眨眼运动有助于缓解蒸发性乾眼症


  【24drs.com】根据一篇新研究,对于蒸发性乾眼症患者,眨眼运动可以帮助减少不完整眨眼以及改善睑板腺功能与症状。
  
  研究者报告指出,对于蒸发性乾眼症的整体治疗与处置,检测与量化不完整眨眼情况以及眨眼训练很重要。
  
  北卡罗莱纳州TearScience公司、波士顿 Korb Associates的David Murakami医师在美国眼科学院2014年会中发表研究结果。不完整眨眼和蒸发性乾眼症密切相关。
  
  他表示,我们处在一个注意力集中的社会,我们盯著计算机、智能型手机、视频游戏,我们被训练为不可以眨眼;如果眨眼不完全,眼油无法从泪腺中排出。
  
  医师报告指出,我们有数百个蒸发性乾眼症患者有眨眼问题。
  
  Murakami医师发表的研究,研究对象是10个诊断有不完整眨眼、有症状的蒸发性乾眼、泪腺功能降低的病患,平均年龄53岁。
  
  所有病患都完成一份乾眼问卷,用LipiView (TearScience公司产品)测量泪膜脂质层的眼科成像装置,记录与分析20秒的习惯性眨眼行为。此外,用Meibomian Gland Evaluator (TearScience公司产品)测量下眼睑功能性睑板腺的数目。
  
  每位病患都被训练且进行个制化眨眼运动,为期至少8周。
  
  Murakami医师表示,我告诉病患要真的暂停、故意闭上眼睛。我们训练眼睑要更强,也要训练脑部执行完整眨眼。用一个眨眼提醒计算机程序帮助提醒病患做这运动。
  
  在介入开始前后都对病患进行评估。
  
  介入组的不完整眨眼百分比显著改善(70.9% vs 23.5%;P= .001),此外,症状减少(10.1 vs 6.7;P= .02)且功能性泪腺平均数目增加(4.1 vs 5.9;P= .02)。
  
  未参与此次研究的纽约市开业眼科医师Barry Farkas表示,对于多年未眨眼或不完整眨眼引起的乾眼症,眨眼运动是一个众所周知的解药。
  
  他表示,我们已经采用这种辅助方法35年以上,在以前大多使用硬式隐形眼镜时,这类运动对于泪水与氧气流动及交换更是需要。
  
  Farkas医师解释,现在,虽然隐形眼镜都是透气材质,对于将水分与养分充份地送往整个角膜表面,完整眨眼依旧重要;即使是没有戴隐形眼镜者,未能定时完整眨眼会使略微不稳定的泪液层与角膜的接触时间太短,导致角膜表面裂开。
  
  他表示,眨眼运动的议题一直都存在,有些人有足够的动机学习这个技巧并持续执行,有些人可能会发现治疗不足以治癒且太困扰。
  
  Murakami医师表示他同意顺从性一定会是个问题,不过,教育是重要的。他指出,不完整眨眼越严重的病患、症状相当明显的病患,因为了解问题点而会遵守。
  
  宾州大学Scheie眼科研究中心、Penn 乾眼暨眼球表面中心的Mina Massaro-Giordano医师表示,眨眼很重要。她表示她已经有注意到,她很惊讶病患有那么多人有不完整眨眼问题,她有建议一些病患进行眨眼运动。
  
  Massaro-Giordano医师表示,这篇研究有趣的是,你可以改善眨眼动作的肌肉,就像任何运动一样,如果你有执行,它就会改善。
  
  但是,她表示,也必须考虑眼睑。她解释,年长患者可能眼睑松弛或外翻,下眼睑因为年龄、之前的手术或伤害而松弛,所以,即使他们努力眨眼仍可能无效。
  
  你也要注意睑脂,如果睑脂完全嵌入且相当紧密,它会很黏稠,那你就要用力眨—它出不来。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7136&x_classno=0&x_chkdelpoint=Y
  

Blinking Exercises Help Ease Evaporative Dry Eye

By Megan Brooks
Medscape Medical News

In patients with evaporative dry eye, blinking exercises can help decrease partial blinking and improve meibomian gland function and symptoms, according to a new study.

Detecting and quantifying partial blinking and blink training might be important in the overall treatment and management of evaporative dry eye, the investigators report.

David Murakami, MPH, OD, from TearScience Inc. in Morrisville, North Carolina, and Korb Associates in Boston, presented the results at the American Academy of Optometry 2014 Annual Meeting in Denver.

Partial blinking is closely involved in evaporative dry eye, he explained in an interview with Medscape Medical News.

"We are a focused society; we stare at computers, smartphones, and video games, and we are trained not to blink. If you aren't blinking fully, you don't express the oil from the glands," he said.

We have hundreds of patients with evaporative dry eye who are on a blinking program," Dr Murakami reported.

Blink and Brain Training

Dr Murakami presented results on 10 patients diagnosed with partial blinking, symptomatic evaporative dry eye, and reduced gland function. Their mean age was 53 years.

All patients completed a dry eye questionnaire, and habitual blinking behavior was recorded for 20 seconds and analyzed with the LipiView (TearScience Inc.), an ophthalmic imaging device used to measure the tear film lipid layer. In addition, the number of functional lower lid meibomian glands was determined with the Meibomian Gland Evaluator (TearScience Inc.).

Each patient was trained in and performed individualized blinking exercises for at least 8 weeks.

"I tell patients to really pause and deliberately close their eyes," Dr Murakami said. "We are training the lids to be stronger, but we are also retraining the brain to do a full blink." A blinking reminder computer program helped remind the patients to do the exercises.

Patients were assessed before and after the intervention.

The percentage of partial blinks improved significantly with the intervention (70.9% vs 23.5%; P = .001). In addition, symptoms decreased (10.1 vs 6.7; P = .02) and the average number of functional glands increased (4.1 vs 5.9; P = .02).

"Blinking exercises have been a well known antidote for dry eye symptoms due to non or partial blinking for many years," Barry Farkas, OD, an optometrist in private practice in New York City, who was not involved in the study.

"We have employed such assistance for over 35 years. In the old days of mostly rigid contact lenses, those exercises were even more necessary for tear and oxygen flow and exchange," he told Medscape Medical News.

Compliance an Issue

"In today's world, where contact lens materials are all breathable, complete blinking still remains more than helpful in spreading both moisture and nutrients to the entire corneal surface," Dr Farkas explained. "Even for those not wearing lenses, failure to blink completely and regularly can push a marginally unstable tear layer toward a too-short contact time with the cornea and lead to corneal surface breakdown."

"The issue with blinking exercises has always been, and remains, finding individuals motivated enough to learn the technique and continue with the process. There are those who might find the treatment not enough of a cure and too much of a nuisance," he said.

Dr Murakami said he agrees that compliance is "always going to be an issue." However, education is important. Patients who demonstrate more severe partial blinking and who tend to be very symptomatic are likely to be compliant because they understand the problem, he pointed out.

Blinking is "important", said Mina Massaro-Giordano, MD, from the Penn Dry Eye and Ocular Surface Center and the Scheie Eye Institute at the University of Pennsylvania in Philadelphia.

She said she has been paying more attention to it. "I was kind of surprised to see the amount of partial blinks my patients have. I do give blinking exercises to some of my patients," she told Medscape Medical News.

"What's interesting about this study," Dr Massaro-Giordano said, "is that it shows you can improve the muscles involved in blinking. It's just like any muscle; if you work it, it improves."

But she said it is also important consider the eyelids. "Older patients may have lax lids or extropion, so even if they are blinking hard, it may be ineffective because that lower lid is just loose from age, prior surgery, or prior damage," she explained.

"You also have to look at the meibum. If you have meibum that is completely socked in and the concretions are really dense and it's very viscous, then you can blink all you want — it's not coming out."

This study was funded by TearScience Inc. Dr Murakami and his coauthors are employees of the company. Dr Farkas and Dr Massaro-Giordano have disclosed no relevant financial relationships.

American Academy of Optometry 2014 Annual Meeting: Poster F-039. Presented November 14, 2014.

    
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