Stapleton Fiona, Argüeso Pablo, Asbell Penny, Azar Dimitri, Bosworth Charles, Chen Wei, Ciolino Joseph B, Craig Jennifer P, Gallar Juana, Galor Anat, Gomes José A P, Jalbert Isabelle, Jie Ying, Jones Lyndon, Konomi Kenji, Liu Yang, Merayo-Lloves Jesus, Oliveira Fabiola R, Perez Victor L, Rocha Eduardo M, Sullivan Benjamin D, Sullivan David A, Vehof Jelle, Vitale Susan, Willcox Mark, Wolffsohn James S, Dogru Murat
From the School of Optometry and Vision Science (F.S., P.As., I.J., M.W.), UNSW Sydney, New South Wales, Australia.
Department of Ophthalmology (P.Ar.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Am J Ophthalmol. 2025 Jun 4;279:451-553. doi: 10.1016/j.ajo.2025.05.040.
This digest summarizes the interdisciplinary research in dry eye disease (DED) published since the 2017 TFOS DEWS II reports. It comprises 7 topics including Sex, Gender, and Hormones; Epidemiology; Pathophysiology; Tear Film; Pain and Sensation; Iatrogenic Dry Eye; and Clinical Trial Design and explores how each of these inform diagnostic methodology, disease subtype, and management of DED. Sex- and gender-related differences significantly influence the ocular surface due to hormones, sex chromosomes, sex-specific autosomal factors, epigenetics, care-seeking behaviors, and service use. Epidemiologic data reveal that DED prevalence varies by age and sex, influenced by diagnostic criteria and the multifactorial nature of the disease. New risk factors for DED include environmental, iatrogenicity, systemic diseases, and lifestyle domains. Pathophysiological distinctions between aqueous deficient and more evaporative forms of DED have been clarified, with the latter most commonly characterized by a muted inflammatory response at the ocular surface, meibomian gland dysfunction, and conceivably phenotypic changes in corneal epithelial cells. There is an expanding role for metabolic, hormonal, physical, neural and cellular stresses, including hyperosmolarity, mitochondrial stress, and neurogenic inflammation. Advancements in tear film research recommend new approaches to understanding DED pathogenesis and identifying biomarkers, such as microRNAs. Ocular pain perception is linked to structural integrity of corneal nerves, functional capacities of neurons, and activity of the central and peripheral nervous systems. Iatrogenic DED can result from medications, contact lenses, and surgical procedures. Clinical trials now emphasize aligning design and end points with DED subtypes and therapeutic mechanisms, with new therapeutics and trial designs under consideration.
本摘要总结了自2017年TFOS DEWS II报告发布以来发表的关于干眼病（DED）的跨学科研究。它涵盖7个主题，包括性别、激素与荷尔蒙；流行病学；病理生理学；泪膜；疼痛与感觉；医源性干眼；以及临床试验设计，并探讨了这些主题如何为DED的诊断方法、疾病亚型和管理提供信息。由于激素、性染色体、性别特异性常染色体因素、表观遗传学、就医行为和服务使用情况，性别相关差异会对眼表产生重大影响。流行病学数据显示，DED的患病率因年龄和性别而异，受诊断标准和疾病的多因素性质影响。DED的新风险因素包括环境、医源性因素、全身性疾病和生活方式等方面。已经明确了水液缺乏型和蒸发过强型DED在病理生理学上的区别，后者最常见的特征是眼表炎症反应减弱、睑板腺功能障碍，以及角膜上皮细胞可能出现的表型变化。代谢、激素、物理、神经和细胞应激（包括高渗、线粒体应激和神经源性炎症）所起的作用越来越大。泪膜研究的进展推荐了理解DED发病机制和识别生物标志物（如微小RNA）的新方法。眼部疼痛感知与角膜神经的结构完整性、神经元的功能能力以及中枢和外周神经系统的活动有关。医源性干眼可能由药物、隐形眼镜和手术操作引起。现在的临床试验强调使设计和终点与DED亚型及治疗机制相一致，同时正在考虑新的治疗方法和试验设计。
