Aljarousha Mohammed, Badarudin Noor Ezailina, Che Azemin Mohd Zulfaezal, Aljeesh Yousef, Amer Abuimara, Abdul Rahim Muhammad Afzam Shah
Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia.
Department of Optometry, Faculty of Health Science, Islamic University of Gaza, Gaza Strip, Palestine.
Malays J Med Sci. 2024 Apr;31(2):72-97. doi: 10.21315/mjms2024.31.2.8. Epub 2024 Apr 23.
The prevalence of dry eye disease (DED) is rising globally and needs to be urgently addressed by medical professionals because it lowers patients' quality of life. There are as yet no available data in the literature about the prevalence of and risk factors for DED in the Gaza Strip, a gap that the present study seeks to address.
A cross-sectional study was carried out between March and August 2022 in Gaza governorates using a proportional stratified sampling technique. Only Gazan individuals ≥ 18 years old and able to follow the instructions were included. The Ocular Surface Disease Index (OSDI) questionnaire, which has previously been translated into Arabic and validated, was applied to evaluate DED symptoms. Subjective clinical tests for DED conducted were tear meniscus height (TMH), meibomian gland dysfunctions (MGDs), Marx line (ML), conjunctival Lissamine green staining (LGS), tear film break-up time test (TBUT), corneal fluorescein staining (CFS) and Schirmer II tear test (STT). DED was defined based on an Arab-OSDI score ≥ 13 and at least one positive clinical sign.
A total of 426 participants were assessed from four areas (North Gaza Strip, 82; Gaza City, 147; Mid-Zone Gaza Strip, 62; South Gaza Strip, 135). The prevalence of DED in the present study was 31.5% (95% CI: 27.1, 36.1). Age > 50 years old (odds ratio [OR] = 10.45; 95% CI: 2.95, 37.05; < 0.001), female gender (OR = 3.24; 95% CI: 1.40, 7.52, = 0.006), menopause or pregnancy (OR = 2.59; 95% CI: 1.25, 5.35; = 0.03) and pharmacotherapy (artificial tears; OR = 9.91; 95% CI: 2.77, 35.46; < 0.001) were each associated with DED symptoms. South Gaza Strip (OR = 0.04; 95% CI: 0.01, 0.12; < 0.001), unemployed (OR = 11.67; 95% CI: 1.43, 95.44; = 0.02), non-consumption of caffeine (OR = 0.40; 95% CI: 0.19, 0.88; = 0.02) and TMH < 0.2 (OR = 1.80; 95% CI: 1.02, 3.19; = 0.04) were associated with TBUT < 5 s. LGS was associated with those > 50 years old (OR = 2.70; 95% CI: 1.38, 5.28; = 0.004), previous refractive or ocular surface surgeries (OR = 2.97; 95% CI: 1.34, 6.59; = 0.008) and CFS ≥ 1 (OR = 1.91; 95% CI: 1.07, 3.44; = 0.03).
Various aspects of DED were linked with different risk factors, suggesting that DED subtypes have different underlying pathophysiologies.
全球范围内干眼症（DED）的患病率呈上升趋势，因其降低了患者的生活质量，医学专业人员迫切需要对此加以应对。关于加沙地带干眼症的患病率及危险因素，目前尚无文献数据，本研究旨在填补这一空白。
2022年3月至8月，在加沙地带各省份采用比例分层抽样技术进行了一项横断面研究。仅纳入年龄≥18岁且能够遵循指示的加沙地区居民。应用先前已翻译成阿拉伯语并经过验证的眼表疾病指数（OSDI）问卷来评估干眼症症状。针对干眼症进行的主观临床检查包括泪河高度（TMH）、睑板腺功能障碍（MGD）、马克思线（ML）、结膜丽丝胺绿染色（LGS）、泪膜破裂时间测试（TBUT）、角膜荧光素染色（CFS）和Schirmer II泪液试验（STT）。干眼症的定义为阿拉伯语版OSDI评分≥13分且至少有一项阳性临床体征。
共从四个地区（加沙地带北部82人；加沙市147人；加沙地带中部62人；加沙地带南部135人）评估了426名参与者。本研究中干眼症的患病率为31.5%（95%置信区间：27.1，36.1）。年龄>50岁（优势比[OR]=10.45；95%置信区间：2.95，37.05；P<0.001）、女性（OR=3.24；95%置信区间：1.40，7.52，P=0.006）、绝经或怀孕（OR=2.59；95%置信区间：1.25，5.35；P=0.03）以及药物治疗（人工泪液；OR=9.91；95%置信区间：2.77，35.46；P<0.001）均与干眼症症状相关。加沙地带南部（OR=0.04；95%置信区间：0.01，0.12；P<0.001）、失业（OR=11.67；95%置信区间：1.43，95.44；P=0.02）、不摄入咖啡因（OR=0.40；95%置信区间：0.19，0.88；P=0.02）以及TMH<0.2（OR=1.80；95%置信区间：1.02，3.19；P=0.04）与TBUT<5秒相关。LGS与年龄>50岁（OR=2.70；95%置信区间：1.38，5.28；P=0.004）、既往屈光或眼表手术（OR=2.97；95%置信区间：1.34，6.59；P=0.008）以及CFS≥1（OR=1.91；95%置信区间：1.07, 3.44；P=0.03）相关。
干眼症的各个方面与不同的危险因素相关，这表明干眼症的亚型具有不同的潜在病理生理学机制。
