高级检索
中华实验眼科杂志
期刊首页
过刊列表
高级检索
稿件发表
• 综述 •
ENGLISH ABSTRACT
干眼与神经调节异常相关研究进展
赵展琳
傅瑶 [综述]
范先群 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.issn.2095-0160.2020.03.014
Association between neurosensory abnormalities and dry eye
Zhao Zhanlin
Fu Yao
Fan Xianqun
Authors Info & Affiliations
Zhao Zhanlin
Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, China
Fu Yao
Fan Xianqun
·
DOI： 10.3760/cma.j.issn.2095-0160.2020.03.014
1441
457
0
1
7
0
PDF下载
APP内阅读
摘要

干眼发病机制十分复杂，趋于一种多因素共同参与的恶性循环机制。泪液分泌受交感神经与副交感神经系统共同调控，神经纤维末梢分泌神经递质、神经肽，参与维系眼表稳态。因此神经调节异常可致泪液分泌异常、眼表稳态失衡，进而引起干眼。同时，干眼患者泪膜持续异常可损伤眼表正常修复机制，使眼表和泪腺处于一种慢性炎症状态。干眼患者角膜对温度变化和机械刺激敏感，眼痛症状可能与慢性炎症影响角膜疼痛传导通路有关。目前，活体激光扫描共聚焦显微镜、角膜知觉测量仪等仪器可评估干眼患者角膜神经形态及功能状况。使用神经相关因子营养角膜，通过刺激神经或相关受体促进泪液分泌等方法有助于完善干眼的综合治疗。本文就神经调节、神经感受异常与干眼的联系进行综述。

干眼;泪膜;眼表;角膜神经;角膜知觉;活体激光扫描共聚焦显微镜
ABSTRACT

Dry eye affects a large number of people worldwide.A vicious cycle involving multiple factors tends to be implicated in its pathophysiology.Tear secretion is regulated by the sympathetic and parasympathetic nervous systems.Corneal nerve fibers secrete neurotransmitters and neuropeptides, which together participate in the maintenance of ocular surface homeostasis.Abnormal neuromodulation can cause abnormal tear secretion and a disruption of ocular surface homeostasis, leading to dry eye.The persistent abnormal tear film in dry eye can damage the normal repair system of ocular surface and leave the ocular surface and the lacrimal gland in a chronic inflammatory state.The cornea in dry eye patients is more sensitive to temperature change and mechanical stimulation than in healthy individuals.Symptomatic eye pain may be related to the effect of chronic inflammation on the corneal pain signal pathway.In vivo confocal microscopy and corneal esthesiometry can be used to evaluate the corneal nerve morphology and function in dry eye patients.This may ead to a more comprehensive treatment of dry eyes through the use of nerve related factors to nourish the cornea and the stimulation of neural pathways or related neural receptors to increase tear secretion.This study reviewed the relationship between neurosensory abnormalities and dry eye.

Dry eye;Tear film;Ocular surface;Corneal nerves;Corneal sensitivity;In vivo confocal microscope
Fan Xianqun, Email: nc.defudabe.utjsqxnaf
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

赵展琳,傅瑶,范先群. 干眼与神经调节异常相关研究进展[J]. 中华实验眼科杂志,2020,38(03)：233-237.

DOI:10.3760/cma.j.issn.2095-0160.2020.03.014

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

干眼在全球的患病率为5%～50%，而来自东南亚的流行病学研究显示干眼的患病率达20.0%～52.4% [ 1 ]。目前干眼的发病机制尚未完全阐明，趋向于一种多因素共同参与的恶性循环机制 [ 2 ]。任何影响泪膜完整性和正常功能的环节，都可能造成眼表稳态失衡，从而造成眼干、眼痒、异物感、畏光、视疲倦、对外界刺激敏感等多种眼部症状，对患者视力、生活质量、工作效率、精神和生理上都有影响。国际干眼小组(Dry Eye WorkShop，DEWS)于2017年更新了干眼的定义，首次将神经调节异常列入其中 [ 3 ]。理解神经调节异常在干眼中的作用以及干眼对神经感受功能的影响对解释这些问题起到重要作用。
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Stapleton F , Alves M , Bunya VY ,et al. TFOS DEWS Ⅱ epidemiology report[J]. Ocul Surf, 2017,15(3):334-365. DOI： 10.1016/j.jtos.2017.05.003 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Baudouin C , Aragona P , Messmer EM ,et al. Role of hyperosmolarity in the pathogenesis and management of dry eye disease：proceedings of the OCEAN group meeting[J]. Ocul Surf, 2013,11(4):246-258. DOI： 10.1016/j.jtos.2013.07.003 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Craig JP , Nichols KK , Akpek EK ,et al. TFOS DEWS Ⅱ definition and classification report[J]. Ocul Surf, 2017,15(3):276-283. DOI： 10.1016/j.jtos.2017.05.008 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
BOTELHO SY . Tears and the lacrimal gland[J]. Sci Am, 1964,211:78-86. DOI： 10.1038/scientificamerican1064-78 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Bron AJ , Tiffany JM , Gouveia SM ,et al. Functional aspects of the tear film lipid layer[J]. Exp Eye Res, 2004,78(3):347-360. DOI： 10.1016/j.exer.2003.09.019 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Holly FJ , Lemp MA . Tear physiolo gy and dry eyes [J]. Surv Ophthalmol, 1977,22(2):69-87. DOI： 10.1016/0039-6257(77)90087-x .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Jumblatt JE , Jumblatt MM . Regulation of ocular mucin secretion by P2Y2 nucleotide receptors in rabbit and human conjunctiva[J]. Exp Eye Res, 1998,67(3):341-346. DOI： 10.1006/exer.1998.0520 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Shiue MH , Kulkarni AA , Gukasyan HJ ,et al. Pharmacological modulation of fluid secretion in the pigmented rabbit conjunctiva[J]. Life Sci, 2000,66(7):PL105-111. DOI： 10.1016/s0024-3205(99)00638-4 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Ríos JD , Horikawa Y , Chen LL ,et al. Age-dependent alterations in mouse exorbital lacrimal gland structure, innervation and secretory response[J]. Exp Eye Res, 2005,80(4):477-491. DOI： 10.1016/j.exer.2004.10.012 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Burgalassi S , Panichi L , Chetoni P ,et al. Development of a simple dry eye model in the albino rabbit and evaluation of some tear substitutes[J]. Ophthalmic Res, 1999,31(3):229-235. DOI： 10.1159/000055537 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Viau S , Maire MA , Pasquis B ,et al. Time course of ocular surface and lacrimal gland changes in a new scopolamine-induced dry eye model[J]. Graefe's Arch Clin Exp Ophthalmol, 2008,246(6):857-867. DOI： 10.1007/s00417-008-0784-9 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Zoukhri D1 , Hodges RR , Dartt DA . Lacrimal gland innervation is not altered with the onset and progression of disease in a murine model of Sjögren's syndrome[J]. Clin Immunol Immunopathol, 1998,89(2):126-133.
返回引文位置Google Scholar
百度学术
万方数据
[13]
Tervo T , Tervo K , Eränkö L . Ocular neuropeptides[J]. Med Biol, 1982,60(2):53-60.
返回引文位置Google Scholar
百度学术
万方数据
[14]
Nakamura A , Hayakawa T , Kuwahara S ,et al. Morphological and immunohistochemical characterization of the trigeminal ganglion neurons innervating the cornea and upper eyelid of the rat[J]. J Chem Neuroanat, 2007,34(3-4):95-101. DOI： 10.1016/j.jchemneu.2007.05.005 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Schmid E , Leierer J , Doblinger A ,et al. Neurokinin a is a main constituent of sensory neurons innervating the anterior segment of the eye[J]. Invest Ophthalmol Vis Sci, 2005,46(1):268-274. DOI： 10.1167/iovs.04-0608 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Sacchetti M , Scorcia V , Lambiase A ,et al. Preliminary evidence of neuropeptides involvement in keratoconus[J]. Acta Ophthalmol, 2015,93(4):e315-316. DOI： 10.1111/aos.12483 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
He J , Bazan HE . Neuroanatomy and neurochemistry of mouse cornea[J]. Invest Ophthalmol Vis Sci, 2016,57(2):664-674. DOI： 10.1167/iovs.15-18019 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Müller LJ , Marfurt CF , Kruse F ,et al. Corneal nerves：structure, contents and function[J]. Exp Eye Res, 2003,76(5):521-542. DOI： 10.1016/s0014-4835(03)00050-2 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Lambiase A , Micera A , Sacchetti M ,et al. Alterations of tear neuromediators in dry eye disease[J]. Arch Ophthalmol, 2011,129(8):981-986. DOI： 10.1001/archophthalmol.2011.200 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
De Paiva CS , Chen Z , Koch DD ,et al. The incidence and risk factors for developing dry eye after myopic LASIK[J]. Am J Ophthalmol, 2006,141(3):438-445. DOI： 10.1016/j.ajo.2005.11.020 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Chao C , Golebiowski B , Zhao X ,et al. Long-term effects of LASIK on corneal innervation and tear neuropeptides and the associations with dry eye[J]. J Refract Surg, 2016,32(8):518-524. DOI： 10.3928/1081597X-20160603-01 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Xie W . Recent advances in laser in situ keratomileusis-associated dry eye[J]. Clin Exp Optom, 2016,99(2):107-112. DOI： 10.1111/cxo.12361 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Belmonte C , Tervo T , Gallar J . Sensory innervation of the eye[M]. 11th ed. Adler's Physiology of the Eye, 2011:363-384.
返回引文位置
[24]
Hirata H , Meng ID . Cold-sensitive corneal afferents respond to a variety of ocular stimuli central to tear production：implications for dry eye disease[J]. Invest Ophthalmol Vis Sci, 2010,51(8):3969-3976. DOI： 10.1167/iovs.09-4744 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
González-González O , Bech F , Gallar J ,et al. Functional properties of sensory nerve terminals of the mouse cornea[J]. Invest Ophthalmol Vis Sci, 2017,58(1):404-415. DOI： 10.1167/iovs.16-20033 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Corcoran P , Hollander DA , Ousler GW ,et al. Dynamic sensitivity of corneal trpm8 receptors to menthol instillation in dry eye versus normal subjects[J]. J Ocul Pharmacol Ther, 2017,33(9):686-692. DOI： 10.1089/jop.2017.0050 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Kaido M , Kawashima M , Ishida R ,et al. Relationship of corneal pain sensitivity with dry eye symptoms in dry eye with short tear break-up time[J]. Invest Ophthalmol Vis Sci, 2016,57(3):914-919. DOI： 10.1167/iovs.15-18447 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Tashiro A , Okamoto K , Chang Z ,et al. Behavioral and neurophysiological correlates of nociception in an animal model of photokeratitis[J]. Neuroscience, 2010,169(1):455-462. DOI： 10.1016/j.neuroscience.2010.04.034 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Ferrari G , Bignami F , Giacomini C ,et al. Ocular surface injury induces inflammation in the brain：in vivo and ex vivo evidence of a corneal-trigeminal axis[J]. Invest Ophthalmol Vis Sci, 2014,55(10):6289-6300. DOI： 10.1167/iovs.14-13984 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Launay PS , Reboussin E , Liang H ,et al. Ocular inflammation induces trigeminal pain, peripheral and central neuroinflammatory mechanisms[J]. Neurobiol Dis, 2016,88:16-28. DOI： 10.1016/j.nbd.2015.12.017 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Crane AM , Feuer W , Felix ER ,et al. Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints：incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain[J]. Br J Ophthalmol, 2017,101(9):1238-1243. DOI： 10.1136/bjophthalmol-2016-309658 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Labbé A , Liang Q , Wang Z ,et al. Corneal nerve structure and function in patients with non-sjogren dry eye：clinical correlations[J]. Invest Ophthalmol Vis Sci, 2013,54(8):5144-5150. DOI： 10.1167/iovs.13-12370 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Matsumoto Y , Sato EA , Ibrahim OM ,et al. The application of in vivo laser confocal microscopy to the diagnosis and evaluation of meibomian gland dysfunction[J]. Mol Vis, 2008,14:1263-1271.
返回引文位置Google Scholar
百度学术
万方数据
[34]
陆炯，梁庆丰．角膜共聚焦显微镜检查辅助治疗干眼症的临床研究[J]．中华眼科医学杂志(电子版)， 2016，6(5)：213-218. DOI： 10.3877/cma.j.issn.2095-2007.2016.05.004 .
返回引文位置Google Scholar
百度学术
万方数据
Lu J , Liang QF . Clinical study on corneal confocal microscope assisted treatment of xerophthalmia[J]. 2016,6(5):213-218. DOI: 10.3877/cma.j.issn.2095-2007.2016.05.004 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Rahman EZ , Lam PK , Chu CK ,et al. Corneal sensitivity in tear dysfunction and its correlation with clinical parameters and blink rate[J]. Am J Ophthalmol, 2015,160(5):858-866.e5. DOI： 10.1016/j.ajo.2015.08.005 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Lee HK , Lee KS , Kim HC ,et al. Nerve growth factor concentration and implications in photorefractive keratectomyvs laser in situ keratomileusis[J]. Am J Ophthalmol, 2005,139(6):965-971. DOI： 10.1016/j.ajo.2004.12.051 .
返回引文位置Google Scholar
百度学术
万方数据
[37]
Liu Q , McDermott AM , Miller WL . Elevated nerve growth factor in dry eye associated with established contact lens wear[J]. Eye Contact Lens, 2009,35(5):232-237. DOI： 10.1097/ICL.0b013e3181b3e87f .
返回引文位置Google Scholar
百度学术
万方数据
[38]
Jain P , Li R , Lama T ,et al. An NGF mimetic, MIM-D3, stimulates conjunctival cell glycoconjugate se cretion and demonstrates therapeutic efficacy in a rat model of dry eye [J]. Exp Eye Res, 2011,93(4):503-512. DOI： 10.1016/j.exer.2011.06.014 .
返回引文位置Google Scholar
百度学术
万方数据
[39]
Bazan NG . The onset of brain injury and neurodegeneration triggers the synthesis of docosanoid neuroprotective signaling[J]. Cell Mol Neurobiol, 2006,26(4-6):901-913. DOI： 10.1007/s10571-006-9064-6 .
返回引文位置Google Scholar
百度学术
万方数据
[40]
Cortina MS , He J , Russ T ,et al. Neuroprotectin D1 restores corneal nerve integrity and function after damage from experimental surgery[J]. Invest Ophthalmol Vis Sci, 2013,54(6):4109-4116. DOI： 10.1167/iovs.13-12075 .
返回引文位置Google Scholar
百度学术
万方数据
[41]
Jumblatt JE , Jumblatt MM . Regulation of ocular mucin secretion by P2Y2 nucleotide receptors in rabbit and human conjunctiva[J]. Exp Eye Res, 1998,67(3):341-346. DOI： 10.1006/exer.1998.0520 .
返回引文位置Google Scholar
百度学术
万方数据
[42]
Fujihara T , Murakami T , Fujita H ,et al. Improvement of corneal barrier function by the P2Y(2) agonist INS365 in a rat dry eye model[J]. Invest Ophthalmol VisSci, 2001,42(1):96-100.
返回引文位置Google Scholar
百度学术
万方数据
[43]
Lau OC , Samarawickrama C , Skalicky SE . P2Y2 receptor agonists for the treatment of dry eye disease：a review[J]. Clin Ophthalmol, 2014,8:327-334. DOI： 10.2147/OPTH.S39699 .
返回引文位置Google Scholar
百度学术
万方数据
[44]
Galor A , Moein HR , Lee C ,et al. Neuropathic pain and dry eye[J]. Ocul Surf, 2018,16(1):31-44. DOI： 10.1016/j.jtos.2017.10.001 .
返回引文位置Google Scholar
百度学术
万方数据
[45]
Tsifetaki N , Kitsos G , Paschides CA ,et al. Oral pilocarpine for the treatment of ocular symptoms in patients with Sjögren's syndrome：a randomised 12 week controlled study[J]. Ann Rheum Dis, 2003,62(12):1204-1207. DOI： 10.1136/ard.2002.003889 .
返回引文位置Google Scholar
百度学术
万方数据
[46]
Gumus K , Pflugfelder SC . Intranasal tear neurostimulation：an emerging concept in the treatment of dry eye[J]. Int Ophthalmol Clin, 2017,57(2):101-108. DOI： 10.1097/IIO.0000000000000163 .
返回引文位置Google Scholar
百度学术
万方数据
[47]
Friedman NJ , Butron K , Robledo N ,et al. A nonrandomized, open-label study to evaluate the effect of nasal stimulation on tear production in subjects with dry eye disease[J]. Clin Ophthalmol, 2016,10:795-804. DOI： 10.2147/OPTH.S101716 .
返回引文位置Google Scholar
百度学术
万方数据
[48]
Gumus K , Schuetzle KL , Pflugfelder SC . Randomized controlled crossover trial comparing the impact of sham or intranasal tear neurostimulation on conjunctival goblet cell degranulation[J]. Am J Ophthalmol, 2017,177:159-168. DOI： 10.1016/j.ajo.2017.03.002 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
范先群，Email： nc.defudabe.utjsqxnaf
B
所有作者均声明不存在利益冲突
C
国家自然科学基金项目 (81770888)
上海市科委基础研究项目 (19JC1411703)
上海市科委科技成果转化和产业化项目 (17411963800)
上海交通大学医学院"高峰高原计划—研究型医师"项目 (20161421)
上海市重点实验室资助项目 (17DZ2260100)
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
梅杰综合征的临床诊疗进展
刘小兰 等
中华疼痛学杂志 2022,18(03)
中国干眼专家共识：生活方式相关性干眼（2022年）
亚洲干眼协会中国分会 等
中华眼科杂志 2022,58(08)
舌下神经－面神经侧－端吻合术治疗听神经瘤术后重度周围性面瘫的效果分析
郭超 等
中华神经外科杂志 2022,38(12)
面神经阻滞技术在面神经功能障碍性疾病中的应用中国疼痛专家共识（2022版）
黄冰 等
中华疼痛学杂志 2022,18(02)
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大