《泪膜与眼表协会干眼病诊疗指南第三版：精要汇编》
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发布时间: 2025-06-04
英文标题: TFOS DEWS III: Digest
作者: Fiona Stapleton 1, Pablo Argüeso 2, Penny Asbell 3, Dimitri Azar 4, Charles Bosworth 5, Wei Chen 6,
出处: Am J Ophthalmol. 2025 Jun 4:279:451-553.
内容介绍:
本精要汇编总结了自2017年《泪膜与眼表协会干眼病诊疗指南第二版》（TFOS DEWS II）报告发布以来，干眼病（DED）领域发表的多学科研究成果。内容涵盖7个主题，包括：性别、激素与性别因素；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，并探讨了各主题如何为干眼病的诊断方法、疾病分型及治疗管理提供依据。性别相关差异因激素、性染色体、性特异性常染色体因素、表观遗传学、就医行为及医疗服务利用等因素，对眼表产生显著影响。流行病学数据显示，干眼病患病率因年龄和性别而异，且受诊断标准及疾病多因素特性的影响。干眼病的新风险因素包括环境因素、医源性因素、全身性疾病及生活方式领域。在病理生理学方面，水液缺乏型与蒸发过强型干眼病的区别已得到明确，后者以眼表炎症反应减弱、睑板腺功能障碍及角膜上皮细胞表型改变为典型特征。代谢、激素、物理、神经及细胞应激（包括高渗状态、线粒体应激及神经源性炎症）在干眼病中的作用日益凸显。泪膜研究进展提出了理解干眼病发病机制及识别生物标志物（如微小RNA）的新方法。眼部疼痛感知与角膜神经结构完整性、神经元功能及中枢与外周神经系统活动相关。医源性干眼可由药物、角膜接触镜及手术操作引起。当前临床试验强调设计及终点指标需与干眼病亚型及治疗机制相匹配，新型治疗药物及试验设计正纳入考量范围。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.
本精要汇编总结了自2017年《泪膜与眼表协会干眼病诊疗指南第二版》（TFOS DEWS II）报告发布以来，干眼病（DED）领域发表的多学科研究成果。内容涵盖7个主题，包括：性别、激素与性别因素；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，并探讨了各主题如何为干眼病的诊断方法、疾病分型及治疗管理提供依据。性别相关差异因激素、性染色体、性特异性常染色体因素、表观遗传学、就医行为及医疗服务利用等因素，对眼表产生显著影响。流行病学数据显示，干眼病患病率因年龄和性别而异，且受诊断标准及疾病多因素特性的影响。干眼病的新风险因素包括环境因素、医源性因素、全身性疾病及生活方式领域。在病理生理学方面，水液缺乏型与蒸发过强型干眼病的区别已得到明确，后者以眼表炎症反应减弱、睑板腺功能障碍及角膜上皮细胞表型改变为典型特征。代谢、激素、物理、神经及细胞应激（包括高渗状态、线粒体应激及神经源性炎症）在干眼病中的作用日益凸显。泪膜研究进展提出了理解干眼病发病机制及识别生物标志物（如微小RNA）的新方法。眼部疼痛感知与角膜神经结构完整性、神经元功能及中枢与外周神经系统活动相关。医源性干眼可由药物、角膜接触镜及手术操作引起。当前临床试验强调设计及终点指标需与干眼病亚型及治疗机制相匹配，新型治疗药物及试验设计正纳入考量范围。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.