Periman Eye Center, Seattle, Washington.
Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
J Ocul Pharmacol Ther. 2020 Apr;36(3):137-146. doi: 10.1089/jop.2019.0060. Epub 2020 Mar 12.
Homeostasis of the lacrimal functional unit is needed to ensure a well-regulated ocular immune response comprising innate and adaptive phases. When the ocular immune system is excessively stimulated and/or immunoregulatory mechanisms are disrupted, the balance between innate and adaptive phases is dysregulated and chronic ocular surface inflammation can result, leading to chronic dry eye disease (DED). According to the Tear Film and Ocular Surface Society Dry Eye Workshop II definition, DED is a multifactorial disorder of the ocular surface characterized by impairment and loss of tear homeostasis (hyperosmolarity), ocular discomfort or pain, and neurosensory abnormalities. Dysregulated ocular immune responses result in ocular surface damage, which is a further contributing factor to DED pathology. Several therapeutics are available to break the vicious circle of DED and prevent chronic disease and progression, including immunosuppressive agents (steroids) and immunomodulators (cyclosporine and lifitegrast). Given the chronic inflammatory nature of DED, each of these agents is commonly used in clinical practice. In this study, we review the immunopathology of DED and the molecular and cellular actions of current topical DED therapeutics to inform clinical decision making.
泪液功能单位的稳态对于确保受到良好调节的眼部免疫反应是必需的，该反应包含固有和适应性阶段。当眼部免疫系统受到过度刺激和/或免疫调节机制被破坏时，固有和适应性阶段之间的平衡被打乱，可能导致慢性眼表炎症，进而导致慢性干眼（DED）。根据泪膜和眼表面学会干眼工作坊 II 定义，DED 是一种眼表多因素疾病，其特征为泪液稳态（高渗透压）受损和丧失、眼部不适或疼痛以及神经感觉异常。失调的眼部免疫反应导致眼表损伤，这是 DED 病理学的另一个促成因素。目前有多种疗法可打破 DED 的恶性循环，预防慢性疾病和进展，包括免疫抑制剂（皮质类固醇）和免疫调节剂（环孢素和利福平司特）。鉴于 DED 的慢性炎症性质，这些药物在临床实践中均有应用。在这项研究中，我们回顾了 DED 的免疫病理学以及目前用于治疗 DED 的局部药物的分子和细胞作用，以为临床决策提供信息。
