| Background Dry eye is a disease of ocular symptoms and visual disturbance aroused by tear film instability and/or ocular surface damage due to quantitative/qualitative changes in tear or abnormal fluid dynamics.With the progress of science and technology and society,and the changes in living habits,working styles and environmental factors,the prevalence of dry eye increases year by year and tends to be younger,which makes dry eye become a common ophthalmic disease affecting patients living quality.Dry eye is based on etiologies of aqueous deficient dry eye,evaporative dry eye and the mixed.Aqueous deficient dry eye caused by lacrimal gland disease or dysfunction and evaporative dry eye mainly referred to meibomian gland dysfunction(MGD).MGD is a chronic,diffuse meibomian glands lesion,characterized by terminal duct obstruction of meibomian glands and/or abnormal quality or quantity of meibum.Clinically,this may result in tear film abnormality and ocular surface inflammation,leading to eye irritation symptoms.In severe cases,it may damage the cornea and affect the visual function,and it is the leading cause of evaporative dry eye.Therefore,timely and effective treatment of MGD has important clinical significance in improving the ocular symptoms for patients with evaporative dry eye.The ultrasonic atomizer could atomize and heat the liquid,and the atomization of liquid could be diffused around the eyes through a special pipe and eye masks,which could increase the eyelids surface temperature,improve the blood circulation and lymphatic circulation of local tissues,so as to change the viscosity of meibomian gland secretions and increase the ease of meibomian gland expressibility.Considering that mechanical massage might be ameliorate ductal obstruction and facilitate the drainage of intraductal secretions,that could enhance and/or restore the function of the glands.Therefore,the study was designed to investigate the clinical efficacy and safety of ultrasonic atomization combined with meibomian gland massage for treatment of patients with evaporative dry eye.Purpose To observe the efficacy of ultrasonic atomization combined with meibomian gland massage for treatment of patients with evaporative dry eye.Methods This study was a prospective,randomized and controlled clinical trial.According to the inclusion criteria and exclusion criteria,sixty patients(120 eyes)with evaporative dry eye were randomly divided into two groups:the observation group and the control group.In the control group,30 patients(60 eyes)were treated by lid warming,lid scrub,and local drugs.In the observation group,30 patients(60 eyes)were given an additional ultrasonic atomization combined with meibomian gland massage conducted by the same doctor once a week for 4 consecutive times.The following examinations were performed and recorded before treatment and 4 times after treatment:the ocular surface disease index(OSDI)questionnaire was used to evaluate ocular symptoms,the morphological changes of the meibomian glands was checked and recorded by a Keratograph Ocular surface analyzer,breakup time(BUT)and corneal fluorescein staining(CFS)were observed through slit lamp microscope under the cobalt blue filter,and the expressibility and quality of meibomian gland were also checked.The best corrected visual acuity,intraocular pressure and slit lamp microscopy examination were performed before and after each treatment to determine whether there were any complications or adverse reactions.All patients voluntarily accepted the above examinations and signed the informed consent form.The same examination and treatment were conducted by the same examiner under the same conditions.Results Each group contained 30 patients(60 eyes),and there were no significant difference in male/female distribution and age between the two groups(all P>0.05).There were no significant difference between the two groups before treatment in the best corrected visual acuity,intraocular pressure,OSDI score,the morphological loss of meibomian glands,CFS,BUT,the score of meibum expressibility and meibum quality(all P>0.05).The ocular symptoms were mainly manifested as blurred vision,dryness of eye,eyestrain,difficulty in opening eye,painful or sore eye,photophobia,lacrimation,gritty,burning sensation,etc.Some patients showed two or more above symptoms,and these symptoms were relieved to different degrees after treatment in both groups.After treatment,the OSDI score of both groups decreased statistically(all P<0.05)and the improvement of observation group was more obvious than the control group(P<0.05).Compared with the results pretreatment,BUT extended and CFS decreased in both groups,and the differences were statistically significant(all P<0.05),and this improvement were more obvious in the observation group than those of control group(all P<0.05).The meibomian gland expressibility and meibum quality improved evidently after treatment in the observation group(all P<0.05),while no changes in control group(all P>0.05).There was no significant improvement in meibomian glands loss scores in the observation group(P>0.05).After treatment,the morphological loss of meibomian glands,meibum expressibility and meibum quality score of the control group were not significantly improved,and the differences were not statistically significant(all P>0.05).There were no complications and adverse reactions such as eyelid subcutaneous ecchymosis,conjunctival hemorrhage,or corneal epithelial damage were appeared in either group during follow-up.Conclusion Ultrasonic atomization in combination with meibomian gland massage could promote meibomian gland expressibility and meibum quality,enhance tear film stability,improve cornea epithelial integrity and alleviate the ocular symptoms effectively,and there was no complaints and/or complications were appeared in either group during follow-up.Therefore,ultrasonic atomization combined with meibomian gland massage might be effective and safe for treatment of patients with evaporative dry eye. |
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