Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA.
Clin Exp Optom. 2022 Mar;105(2):177-185. doi: 10.1080/08164622.2021.1962210. Epub 2021 Aug 8.
Dry Eye Disease (DED) is a complex and multifactorial disorder of tear homoeostasis that results in pain, visual disturbance, and ocular surface damage. It is highly prevalent around the world and is associated with many co-morbidities that may contribute to or exacerbate symptoms and signs of disease and affect disease phenotype. However, DED is not one disease and can manifest with a variety of symptoms and/or signs. In this review, we discuss relationships between various co-morbidities and DED phenotypes. For example, individuals with immune mediated diseases, like Sjögren's Syndrome and Graft versus Host Disease, often present with aqueous tear deficiency (ADDE) in the setting of lacrimal gland dysfunction. Individuals with disorders that affect the periocular skin, like rosacea and seborrhoeic dermatitis, often present with evaporative dry eye (EDE) in the setting of eyelid and/or meibomian gland abnormalities. Individuals with pain related disorders, such as chronic pain syndrome and migraine, often present with ocular pain out of proportion to tear film abnormalities, often with accompanying corneal nerve hypersensitivity. Individuals with diabetes mellitus often present with an epitheliopathy in the setting of decreased sensation (neurotrophic keratitis). While not absolute, understanding relationships between co-morbidities and DED phenotypes can help tailor a therapeutic plan to the individual patient.
干眼症(DED)是一种复杂的多因素泪液稳态失调疾病,可导致疼痛、视觉障碍和眼表损伤。它在全球范围内广泛存在,并与许多合并症相关,这些合并症可能导致或加重疾病的症状和体征,并影响疾病表型。然而,DED 并不是一种单一的疾病,它可以表现出多种不同的症状和/或体征。在这篇综述中,我们讨论了各种合并症与 DED 表型之间的关系。例如,患有免疫介导疾病(如干燥综合征和移植物抗宿主病)的个体,常因泪腺功能障碍而出现水样液缺乏症(ADDE)。患有影响眼周皮肤疾病(如酒渣鼻和脂溢性皮炎)的个体,常因眼睑和/或睑板腺异常而出现蒸发性干眼症(EDE)。患有疼痛相关疾病(如慢性疼痛综合征和偏头痛)的个体,常因眼痛与泪膜异常不成比例而就诊,常伴有角膜神经敏感性增加。患有糖尿病的个体,常因感觉减退(神经营养性角膜病变)而出现上皮病变。虽然并非绝对,但了解合并症与 DED 表型之间的关系有助于针对个体患者制定治疗计划。