Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
권호 표지

Current Trends in the Recognition and Treatment of Dry Eye: A Survey of Ophthalmologists

설문조사에 의한 국내 건성안 환자의 진단 및 치료 현황

Kim, Wung-Jae;Kim, Man-Soo;Kim, Hyun-Seung
김웅재;김만수;김현승

  • Published : 2007.12.15
⟨ Previous Next ⟩

Abstract

Purpose: Based on the questionnaires for dry eyes in 2006, we have investigated the current status and new trends in the recognition and management of the dry eye. Methods: We ask the 15 questionnaires to 197 ophthalmologists. After reorganizing the data based on each questions, we compared the result with the most current studies in Korea and other countries as well. Then, we report the current trends in the diagnosis and treatment of dry eye. Results: Dry eye patients account for take up about 20-30% of total outpatients and it is currently accepted etiology that dry eye inflammation is related to the function of the immune system. Patient's symptoms and slit lamp examination are important for diagnosis. An anti-inflammatory therapy is needed for patients with moderate to severe dry eye. Conclusions: Increasingly, there are positive attitudes toward accepting that persistent dry eye is an inflammatory disease; therefore, there are increases in use of an anti-inflammatory agent for treatment.

목적 : 2006년 실시한 건성안에 대한 설문 조사 결과를 바탕으로 건성안의 변화된 개념에 대한 이해도, 현 건성안의 진단 및 치료 방법 및 변화에 대한 추세를 알아보았다. 대상과 방법 : 197명의 안과의사를 대상으로 총 15문항의 설문지로 설문조사를 실시하였다. 각 문항별로 결과를 정리한 후 이를 국내외 최신 지견을 바탕으로 설문조사 결과를 분석하고 국내 안과의사들의 건성안에 대한 인식 그리고 진단과 치료에 대한 추세를 분석하였다. 결과 : 외래 환자 중 건성안이 차지하는 비율은 20~30%정도를 보였으며, 건성안에 대한 국내 안과의사들의 인식이 면역학적 개념에 기초를 둔 염증성 질환으로 바뀌어 가고 있음을 알 수 있었다. 건성안을 진단하는데 환자의 증상과 세극등 현미경 검사를 중요시 여기고 있었고, 중등도 이상의 건성안 치료에 항염증 제제의 비중이 증가되어 있음을 알 수 있었다. 결론 : 염증성 질환으로써의 건성안의 변화된 개념에 긍정적이었고, 이에 따른 항염증제제의 사용이 증가하였다.

Keywords

References

  1. Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J 1995;21:221-32
  2. Stern ME, Beuerman RW, Fox RI, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea 1998;17:584-9 https://doi.org/10.1097/00003226-199811000-00002
  3. Stern ME, Gao J, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res 2004;78:409-16 https://doi.org/10.1016/j.exer.2003.09.003
  4. Dana MR, Hamrah P. Role of immunity and inflammation in corneal and ocular surface disease associated with dry eye. Adv Exp Med Biol 2002;506:729-38
  5. Behrens A, Doule JJ, Stern L, et al. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea 2006;25;900-7 https://doi.org/10.1097/01.ico.0000214802.40313.fa
  6. Schein OD, Munoz B, Tielsch JM, et al. Prevalence of dry eye among the elderly. Am J Ophthalmol 1997;124:723-8 https://doi.org/10.1016/S0002-9394(14)71688-5
  7. Lin PY, Tsai SY, Cheng CY, et al. Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 2003;110:1096-101 https://doi.org/10.1016/S0161-6420(03)00262-8
  8. Brewitt H, Sistani F. Dry eye disease: the scale of the problem. Surv Ophthalmol 2001;45:199-202 https://doi.org/10.1016/S0039-6257(00)00202-2
  9. Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol 2000;118:1264-8 https://doi.org/10.1001/archopht.118.9.1264
  10. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol 2003;136:318-26 https://doi.org/10.1016/S0002-9394(03)00218-6
  11. Hikichi T, Yoshida A, Fukui Y, et al. Prevalence of dry eye in Japanese eye centers. Graefes Arch Clin Exp Ophthalmol 1995;233:555-8 https://doi.org/10.1007/BF00404705
  12. Lin PY, Tsai SY, Cheng CY, et al. Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 2003;110:1096-101 https://doi.org/10.1016/S0161-6420(03)00262-8
  13. Stern ME, Beuerman RW, Fox RI, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea 1998;17:584-9 https://doi.org/10.1097/00003226-199811000-00002
  14. Kim DK, Song BR. The Concentration of Tear Lysozyme in Normal Subjects and Dry Eye. J Korean Ophthalmol Soc 1999;40;2693-700
  15. Puehler W, Rittner HL, Mousa SA, et al. Interleukin-1 beta contributes to the upregulation of kappa opioid receptor mrna in dorsal root ganglia in response to peripheral inflammation. Neuroscience 2006;25;141:989-98
  16. Kroemer G, Martinez C. Cytokines and autoimmune disease. Clin Immunol Immunopathol 1991;61:275-95 https://doi.org/10.1016/S0090-1229(05)80001-7
  17. Rowe D, Griffiths M, Stewart J, et al. HLA class I and II, interferon, interleukin 2, and the interleukin 2 receptor expression on labial biopsy specimens from patients with Sjogren's syndrome. Ann Rheum Dis 1987;46:580-6 https://doi.org/10.1136/ard.46.8.580
  18. Jones DT, Monroy D, Ji Z, et al. Sjogren's syndrome: cytokine and Epstein-Barr viral gene expression within the conjunctival epithelium. Invest Ophthalmol Vis Sci 1994;35:3493-504
  19. Narayanan S, Miller WL, McDermott AM. Conjunctival cytokine expression in symptomatic moderatedry eye subjects. Invest Ophthalmol Vis Sci 2006;47:2445-50 https://doi.org/10.1167/iovs.05-1364
  20. Gao J, Gelber-Schwalb TA, Addeo JV, Stern ME. Apoptosis in the lacrimal gland and conjunctiva of dry eye dogs. Adv Exp Med Biol 1998;438:453-60
  21. Korb DR. The tear film: its role today and in the future. In: Korb DR, Craig J, Doughty M, eds. The tear film: structure, function and clinical examination. Oxford: Butterworth Heinemann, 2002: chap. 7
  22. Lee JK, Ki CW, Roh KG. The Significance of the Tear Film Break-up Time (BUT) in the Diagnosis of the Dry Eye Syndrome. J Korean Ophthalmol Soc 1985;26:1311-5
  23. Shyn KH, Kim BH, Kim JC. A Study of the Conjunctival Epithelial Changes in Patients with Dry Eye Syndrome by Impression Cytology and Comparisons of Those Results with BUT, Schirmer Test, Rose Bengal Staining. J Korean Ophthalmol Soc 1994;35;362-70
  24. Dogru M, Stern ME, Smith JA, et al. Changing trends in the definition and diagnosis of dry eyes. Am J Ophthalmol 2005;140:507-8
  25. Korb DR, Greiner JV, Herman J. Comparison of fluorescein break-up time measurement reproducibility using standard fluorescein strips versus the Dry Eye Test (DET) method. Cornea 2001;20:811-5 https://doi.org/10.1097/00003226-200111000-00007
  26. Dogru M, Ishida K, Matsumoto Y, et al. Strip meniscometry: a new and simple method of tear meniscus evaluation. Invest Ophthalmol Vis Sci 2006;47:1895-901 https://doi.org/10.1167/iovs.05-0802
  27. Cho BJ, Lee JH, Shim OJ. The Relation Between Clinical Manifestations of Dry Eye Patients and Their BUTs. J Korean Ophthalmol Soc 1992;33;297-302
  28. Calonge M. The treatment of dry eye. Surv Ophthalmol 2001;452:S227-39
  29. Nelson JD, Farris RL. Sodium hyaluronate and polyvinyl alcohol artificial tear preparations. A comparison in patients with keratoconjunctivitis sicca. Arch Ophthalmol 1988;106: 484-7 https://doi.org/10.1001/archopht.1988.01060130530029
  30. Kwon DJ, Park DH, Park D, et al. Clinical Investigation of Therapeutic Effect and Extrusion Rate of Punctal Plug for Dry Eye Syndrome. J Korean Ophthalmol Soc 2006;47;1204-11
  31. Jeong SH, Lee YJ, Kim HY, et al. The Relationship between the Dacryoscintigraphy and the Satisfaction with Punctal Occlusion in Patients with Dry Eye Syndrome. J Korean Ophthalmol Soc 2003;44;1723-7
  32. Lew HM, Jang JW, Lee EH. The Changes of Tear Osmolarity and Protein After Silicone Punctal Plug Insertion In Dry Eye. J Korean Ophthalmol Soc 2001;42;1509-14
  33. Her J, Yu SI, Seo SG. Clinical Effects of Various Antiinflammatory Therapies in Dry Eye Syndrome. J Korean Ophthalmol Soc 2006;47;1901-10