Academy of Eye Care Education, L V Prasad Eye Institute, Hyderabad, India.
The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
Semin Ophthalmol. 2022 Oct-Nov;37(7-8):801-812. doi: 10.1080/08820538.2022.2075706. Epub 2022 May 19.
Aqueous deficiency dry eye disease is a chronic and potentially sight-threatening condition, that occurs due to the dysfunction of the lacrimal glands. The aim of this review was to describe the various recent developments in the understanding, diagnosis and treatment of lacrimal gland insufficiency in aqueous deficiency dry eye disease.
A MEDLINE database search using PubMed was performed using the keywords: "dry eye disease/syndrome", "aqueous deficient/deficiency dry eye disease", "lacrimal gland" and "Sjogren's syndrome". After scanning through 750 relevant abstracts, 73 eligible articles published in the English language from 2016 to 2021 were included in the review.
Histopathological and ultrastructural studies have revealed new insights into the pathogenesis of cicatrising conjunctivitis-induced aqueous deficiency, where the lacrimal gland acini remain uninvolved and retain their secretory property, while significant ultrastructural changes in the gland have been observed. Recent advances in diagnosis include the techniques of direct clinical assessment of the lacrimal gland morphology and secretion, tear film osmolarity, tear film lysozyme and lactoferrin levels, tear film interferometry and lacrimal gland confocal microscopy. Developments in the treatment of aqueous deficiency dry eye disease, apart from the nanoparticle-based tear substitutes, include secretagogues like diquafosol tetrasodium and rebamipide, anti-inflammatory topical agents like nanomicellar form of cyclosporine and lifitegrast, scleral contact lenses, neurostimulation, and acupuncture for increasing the amount of tear production, minor salivary gland transplantation, faecal microbial transplantation, lacrimal gland regeneration and mesenchymal stem cell therapy.
Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade. Of which, translational breakthroughs in terms of newer drug formulations and regenerative medicine are most promising.
水液缺乏性干眼症是一种慢性且可能威胁视力的疾病，是由于泪腺功能障碍引起的。本综述旨在描述水液缺乏性干眼症中泪液分泌不足的理解、诊断和治疗方面的最新进展。
使用 MEDLINE 数据库在 PubMed 上进行搜索，使用的关键词是：“干眼症/综合征”“水液缺乏/缺乏性干眼症”“泪腺”和“Sjogren 综合征”。在浏览了 750 篇相关摘要后，纳入了 2016 年至 2021 年期间以英文发表的 73 篇符合条件的文章。
组织病理学和超微结构研究揭示了瘢痕性结膜炎引起的水液缺乏发病机制的新见解，在这种情况下，泪腺腺泡不受影响并保留其分泌特性，而观察到腺体有明显的超微结构变化。最近在诊断方面的进展包括直接评估泪腺形态和分泌、泪膜渗透压、泪膜溶菌酶和乳铁蛋白水平、泪膜干涉测量和泪腺共聚焦显微镜的技术。除了基于纳米颗粒的人工泪液替代物外，水液缺乏性干眼症的治疗方法还包括促分泌剂（如二氢喹诺酮四钠盐和瑞巴派特）、局部抗炎药物（如环孢素纳米胶束和利福平）、巩膜接触镜、神经刺激和针灸（用于增加泪液分泌量）、小唾液腺移植、粪便微生物移植、泪腺再生和间充质干细胞治疗。
在过去十年的后半期，人们对泪液分泌不足及其在水液缺乏性干眼症中的作用的理解、诊断和管理方面取得了重大进展。其中，在新型药物制剂和再生医学方面的转化突破最有希望。
