McCulley J P, Dougherty J M
Trans Ophthalmol Soc U K (1962). 1986;105 ( Pt 3):314-8.
Patients with all forms of chronic blepharitis were thoroughly evaluated. These patients were found to have evidence for a primary bacterial component in the disease process only in the clinical staphylococcal and mixed seborrheic/staphylococcal forms of chronic blepharitis. Evidence was found for a shared common pathway for Staphylococcus aureus, coagulase negative staphylococci, and Propionibacterium acnes to contribute to the disease process. These organisms were found to produce lypolytic exoenzymes including fatty wax esterase, cholesteryl esterase, and triglyceride lipase. Statistically significantly larger numbers of coagulase negative staphylococci were found to produce these enzymes in patients with the various forms of seborrheic blepharitis and meibomian keratoconjunctivitis. Additionally, abnormalities in the free fatty acid component of the meibomian secretions were found in these patients supporting the hypothesis that lypolytic exoenzymes produced by bacteria might alter the meibomian secretion. Even though a primary pathogen is identifiable only in staphylococcal and mixed seborrheic/staphylococcal blepharitis, several different bacteria may contribute to the expression of disease in all other forms of chronic blepharitis.
对所有类型的慢性睑缘炎患者进行了全面评估。仅在临床诊断为葡萄球菌性以及脂溢性/葡萄球菌混合性慢性睑缘炎的患者中，发现疾病过程存在原发性细菌成分的证据。已发现金黄色葡萄球菌、凝固酶阴性葡萄球菌和痤疮丙酸杆菌在疾病过程中有共同的作用途径。这些微生物可产生脂解外酶，包括脂肪蜡酯酶、胆固醇酯酶和甘油三酯脂肪酶。在患有各种类型脂溢性睑缘炎和睑板腺角膜结膜炎的患者中，发现产生这些酶的凝固酶阴性葡萄球菌数量在统计学上显著更多。此外，在这些患者中还发现睑板腺分泌物的游离脂肪酸成分存在异常，这支持了细菌产生的脂解外酶可能改变睑板腺分泌物的假说。尽管仅在葡萄球菌性以及脂溢性/葡萄球菌混合性睑缘炎中可鉴定出主要病原体，但在所有其他类型的慢性睑缘炎中，几种不同的细菌可能都与疾病的表现有关。
