干眼的3种分类方法,你都清楚吗?

2023-05-03 MedSci原创 MedSci原创 发表于上海

干眼尚无统一分类标准,部分国际干眼共识甚至没有制定干眼的分类。

干眼(DE)是一种常见的眼部疾病,与男性相比,女性的DE患病率更高, 并且随着年龄的增长而增加。据数据显示,我国50岁以上的人群DE患病率为 11.3%,且75岁以上的女性患病率高达22.8%

随着人 口老龄化加剧,DE的患病率将会持续增加。目前,DE主要的致病因素有泪膜不稳 定、上皮功能损伤、炎症反应、睑缘异常和神经损伤等。然而,国际泪膜与眼表协会和亚洲干眼协会对干眼定义的表述各有侧重,不同的定义均强调了干眼为多因素疾病、泪膜不稳定是干眼的核心特征以及干眼症状呈多样性。

此外,干眼尚无统一分类标准,部分国际干眼共识甚至没有制定干眼的分类。考虑到我国临床治疗和疗效判定的需要,有利于临床的诊断和治疗,《中国干眼专家共识:定义和分类(2020年)》制定了3种分类方法。本文将重点整理出来,以供各位同道学习。

01 发病原因和危险因素分类

干眼由多因素导致,在病情进展过程中可能另有因素加入,部分患者发病很难用一种病因完全解释。在临床上,若找到病因及危险因素,给诊治带来一定的方向。

02 泪液主要成分或功能异常分类

眼表泪膜主要由脂质层、水液层及黏蛋白层组 成,通过泪液动力学(包括眨眼等)将泪液分布在眼表,并最后排出眼部。按照泪液的主要成分及泪液动力学因素进行分类,分为水液缺乏型干眼、脂质异常型干眼、黏蛋白异常型干眼、泪液动力学异常型干眼和混合型干眼。

03 干眼严重程度分类

干眼按照严重程度进行分类,对于评估病情和 临床药物治疗效果均有很大帮助。根据体征的严重程度干眼可分为以下几类:轻度、中度和重度。

1,轻度:裂隙灯显微镜下检查无明显眼表损 伤体征(角膜荧光素染色点<5 个),泪膜破裂时间 breakup timeBUT)在2 s及以上。

2,中度:裂隙灯显微镜下检查角膜损伤范围 不超过 2 个象限和(或)角膜荧光素染色点≥5 <30个,BUT2 s及以上。

3,重度:裂隙灯显微镜检查角膜损伤范围 2 个象限及以上和(或)角膜荧光染色点≥30 个, BUT<2 s。角膜荧光素染点融合成粗点、片状或伴有丝状物。

参考资料

亚洲干眼协会中国分会,海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组,中国医师协会眼科医师分会眼表与干眼学组.中国干眼专家共识:定义和分类(2020年)[J] . 中华眼科杂志,2020,56 (06): 418-422.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-07 brykzx 来自山东省

    比较合理,有利于临床诊治。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-07 brykzx 来自山东省

    比较合理,有利于临床诊治。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-04 13d0179fm99暂无昵称 来自山西省

    干眼分为轻度中度重度三型

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-04 1212ad1cm87暂无昵称

    不错,学习了。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-04 仁术2021 来自吉林省

    不错,学习了。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2130659, encodeId=adcc213065908, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:37:35 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2130658, encodeId=56b621306587d, content=比较合理,有利于临床诊治。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a953010315, createdName=brykzx, createdTime=Sun May 07 04:36:26 CST 2023, time=2023-05-07, status=1, ipAttribution=山东省), GetPortalCommentsPageByObjectIdResponse(id=2129983, encodeId=0fa42129983cf, content=干眼分为轻度中度重度三型, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65724176436, createdName=13d0179fm99暂无昵称, createdTime=Thu May 04 08:41:30 CST 2023, time=2023-05-04, status=1, ipAttribution=山西省), GetPortalCommentsPageByObjectIdResponse(id=2129966, encodeId=40cc2129966fa, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00332233446, createdName=1212ad1cm87暂无昵称, createdTime=Thu May 04 06:36:00 CST 2023, time=2023-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2129959, encodeId=f32f212995993, content=不错,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Thu May 04 05:35:20 CST 2023, time=2023-05-04, status=1, ipAttribution=吉林省), GetPortalCommentsPageByObjectIdResponse(id=2129925, encodeId=3f1b2129925f4, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed May 03 22:51:18 CST 2023, time=2023-05-03, status=1, ipAttribution=浙江省)]
    2023-05-03 1209e435m98(暂无昵称) 来自浙江省

    学习了,谢谢分享

    0

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