Thanks to the efforts of the International Workshop on Meibomian Gland Dysfunction, clinicians now have a road map for classifying and managing this condition.1 The workshop standardized the definition of meibomian gland dysfunction (MGD), which can be one component of eyelid inflammation, called blepharitis. Blepharitis, which often contributes to dry eye syndrome, can cause many ocular symptoms, including itching, grittiness, photophobia, eyelid crusting, and red, swollen eyes. Beyond causing patient discomfort, the presence of blepharitis can affect the outcomes of cataract and refractive surgery. And, as the prevalence of blepharitis increases with age, clinicians can expect to see a growing number of cases in the coming years. How can ophthalmologists best manage this common, yet complex, condition? Starting with how to assess symptoms to determine appropriate treatment, three experts outline their approaches—with an eye to the tried and-true, as well as to newer techniques—that maybe prove helpful for some patients. The Significance of Symptoms A thorough ophthalmologic evaluation, along with a careful history, is critical for zeroing in on the best treatment approaches. Henry D. Perry, MD, chief of the cornea service at Nassau University Medical Center in East Meadow, N.Y., asks patients to complete the Ocular Surface Disease Index questionnaire to determine their symptoms, environment, and overall functioning. “This gives me an ability to quickly assess the significance of the problem on a scale of mild, moderate, or severe,” he said. Tests. In addition, Dr. Perry performs a number of tests to pinpoint whether symptoms are related to dry eye or MGD plus dry eye; these may include Schirmer tests without anesthesia, tear osmolarity tests, and lissamine green and fluorescein staining. “We also do meibomian gland expression, which helps us further categorize the degree of the problem,” said Dr. Perry. Dear diary. J. Daniel Nelson, MD, professor of ophthalmology at the University of Minnesota, in Minneapolis, involves patients in tracking clues to their condition. When symptoms arise, he has patients ask themselves three basic questions: 1. Is it me? Do I have a systemic condition, such as rosacea or lupus that’s become active? Are my joints achy? How am I feeling overall? Where am I in my menstrual cycle? The last question can be important, Dr. Nelson noted, because estrogen promotes inflammation. 2. Is it something I did? Did I switch cosmetics or just get my nails or hair done? Did I start a new medication? 3. Is it my environment? Have I started a new job or moved into a new place? Have I taken up a new hobby, such as painting? If patients can predict when symptoms will worsen, they can also be more aggressive with treatment, as needed, said Dr. Nelson. And even though blepharitis is typically treated only when symptoms are present, asymptomatic blepharitis may also need to be addressed before ocular surgery, he added. First Step: Patient Self-Care Patient self-care plays a major role in the management of blepharitis. Fatty acids. Omega-3 fatty acids are known to be anti-inflammatory, said Dr. Nelson. He starts some blepharitis patients on supplements of 1 to 3 g, two to three times daily. He advises, however, that it can take six to 12 months to see a definite effect. A small randomized clinical trial shows that omega-3 supplements are beneficial for MDG and blepharitis,2 but more

由于國(guó)際瞼板腺功能障礙研討會(huì)的努力，臨床醫(yī)生現(xiàn)在有了分類和管理這種狀況的路線圖。1該研討會(huì)標(biāo)準(zhǔn)化了瞼板腺功能障礙（MGD）的定義，MGD是眼瞼炎癥的一個(gè)組成部分，稱為瞼緣炎。瞼緣炎通常會(huì)導(dǎo)致干眼癥，會(huì)引起許多眼部癥狀，包括瘙癢，沙啞，畏光，眼瞼結(jié)s和眼睛紅腫。除了引起患者不適之外，瞼緣炎的存在還會(huì)影響白內(nèi)障和屈光手術(shù)的結(jié)果。并且，隨著瞼緣炎的患病率隨著年齡的增長(zhǎng)而增加，臨床醫(yī)生可以期望在未來幾年中看到越來越多的病例。眼科醫(yī)生如何才能最好地管理這種常見而又復(fù)雜的狀況？從如何評(píng)估癥狀以確定合適的治療方法開始，三位專家概述了他們的方法-著眼于久經(jīng)考驗(yàn)的，真實(shí)的以及更新的技術(shù)-可能對(duì)某些患者有用。癥狀的重要性全面的眼科評(píng)估以及仔細(xì)的病史對(duì)于確定最佳治療方法至關(guān)重要。紐約州東梅多市拿騷大學(xué)醫(yī)學(xué)中心角膜服務(wù)負(fù)責(zé)人亨利·D·佩里（Henry D.Perry）要求患者填寫眼表疾病指數(shù)問卷，以確定其癥狀，環(huán)境和整體功能。他說：“這使我有能力以輕度，中度或嚴(yán)重程度快速評(píng)估問題的嚴(yán)重性?！睖y(cè)試。此外，Perry博士還進(jìn)行了許多測(cè)試，以查明癥狀是否與干眼或MGD加干眼有關(guān)。其中可能包括未麻醉的Schirmer測(cè)試，淚液滲透壓測(cè)試以及賴氨酰胺綠和熒光素染色。佩里博士說：“我們還進(jìn)行瞼板腺表達(dá)，這有助于我們進(jìn)一步對(duì)問題的程度進(jìn)行分類?！庇H愛的日記。明尼阿波利斯明尼蘇達(dá)大學(xué)眼科學(xué)教授J. Daniel Nelson要求患者追蹤病情線索。當(dāng)出現(xiàn)癥狀時(shí)，他會(huì)讓患者問三個(gè)基本問題：1.是我嗎？我有全身性疾病，例如酒渣鼻或狼瘡活躍嗎？我的關(guān)節(jié)疼痛嗎？我總體感覺如何？我月經(jīng)周期在哪里？尼爾森博士指出，最后一個(gè)問題可能很重要，因?yàn)榇萍に貢?huì)促進(jìn)炎癥。 2.我做了什么嗎？我是否換過化妝品，或者只是修剪指甲或頭發(fā)？我開始新藥了嗎？ 3.是我的環(huán)境嗎？我是否已開始新工作或搬到新地方？我是否有新的愛好，例如繪畫？尼爾森博士說，如果患者能夠預(yù)測(cè)何時(shí)癥狀會(huì)惡化，他們也可以根據(jù)需要采取更積極的治療。他補(bǔ)充說，即使通常僅在出現(xiàn)癥狀時(shí)才治療眼瞼炎，但也可能需要在眼科手術(shù)之前解決無癥狀眼瞼炎。

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第一步：患者自我護(hù)理患者自我護(hù)理在瞼緣炎的治療中起著重要作用。脂肪酸。尼爾森博士說，已知Omega-3脂肪酸具有抗炎作用。他開始以1至3 g的補(bǔ)充劑開始某些瞼緣炎患者，每天2至3次。但他建議，可能要花6到12個(gè)月才能看到明確的效果。一項(xiàng)小型的隨機(jī)臨床試驗(yàn)表明，omega-3補(bǔ)充劑對(duì)MDG和瞼緣炎有益2，但更多

(1) Eyelid margin examination reveals inspissated glands (arrows) in meibomian gland dysfunction.

眼瞼邊緣檢查顯示瞼板腺功能異常的腺體（箭頭所示）

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and larger studies are needed to clarify the role of supplementation and other factors. Can’t beat heat. “In my mind, the key treatment for these patients is heat,” said Dr. Nelson. “I have patients apply five minutes of moist heat at bedtime and first thing in the morning.” 我讓患者在就寢時(shí)間和早晨的第一件事上施加五分鐘的濕熱 Dr. Perry prefers heat in the form of warm saltwater soaks, 佩里博士更喜歡以溫暖的鹽水浸泡的形式加熱，他說這是等滲的which he says are more isotonic and thus more comfortable and less likely to wrinkle the eyelid skin. His regimen is four times a day for two weeks, then twice a day for a month, and twice a week after that. （面部肌膚比較敏感，眼部皮膚更加敏感，長(zhǎng)時(shí)間熱敷會(huì)讓皮膚內(nèi)環(huán)境發(fā)生變化，因此熱敷需要遵循時(shí)間原則，不能常年每日多次熱敷，博士建議一天4次，持續(xù)2周，然后一天2次，持續(xù)一個(gè)月，然后一周2次，）He explains to patients how the meibomian glands can become clogged, leading to a change in meibum composition from long-chain fatty acids to free fatty acids. 他向患者解釋了瞼板腺如何被堵塞，從而導(dǎo)致瞼板組成從長(zhǎng)鏈脂肪酸變?yōu)橛坞x脂肪酸 “FFAs, combined with inflammation, cause saponification,” FFA與炎癥相結(jié)合會(huì)導(dǎo)致皂化

(The meibomian glands are dilated and full of meibum that can be easily expressed. Frequently, soapy-looking bubbles are seen along the inferior lid margin. This saponification occurs when excess lipid secretions react with protein in the tears瞼板腺擴(kuò)張，充滿了容易表達(dá)的瞼板。 通常，在下眼瞼邊緣會(huì)看到肥皂泡。 當(dāng)過多的脂質(zhì)分泌物與眼淚中的蛋白質(zhì)反應(yīng)時(shí)，就會(huì)發(fā)生皂化)

?said Dr. Perry, who photographs the patient’s foamy tear film to demonstrate. He tells patients how heating the eyelid margin transforms fats—solid at room temperature—to a liquid, which gets secretions flowing again. 他告訴患者，加熱眼瞼邊緣如何將脂肪（在室溫下為固體）轉(zhuǎn)化為液體，并使分泌物再次流動(dòng)。Eyelid scrubs. Hygiene products come and go, said Dr. Perry. “And about 10 percent of people have an allergic component such as eczema or atopic dermatitis,” he said. “When you put a chemical on these patients, they won’t do well. That’s why I stick to saltwater soaks.” 衛(wèi)生產(chǎn)品來來往往。他說：“大約10％的人患有過敏性成分，如濕疹或特應(yīng)性皮炎。” “當(dāng)您對(duì)這些患者使用化學(xué)藥品時(shí)，他們的病情不會(huì)好轉(zhuǎn)。這就是為什么我堅(jiān)持鹽水浸泡的原因。Dr. Nelson added that while lid scrubs can occasionally be irritating, part of the problem lies in technique. “Patients often pull down the lid and scrub the conjunctiva, rather than the lid margin,” said Dr. Nelson, “so they actually irritate their lids.” 尼爾森博士說：“患者經(jīng)常拉下眼瞼并擦洗結(jié)膜，而不是眼瞼邊緣，所以他們實(shí)際上會(huì)刺激眼瞼?！盩hus, dexterity can be an issue, and instruction is critical. Eyelid compression. Dr. Nelson has largely dispensed with lid scrubs and focuses instead on gentle compression, not rubbing, of closed eyelids—with or without the use of an eye pad. If blepharitis is severe, however, he instructs patients on how to use a cotton-tipped applicator to remove the cap of oil from the gland orifice. 眼瞼壓縮。納爾遜（Nelson）博士在很大程度上省去了眼瞼磨砂，而側(cè)重于輕柔地按壓而不是揉合閉合的眼瞼（無論是否使用眼墊）。He also advises the daytime use of artificial lubricants to help wash out the eyes. 他還建議白天使用人造潤(rùn)滑劑幫助洗眼。。

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需要進(jìn)行更大的研究來闡明補(bǔ)充劑和其他因素的作用。無法擊敗熱。尼爾森博士說：“在我看來，這些患者的主要治療方法是加熱?！?“我讓患者在就寢時(shí)間和早晨的第一件事上施加五分鐘的濕熱。”佩里博士更喜歡以溫暖的鹽水浸泡的形式加熱，他說這是等滲的，因此更舒適，并且不太可能使眼瞼皮膚起皺。面部肌膚比較敏感，眼部皮膚更加敏感，長(zhǎng)時(shí)間熱敷會(huì)讓皮膚內(nèi)環(huán)境發(fā)生變化，因此熱敷需要遵循時(shí)間原則，不能常年每日多次熱敷，博士建議一天4次，持續(xù)2周，然后一天2次，持續(xù)一個(gè)月，然后一周2次。他向患者解釋了瞼板腺如何被堵塞，從而導(dǎo)致瞼板組成從長(zhǎng)鏈脂肪酸變?yōu)橛坞x脂肪酸。佩里博士說：“ FFA與炎癥相結(jié)合會(huì)導(dǎo)致皂化?！彼臄z了病人的泡沫淚膜以進(jìn)行演示。他告訴患者，加熱眼瞼邊緣如何將脂肪（在室溫下為固體）轉(zhuǎn)化為液體，并使分泌物再次流動(dòng)。眼瞼磨砂。佩里博士說，衛(wèi)生產(chǎn)品來來往往。他說：“大約10％的人患有過敏性成分，如濕疹或特應(yīng)性皮炎?！?“當(dāng)您對(duì)這些患者使用化學(xué)藥品時(shí)，他們的病情不會(huì)好轉(zhuǎn)。這就是為什么我堅(jiān)持鹽水浸泡的原因?！?/strong>納爾遜博士補(bǔ)充說，盡管擦洗蓋子有時(shí)會(huì)很煩人，但部分問題在于技術(shù)。尼爾森博士說：“患者經(jīng)常拉下眼瞼并擦洗結(jié)膜，而不是眼瞼邊緣，所以他們實(shí)際上會(huì)刺激眼瞼。”因此，敏捷性可能是一個(gè)問題，而指導(dǎo)至關(guān)重要。眼瞼壓縮。納爾遜（Nelson）博士在很大程度上省去了眼瞼磨砂，而側(cè)重于輕柔地按壓而不是揉合閉合的眼瞼（無論是否使用眼墊）。但是，如果瞼緣炎很嚴(yán)重，他會(huì)指導(dǎo)患者如何使用棉簽涂抹器從腺孔口取下油帽。他還建議白天使用人造潤(rùn)滑劑幫助洗眼。

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Although the connection between Demodex mite infestation and blepharitis has been reported since at least the early 1960s,1 it may be overlooked by clinicians. Recent research points to a strong correlation between levels of Demodex and the severity of blepharitis (Fig. 2).2 “When we eradicate or cut down infestations, we can see patients improve,” said Scheffer C. G. Tseng, MD, PhD, medical director of the Ocular Surface Center in Miami. Subset susceptibility. More than 8 in 10 people over age 60 are infested with Demodex. 2 But some are troubled by the presence of Demodex mites, while others have no symptoms, said Dr. Tseng. He drew an analogy to the house-dust mite—some people can live with it and never get sick, but others have asthma attacks. In addition to precipitating hypersensitivity reactions, mites may cause direct damage, such as eyelash disorders, and may block meibomian glands. “They may also be a vector for a species of bacillus that causes rosacea-like problems,” said Dr. Tseng. Demodex diagnosis. “Demodex infestation is much more commonly found in patients who don’t respond to other treatment,” said Dr. Perry. With recalcitrant cases, Dr. Perry first uses a slit lamp to check for cylindrical dandruff (Fig. 2A), a very common sign of mites. If he finds it, he removes an eyelash and checks for mites under a microscope. When mites mate. On average, mites have a three-week lifespan, and hygiene is critical for interrupting their life cycle, said Dr. Tseng. “Mites should die out if you don’t let them mate.” Unfortunately, eyelids are less accessible to thorough cleaning because they are surrounded by the nose, eyebrow, and cheekbone. ”不幸的是，眼瞼被鼻子，眉毛和che骨所包圍，因此很難徹底清潔。面部如何控制螨蟲數(shù)量？Tea tree oil. With both antimicrobial and anti-inflammatory effects, tea tree oil has been effective at eradicating mites, said Dr. Tseng, in either 50 percent lid scrubs or 5 percent lid massages. Because higher concentrations can be irritating, however, his team (with research supported by the National Eye Institute) worked to identify the active ingredient in tea tree oil for killing mites. They have developed a treatment containing this ingredient, which is better tolerated by patients. Dr. Tseng said, “This new lid scrub regimen, known as Cliradex, will be available this year.”

盡管至少自1960年代初以來就已經(jīng)報(bào)道了蠕形螨螨感染與瞼緣炎之間的聯(lián)系，[1]但臨床醫(yī)生可能會(huì)忽略它。最近的研究表明，蠕形螨病的嚴(yán)重程度和眼瞼炎的嚴(yán)重程度之間存在很強(qiáng)的相關(guān)性（圖2）。2“當(dāng)根除或減少侵染時(shí)，我們可以看到患者有所改善，”醫(yī)學(xué)總監(jiān)Scheffer CG Tseng博士位于邁阿密的眼表中心。子集敏感性。在60歲以上的人群中，有十分之八以上的人感染了蠕形螨。 2曾博士說，但有些人因蠕形螨的存在而感到困擾，而另一些則沒有癥狀。他比喻為屋塵螨-有些人可以忍受而不會(huì)生病，而其他人則患有哮喘。除引起過敏反應(yīng)外，螨蟲還可能引起直接傷害，例如睫毛疾病，并可能阻塞瞼板腺。曾博士說：“它們也可能是引起像酒渣鼻樣問題的芽孢桿菌的媒介。”蠕形螨病診斷。佩里博士說：“對(duì)其他療法無反應(yīng)的患者更常出現(xiàn)脫德莫克斯病?！睂?duì)于頑強(qiáng)的病例，Perry博士首先使用裂隙燈檢查圓柱形頭皮屑（圖2A），這是螨蟲非常常見的跡象。如果找到了，就移開睫毛，并在顯微鏡下檢查螨蟲。螨交配時(shí)。曾博士說，平均而言，螨蟲的壽命為三周，而衛(wèi)生對(duì)于中斷其生命周期至關(guān)重要。 “如果不讓螨交配，螨應(yīng)該滅絕?！辈恍业氖?，眼瞼被鼻子，眉毛和che骨所包圍，因此很難徹底清潔。茶樹油。曾博士說，茶樹油具有抗菌和消炎作用，可以有效根除螨蟲，無論是50％的眼瞼磨砂膏還是5％的眼瞼按摩膏。但是，由于較高的濃度可能會(huì)令人煩惱，因此，他的團(tuán)隊(duì)（在國(guó)家眼科研究所的支持下進(jìn)行了研究）致力于確定茶樹油中的殺螨活性成分。他們開發(fā)了一種含有這種成分的治療方法，患者對(duì)此病的耐受性更好。曾博士說：“這種名為Cliradex的新蓋擦洗方案將于今年推出。”

(2) Ocular manifestations of Demodex infestation. (A) typical cylindrical dandruff at the root of the eyelashes (red arrow); (B) misdirected lashes (blue arrow); (C) meibomian gland dysfunction (orange arrow); (D) lid margin inflammation (black arrow); (E) bulbar conjunctiva inflammation; (F) corneal infiltration and pannus (yellow arrow).

（2）蠕形螨病的眼部表現(xiàn)。 （A）睫毛根部的典型圓柱形頭皮屑（紅色箭頭）； （B）睫毛方向錯(cuò)誤（藍(lán)色箭頭）； （C）瞼板腺功能障礙（橙色箭頭）； （D）眼瞼緣發(fā)炎（黑色箭頭）； （五）延髓結(jié)膜發(fā)炎； （六）角膜浸潤(rùn)和血管pan（黃色箭頭）。

Blinking. 眨眼

?Expression of the meibomian glands is also important.瞼板腺的擠壓也很重要Meibomian glands secrete oil by nerve action and the mechanical action of blinking, said Dr. Nelson. But the rate of blinking decreases with age and near vision tasks such as computer use. 瞼板腺通過神經(jīng)作用和眨眼的機(jī)械作用分泌油脂。但是，眨眼的速度會(huì)隨著年齡的增長(zhǎng)和近距視覺任務(wù)（例如計(jì)算機(jī)的使用）而降低?！癐’ve been amazed how symptoms will resolve just with heat and blinking exercises,” 他說：“令我驚訝的是，僅通過加熱和眨眼運(yùn)動(dòng)，癥狀就會(huì)如何解決。he said, noting that this is the main change he’s instituted in recent years. 他指出，這是他近年來做出的主要改變。He advises patients to concentrate on blinking at least 20 times, four times a day. 他建議患者每天至少眨眼20次，一天四次。Add Medications If Needed If self-care measures are not effective, medication may be needed. Topical antibiotics. Dr. Nelson adds an antibiotic, such as erythromycin or bacitracin ointment, if inflammation remains a problem. “I start with erythromycin ointment at bedtime because it has both antibiotic and anti-inflammatory effects and is really cheap.” 添加一種抗生素，例如紅霉素或桿菌肽軟膏。 “我從睡前開始就用紅霉素軟膏（部分用戶會(huì)感到刺激性，鹽酸左氧氟沙星眼膏眼毒性和刺激性相對(duì)較?。?/strong>因?yàn)樗染哂锌股刈饔糜志哂邢鬃饔?，而且確實(shí)很便宜。Instead of squirting the medication into the eye, Dr. Nelson has patients put a little on a fingertip and wipe it across the closed eyelid near the lashes. 尼爾森博士沒有將藥物噴入眼中，而是讓患者將手指放在指尖上一點(diǎn)，然后在靠近睫毛的閉合眼瞼上擦拭。他說，以這種方式使用的藥物可以非常有效地到達(dá)瞼板腺和結(jié)膜。對(duì)于急性前眼瞼瞼炎Medication applied in this way reaches the meibomian glands and conjunctiva quite effectively, he said. For acute anterior blepharitis, Dr. Perry prefers bacitracin ointment, a potent option with good results over short periods of time. He noted that erythromycin has a place for infectious blepharitis in patients who are sensitive to bacitracin, but resistance rates as high as 50 percent remain a big concern. 但高達(dá)50％的耐藥率仍然是一個(gè)大問題。3 A new option. For chronic cases of blepharitis, Dr. Perry routinely uses AzaSite after lid massage. This new option consists of azithromycin in a viscous, mucoadhesive ophthalmic formulation that is effective against gram-positive and gram-negative bacteria.4 “It has good penetration and lasts a long time—usually for a week or two.” Oral antibiotics. For posterior blepharitis, long-term oral tetracycline, minocycline, or doxycycline is more effective than topical antibiotics, said Dr. Perry, especially for patients一個(gè)新的選擇。對(duì)于慢性眼瞼炎，Perry醫(yī)生在蓋按摩后通常使用AzaSite。這種新的選擇包括粘性，粘膜粘附性眼科制劑中的阿奇霉素，該制劑對(duì)革蘭氏陽性和革蘭氏陰性細(xì)菌有效。4“它具有良好的滲透性，并且持續(xù)時(shí)間很長(zhǎng)，通常持續(xù)一到兩周。

with rosacea. “As little as one pill twice a week can maintain a relatively good therapeutic dose in these patients for long periods.” Cyclosporine. Dr. Nelson finds topical cyclosporine to be more effective for blepharitis than for severe dry eye, although the results are not instantaneous.5 “If I’m considering it, I’ll start out with a topical steroid and then switch to cyclosporine.” One disadvantage, he said, is that it can lead to eye irritation. Steroids. Although steroids such as loteprednol ointment and antibioticsteroid combinations such as tobramycin-dexamethasone (TobraDex) or prednisolone-sulfacetamide (Blephamide) can work well, they’re not ideal, said Dr. Nelson. “As you increase the intensity of therapy, you increase the risk of side effects or complications,” he said. 他說：“隨著治療強(qiáng)度的增加，副作用或并發(fā)癥的風(fēng)險(xiǎn)也會(huì)增加。“With steroids, you always have to worry about infection, cataract development, and increased IOP.” Dr. Perry added another cautionary note: “Not all cases of blepharitis are due to MGD or allergy or staph infections. Some are actually caused by herpetic infections. I’ve seen two or three cases that worsened from corticosteroid use.” ”佩里博士補(bǔ)充了另一條警告提示：“并非所有的瞼緣炎病例都?xì)w因于MGD或過敏或葡萄球菌感染。有些實(shí)際上是由皰疹感染引起的。我發(fā)現(xiàn)有兩到三例因使用皮質(zhì)類固醇而惡化。1 Report of the TFOS Workshop on Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci. Special Issue. 2011;52(4):1917-2085. Available at: www.iovs.org/content/ 52/4.toc.

眨眼

閃爍瞼板腺的表達(dá)也很重要。尼爾森博士說，瞼板腺通過神經(jīng)作用和眨眼的機(jī)械作用分泌油脂。但是，眨眼的速度會(huì)隨著年齡的增長(zhǎng)和近距視覺任務(wù)（例如計(jì)算機(jī)的使用）而降低。他說：“令我驚訝的是，僅通過加熱和眨眼運(yùn)動(dòng)，癥狀就會(huì)如何緩解?！彼赋?，這是他近年來做出的主要改變。他建議患者每天至少眨眼20次，四次。如果需要，請(qǐng)?zhí)砑铀幬锶绻晕易o(hù)理措施無效，則可能需要藥物治療。外用抗生素。如果炎癥仍然存在問題，Nelson博士會(huì)添加一種抗生素，例如紅霉素或桿菌肽軟膏。 “我從睡前開始就用紅霉素軟膏，因?yàn)樗染哂锌股刈饔糜志哂邢鬃饔茫掖_實(shí)很便宜。”尼爾森博士沒有將藥物噴入眼中，而是讓患者將手指放在指尖上一點(diǎn)，然后在靠近睫毛的閉合眼瞼上擦拭。他說，以這種方式使用的藥物可以非常有效地到達(dá)瞼板腺和結(jié)膜。對(duì)于急性前眼瞼瞼炎，Perry博士更喜歡桿菌肽軟膏，一種有效的選擇，短期內(nèi)效果良好。他指出，對(duì)桿菌肽敏感的患者，紅霉素在感染性瞼緣炎中占有一席之地，但高達(dá)50％的耐藥率仍然是一個(gè)大問題。3一個(gè)新的選擇。對(duì)于慢性眼瞼炎，Perry醫(yī)生在蓋按摩后通常使用AzaSite。這種新的選擇包括粘性，粘膜粘附性眼科制劑中的阿奇霉素，該制劑對(duì)革蘭氏陽性和革蘭氏陰性細(xì)菌有效。4“它具有良好的滲透性，并且持續(xù)時(shí)間很長(zhǎng)，通常持續(xù)一到兩周。

”口服抗生素。佩里博士說，對(duì)于后瞼緣炎，長(zhǎng)期口服四環(huán)素，米諾環(huán)素或強(qiáng)力霉素比局部抗生素更有效。

與酒渣鼻。 “每周兩次低至一丸可以長(zhǎng)期維持這些患者相對(duì)較好的治療劑量?！杯h(huán)孢霉素。尼爾森博士發(fā)現(xiàn)，局部環(huán)孢菌素對(duì)瞼緣炎比對(duì)嚴(yán)重干眼癥更有效，盡管結(jié)果并非瞬間。5“如果考慮的話，我將從局部使用類固醇開始，然后改用環(huán)孢菌素?！彼f，缺點(diǎn)之一是會(huì)導(dǎo)致眼睛刺激。類固醇。納爾遜博士說，盡管類固醇（例如洛特潑諾軟膏）和抗生素類固醇的組合（例如妥布霉素-地塞米松（TobraDex）或潑尼松龍-磺胺乙酰胺（Blephamide））效果良好，但并不理想。他說：“隨著治療強(qiáng)度的增加，副作用或并發(fā)癥的風(fēng)險(xiǎn)也會(huì)增加。” “使用類固醇，您總是必須擔(dān)心感染，白內(nèi)障發(fā)展和眼壓升高?！?strong>佩里博士補(bǔ)充了另一條警告提示：“并非所有的瞼緣炎病例都?xì)w因于MGD或過敏或葡萄球菌感染。有些實(shí)際上是由皰疹感染引起的。我發(fā)現(xiàn)有兩到三例因使用皮質(zhì)類固醇而惡化。

?

Novel Therapies

A few newer treatments have made it to market, said Dr. Nelson, but have not undergone sufficient randomized clinical trials to prove their benefit and cost-effectiveness. Intense pulsed light. Developed by Rolando Toyos, MD, intense pulsed light (IPL) therapy was first used by dermatologists for treating rosacea, said Dr. Nelson. Operating much like a heat lamp, the treatment is now also used for patients with MGD. Thermal pulsation. “LipiFlow is an interesting device that provides heat and expresses the lacrimal gland, similar to the combined action of blinking and warm compresses,” said Dr. Nelson. Approved by the FDA, the 12-minute LipiFlow Thermal Pulsation Treatment (TearScience) is not yet covered by insurance, and it generally costs approximately $1,500 to $2,000 for both eyes. It appears to provide months of relief, said Dr. Perry. “But I’m troubled by the expense.” Duct probing. Meibomian gland duct probing, using probes invented by Steven Maskin, MD, works by physically opening up the occlusion caused by MGD. “Due to discomfort, it requires anesthetizing the patient’s lids before passing a small blunt cannula probe into the meibomian glands,” said Dr. Nelson.

新型療法

尼爾森博士說，一些較新的治療方法已經(jīng)投放市場(chǎng)，但是還沒有經(jīng)過足夠的隨機(jī)臨床試驗(yàn)來證明其益處和成本效益。強(qiáng)烈的脈沖光。尼爾森博士說，由醫(yī)學(xué)博士Rolando Toyos開發(fā)的強(qiáng)脈沖光（IPL）療法首先被皮膚科醫(yī)生用于治療酒渣鼻。這種治療方法就像加熱燈一樣，現(xiàn)在也用于MGD患者。

熱脈動(dòng)。納爾遜博士說：“ LipiFlow是一種有趣的裝置，可以提供熱量并表達(dá)淚腺，類似于眨眼和熱敷的聯(lián)合作用。”經(jīng)FDA批準(zhǔn)，12分鐘的LipiFlow熱脈動(dòng)治療（TearScience）尚不包括在保險(xiǎn)范圍內(nèi)，通常兩只眼睛的治療費(fèi)用約為1,500至2,000美元。佩里博士說，這似乎可以減輕數(shù)月的負(fù)擔(dān)。 “但是我為這筆費(fèi)用感到困擾。

”管道探測(cè)。 Meibomian腺導(dǎo)管探測(cè)使用的是MD的Steven Maskin發(fā)明的探頭，其作用是通過物理打開MGD引起的阻塞。尼爾森博士說：“由于不舒服，需要先麻醉病人的眼瞼，然后再將一個(gè)小的鈍頭套管探針穿入瞼板腺?！?/p>

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