in the characteristics and physical properties of the tear film, such as levels of inflammation, pH, osmolarity, volume and stability, also exist between night (sleeping) and day (waking), and over the course of the day itself. Data on diurnal variation in symptom severity and tear film characteristics have been reviewed to recommend a management strategy that supports the various needs of patients with DED over a full 24-hour period. Treatment strategies for DED must be matched to the variations in the severity of DED and to the environments that eyes are subjected to over a 24-hour period. While artificial tears are used to moisturise the ocular surface and reduce damage to the corneal epithelium during the day, gels are used at night-time; they are more viscous and have a longer ocular surface retention time than artificial tears. Several combinations of these products are currently available in tandem to support the 24-hour variation in tear film characteristics. The present review of published literature provides evidence that the approach of the daytime use of artificial tears to protect the eye from aggravating environmental factors in combination with the night-time use of gels to relieve more severe symptomatology. This, in turn, should provide optimal 'around-the-clock' DED management.
干眼症 (DED) 患者的症状严重程度在 24 小时内会发生变化。通常在早上醒来后比稍后更严重，并且在傍晚时会恶化。泪膜的特征和物理性质也存在显著差异，例如炎症水平、pH 值、渗透压、体积和稳定性，这些差异存在于夜间（睡眠）和白天（清醒）之间，以及白天本身的过程中。对症状严重程度和泪膜特征的昼夜变化进行了数据分析，以推荐一种管理策略，该策略可以满足 DED 患者在整整 24 小时内的各种需求。DED 的治疗策略必须与 DED 严重程度的变化以及眼睛在 24 小时内所承受的环境相匹配。虽然人工泪液用于滋润眼表面并减少白天角膜上皮的损伤，但凝胶在夜间使用；它们比人工泪液更粘稠，在眼表面的滞留时间更长。目前有几种这些产品的组合可供选择，以支持泪膜特征的 24 小时变化。本综述分析了已发表的文献，提供了证据表明，白天使用人工泪液来保护眼睛免受加重环境因素的影响，结合夜间使用凝胶来缓解更严重的症状，这种方法应该可以提供最佳的“全天候”DED 管理。
