Tseng S C
J Am Acad Dermatol. 1986 Oct;15(4 Pt 2):860-6. doi: 10.1016/s0190-9622(86)70243-0.
Despite the diverse causes of dry-eye disorders, the ocular surface epithelia in these diseases all undergo squamous metaplasia, manifested by loss of goblet cells, mucin deficiency, and keratinization. These changes account for tearfilm instability, which leads to various ocular symptoms and corneal complications. This article reviews research in the use of topical tretinoin to treat severe dry-eye disorders. To classify squamous metaplasia into stages, a modified impression cytology technique was used to monitor the therapeutic effect of topical tretinoin ointment (0.01% or 0.1%, w/w) in 22 patients. This population had severe dry-eye disorders, including keratoconjunctivitis sicca, Stevens-Johnson syndrome, inactive ocular pemphigoid, drug-induced pseudopemphigoid, and surgery- or radiation-induced dry eyes. After treatment, clinical improvements were correlated with the reversal of squamous metaplasia as evidenced by the impression cytology technique. Tretinoin may also be effective in treating conjunctival keratinization without dry eyes, as illustrated by a case study. This may represent the first reported attempt to treat ocular surface disorders by reversing diseased epithelium.
尽管干眼疾病的病因多种多样，但这些疾病中的眼表上皮均会发生鳞状化生，表现为杯状细胞缺失、黏蛋白缺乏和角化。这些变化导致泪膜不稳定，进而引发各种眼部症状和角膜并发症。本文综述了局部应用维甲酸治疗严重干眼疾病的研究。为了将鳞状化生进行分期，采用改良印片细胞学技术监测22例患者局部应用维甲酸软膏（0.01%或0.1%，w/w）的治疗效果。这些患者患有严重的干眼疾病，包括干燥性角结膜炎、史蒂文斯-约翰逊综合征、静止期眼部类天疱疮、药物性类天疱疮以及手术或放疗引起的干眼。治疗后，印片细胞学技术显示临床改善与鳞状化生的逆转相关。如一项病例研究所示，维甲酸在治疗无干眼的结膜角化方面可能也有效。这可能是首次报道通过逆转病变上皮来治疗眼表疾病的尝试。
