Efficacy of Diagnostic Criteria for the Differential Diagnosis Between Obstructive Meibomian Gland Dysfunction and Aqueous Deficiency Dry Eye
Efficacy of Diagnostic Criteria for the Differential Diagnosis Between Obstructive Meibomian Gland Dysfunction and Aqueous Deficiency Dry Eye
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DOI：
10.1007/s10384-010-0858-1
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发表时间：
2010-09-01
影响因子：
2.4
通讯作者：
Amano, Shiro
中科院分区：
文献类型：
--
作者：
Arita, Reiko;Itoh, Kouzo;Amano, Shiro
目的：评价阻塞性睑板腺功能障碍（MGD）的诊断标准（症状评分、眼睑边缘异常评分和睑板腺形态学变化评分）用于区分阻塞性MGD和水缺乏性干眼（ADDE）。分析了25例（平均年龄66.6岁）阻塞性MGD患者的25只眼和15例（平均年龄61.3岁）ADDE患者的15只眼。根据症状的数量将眼部症状评分为0 - 14。根据眼睑边缘异常的数量，将眼睑边缘异常评分为0 - 4分。使用非接触式睑板造影术（meibo评分）对睑板腺变化进行评分（0 - 6分）。浅层点状角膜病变评分为0 - 3分。睑缘根据体积和质量从0到3分级。滴入荧光素后连续3次测量泪膜破裂时间，取中位数。泪膜生产进行了评估，使用Schirmer test.Results：眼部症状和眼睑边缘异常评分和泪膜破裂时间没有显着差异阻塞性MGD和ADDE组。阻塞性MGD组的睑球评分和meibo评分显著高于ADDE组。ADDE组的Schirmer值显著低于梗阻性MGD组。当阻塞性MGD被诊断为三个分数的基础上，眼症状评分、睑缘异常评分、Meibo评分均异常时，鉴别梗阻性MGD与ADDE的敏感性为68.0%，特异性为80%。尽管在诊断梗阻性MGD时，该标准对于区分梗阻性MGD患者和ADDE患者具有中等可靠性，基于三种异常评分，它们不能提供区分MGD、ADDE和健康个体的综合诊断工具。我们需要在诊断标准中增加其他参数，如Schirmer试验值和睑缘评分，以提高其鉴别MGD和ADDE的可靠性。Jpn J Ophthalmol 2010;54：387-391（C）日本眼科学会2010
Purpose: To evaluate diagnostic criteria for obstructive meibomian gland dysfunction (MGD) using three parameters (symptom score, lid margin abnormality score, and meibomian gland morphologic change scores) for differentiating obstructive MGD from aqueous deficiency dry eye (ADDE).Methods: Twenty-five eyes of 25 patients (mean age, 66.6 years) diagnosed with obstructive MGD and 15 eyes of 15 patients (mean age, 61.3 years) diagnosed with ADDE were analyzed. Ocular symptoms were scored from 0 to 14 according to the number of symptoms. Lid margin abnormality was scored from 0 to 4 according to the number of abnormalities. Meibomian gland changes were scored from 0 to 6 using noncontact meibography (meibo-score). Superficial punctate keratopathy was scored from 0 to 3. Meibum was graded from 0 to 3 according to volume and quality. Tear film break-up time was measured consecutively three times after instillation of fluorescein, and the median value was adopted. Tear film production was evaluated using the Schirmer test.Results: Ocular symptom and lid margin abnormality scores and tear film break-up time did not differ significantly between the obstructive MGD and ADDE groups. The meibum score and meibo-score were significantly higher in the obstructive MGD group than in the ADDE group. The Schirmer value was significantly lower in the ADDE group than in the obstructive MGD group. When obstructive MGD was diagnosed on the basis of three scores (ocular symptom score, lid margin abnormality score, and meibo-score) all being abnormal, the sensitivity and specificity for differentiating between obstructive MGD and ADDE were 68.0% and 80%, respectively.Conclusions: Although the criteria were moderately reliable for differentiating patients with obstructive MGD from those with ADDE when the diagnosis of obstructive MGD was made on the basis of three abnormal scores, they do not provide comprehensive diagnostic tools for differentiating MGD, ADDE, and healthy individuals. We need to add other parameters such as the Schirmer test value and the meibum score to the diagnostic criteria to enhance their reliability for differentiating MGD and ADDE. Jpn J Ophthalmol 2010;54:387-391 (C) Japanese Ophthalmological Society 2010