重视睑缘炎诊疗观念新进展:解读美国眼科临床指南(PPP)睑缘炎分册有感
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摘要
2018年底,美国眼科临床指南(PPP)更新了睑缘炎的诊疗规范。这一版本的PPP对传统睑缘炎的分类、治疗理念等做了大幅修改。相较于去年同时期发表的《我国蠕形螨睑缘炎诊断和治疗专家共识(2018年)》(以下简称《专家共识》),该PPP涵盖的睑缘炎种类更多,它系统地总结了睑缘炎诊疗相关研究的前沿和现状,更符合医师临床实践的需求且有助于推动睑缘炎的规范化诊疗。笔者有幸参与了我国睑缘炎《专家共识》的撰写工作,考虑到美国眼科学会睑缘炎诊疗指南(PPP)与《专家共识》内容相差较多,本文仅在部分交叉部位进行对比解读。通过对美国新版睑缘炎PPP的述评以及重点解读更新部分,以期与国内眼科同道分享睑缘炎的最新诊疗进展。要点包括:强调睑缘炎属于慢性疾病,需要长期随访监测;将睑缘炎分为3个亚类,改变了传统分类方法;与《专家共识》重点强调螨虫不同,干眼、酒糟鼻、脂溢性皮炎等也是睑缘炎的重要危险因素;对于反复发作、标准治疗疗效欠佳的患者可行螨虫检查、微生物培养等;提出了一套基于专家临床经验的鉴别诊断方法,有助于疾病的精确诊断;强调了物理清洁和热敷作为首选治疗的重要性,提出抗生素、激素类药物的使用原则及方案。
In 2018, the Preferred Practice Pattern of blepharitis from American Academy of Opthalmology was updated and made a significant revision on the diagnosis and therapy. Compared with the expert consensus on blepharitis in China(2018), this PPP covers more types of eyelid inflammation, systematically summarizes the frontier, and is more in line with the needs of clinical practice. The authors have been fortunate to participate in the writing of the Chinese expert consensus on blepharitis. Considering that it differs greatly from the PPP of the United States, this comment makes a comparative interpretation, focusing on the updated part in order to share the latest diagnosis and treatment progress. The main points include: emphasize that blepharitis is a chronic disease and need long-term follow-up monitoring; blepharitis is divided into 3 subcategories which is different from the traditional classification method; not only demodex folliculorum infection, but also dry eyes, rosacea, seborrheic dermatitis and so on are important risk factors; for recurrent patients, demodex examination and microbial culture may be recommended; a novel differential diagnosis method based on expert clinical experience is proposed, which is helpful to the accurate diagnosis of disease; the importance of physical cleaning and hot compress as the preferred treatment is emphasized, and the principles of using antibiotics and steroids are provided.
In 2018, the Preferred Practice Pattern of blepharitis from American Academy of Opthalmology was updated and made a significant revision on the diagnosis and therapy. Compared with the expert consensus on blepharitis in China(2018), this PPP covers more types of eyelid inflammation, systematically summarizes the frontier, and is more in line with the needs of clinical practice. The authors have been fortunate to participate in the writing of the Chinese expert consensus on blepharitis. Considering that it differs greatly from the PPP of the United States, this comment makes a comparative interpretation, focusing on the updated part in order to share the latest diagnosis and treatment progress. The main points include: emphasize that blepharitis is a chronic disease and need long-term follow-up monitoring; blepharitis is divided into 3 subcategories which is different from the traditional classification method; not only demodex folliculorum infection, but also dry eyes, rosacea, seborrheic dermatitis and so on are important risk factors; for recurrent patients, demodex examination and microbial culture may be recommended; a novel differential diagnosis method based on expert clinical experience is proposed, which is helpful to the accurate diagnosis of disease; the importance of physical cleaning and hot compress as the preferred treatment is emphasized, and the principles of using antibiotics and steroids are provided.
引文
[1] 亚洲干眼协会中国分会,海峡两岸医药交流协会眼科专业委员会眼表与泪液病学组.我国蠕形螨睑缘炎诊断和治疗专家共识(2018年)[J].中华眼科杂志,2018,54(7):491-495.
[2] American Academy of Ophthalmology Basic and Clinical Science Course Subcommittee.Basic and Clinical Science Course[M].External Disease and Cornea:Section 8,2017-2018.San Francisco,CA:American Academy of Ophthalmology,2017:71.
[3] KOBAYASHI T,VOISIN B,KIM D Y,et al.Homeostatic control of sebaceous glands by innate lymphoid cells regulates commensal bacteria equilibrium[J].Cell,2019,176(5):982-997.
[4] LEMP M A,NICHOLS K K.Blepharitis in the United States 2009:a survey-based perspective on prevalence and treatment[J].Ocul Surf,2009,7(2 Suppl):S1-S14.
[2] American Academy of Ophthalmology Basic and Clinical Science Course Subcommittee.Basic and Clinical Science Course[M].External Disease and Cornea:Section 8,2017-2018.San Francisco,CA:American Academy of Ophthalmology,2017:71.
[3] KOBAYASHI T,VOISIN B,KIM D Y,et al.Homeostatic control of sebaceous glands by innate lymphoid cells regulates commensal bacteria equilibrium[J].Cell,2019,176(5):982-997.
[4] LEMP M A,NICHOLS K K.Blepharitis in the United States 2009:a survey-based perspective on prevalence and treatment[J].Ocul Surf,2009,7(2 Suppl):S1-S14.