Daily Archives: 2025/06/14

藥物與乾眼症 (DED) 和瞼板腺功能障礙 (MGD) Medications DED and MGD

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與乾眼症 (DED) 和瞼板腺功能障礙 (MGD) 相關的藥物包括口服避孕藥，由於其含有雌激素和黃體素，可能導致與 MGD 相關的乾眼症。用於治療攝護腺問題的坦索羅辛和特拉唑嗪也與乾眼症有關。某些抗癌藥物，如甲胺蝶呤和西妥昔單抗，會影響淚腺，導致乾眼症。此外，常用於治療胃灼熱的質子幫浦抑制劑 (PPI) 也可能透過維生素 B12 缺乏或影響腸道菌叢而導致乾眼症。

局部用藥時，苯扎氯銨 (BAK) 是一種存在於許多眼藥水中的防腐劑，它與乾眼症和 MGD 密切相關，因為它會破壞淚膜。許多青光眼藥物也含有 BAK，長期使用會加重乾眼症。

其他可能導致乾眼症 (DED) 和瞼板腺分泌障礙 (MGD) 的因素包括配戴隱形眼鏡（這會加劇症狀）以及眼瞼衛生不良（會導致細菌積聚，從而對瞼板腺分泌產生負面影響）。蠕形蟎在這些疾病中的作用仍在研究中，但一些研究表明其與瞼板腺分泌障礙 (MGD) 有關，尤其是在乾眼症 (DED) 患者中。

治療方法包括透過熱敷、眼瞼按摩和眼瞼擦洗來保持眼瞼衛生，以改善瞼板腺分泌。脂質類人工淚液有助於穩定淚膜，而局部或全身性用藥則可根據 DED/MGD 的嚴重程度進行。診室內操作，例如瞼板腺擠壓術或 LipiFlow，可以幫助疏通阻塞的腺體。

Medications associated with Dry Eye Disease (DED) and Meibomian Gland Dysfunction (MGD) include oral contraceptives, which can lead to MGD-related dry eye due to their estrogen and progesterone content. Tamsulosin and terazosin, used for prostate issues, are also linked to DED. Certain anticancer drugs, such as methotrexate and cetuximab, can affect the lacrimal glands, contributing to dry eye. Additionally, proton pump inhibitors (PPIs), commonly used for heartburn, may cause DED through vitamin B12 deficiency or impacts on the gut microbiome.

Topically, benzalkonium chloride (BAK), a preservative found in many eye drops, is strongly associated with DED and MGD as it disrupts the tear film. Many glaucoma medications contain BAK as well and can worsen dry eye with prolonged use.

Other factors that can contribute to DED and MGD include contact lens wear, which can exacerbate symptoms, and poor eyelid hygiene that allows bacteria to accumulate, thereby negatively affecting meibomian gland secretion. The role of Demodex mites in these conditions is still under investigation, though some studies suggest a link with MGD, particularly in patients with DED.

Treatment options include maintaining eyelid hygiene through the use of warm compresses, eyelid massage, and lid scrubs to improve meibomian gland flow. Lipid-based artificial tears can help stabilise the tear film, while topical or systemic medications may be prescribed based on the severity of DED/MGD. In-office procedures, such as meibomian gland expression or LipiFlow, can help clear blocked glands.

及早察覺瞼板腺功能障礙 Early detection of Meibomian gland dysfunction

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瞼板腺是人體中最辛勤工作的組織之一。它們晝夜不停地運作，製造足夠的油脂分泌出來，凝成及維持穩定的淚膜，減少淚液蒸發，潤滑和保護眼球表面，並確保清晰的視力。這些腺體位於眼瞼內，隨著年齡的增長，以及環境因素和其他影響的影響，它們的數量會逐漸減少。並失去油脂分泌功能，最終萎縮。

瞼板腺功能障礙的初期症狀通常很輕微，許多人可能只是偶爾使用潤滑眼藥水。因此，他們可能直到感到不適才意識到問題所在，而不適通常是在腺體功能嚴重喪失後出現的。當您開始感到嚴重的眼睛不適時，您的瞼板腺功能可能已經喪失了近一半。

雖然一般的居家照護措施（例如使用熱敷、保持眼瞼衛生、保持眼部衛生以及服用歐米伽-3等營養補充劑）可能有所幫助，但它們只是輔助性質。有效的治療需要在診所進行專業的治療。如果沒有及時適當的護理，可能會出現更嚴重的症狀，導致眼球表面損傷、視力模糊，並嚴重影響生活品質。

近年在乾眼症及治療瞼板腺功能障礙的技術上，也突破性的發展。現在更了解清楚乾眼症的成因及病理，可以針對性，精準地，同時處理多方面的病因。更有效，快速及安全地治療，在短時間內改善乾眼徵狀、且效果更可維持半年或以上。

Meibomian glands are among the hardest-working tissues in the body. They work around the clock to produce enough oily secretion to form and maintain a stable tear film, reduce tear evaporation, lubricate and protect the surface of the eyeball, and ensure clear vision. These glands are located in the eyelids, and as we age, along with exposure to environmental factors and other influences, their number gradually decreases. They also tend to lose their oil-secreting function and can eventually atrophy.

The initial symptoms of meibomian gland dysfunction are often subtle, and many people may only occasionally use lubricating eye drops. As a result, they may not recognise the problem until they experience discomfort, which can occur after a significant loss of gland function. By the time you start experiencing substantial eye discomfort, you may have already lost nearly half of your meibomian gland function.

While general home care practices—such as using warm compresses,
Lipid-based artificial tears, maintaining lid hygiene, practicing eye hygiene, and taking nutritional supplements like omega-3—can be helpful, they are only supplementary. Effective treatment requires professional intervention at an ophthalmology clinic. Without timely and appropriate care, more serious symptoms can develop, leading to damage to the eyeball’s surface, blurred vision, and a significant impact on one’s quality of life.

In recent years, there have been breakthroughs in the technology of dry eye and treatment of meibomian gland dysfunction. Now we have a better understanding of the causes and pathology of dry eye, and we can treat multiple causes in a targeted, precise and simultaneous manner. More effective, fast and safe treatment can improve dry eye symptoms in a short period of time, and the effect can last for half a year or more.

乾眼症及瞼板腺功能障礙 Meibomian gland dysfunction (MGD) & Dry eye disease (DED)

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乾眼症 (DED) 是一種高度流行的眼部疾病，其特徵是淚膜和眼表穩態的改變。根據香港中文大學 2022 年的一項調查，約有 30% 的人口患有乾眼症。值得注意的是，80% 的乾眼症病例是脂質缺乏性或蒸發過強型乾眼症，是由瞼板腺功能障礙 (MGD) 引起的。因此，瞼板腺功能障礙影響著數百萬人，尤其是在亞洲國家。

瞼板腺功能障礙 (MGD) 患者的眼瞼油脂分泌腺無法分泌足夠或適當的油脂，從而導致乾眼症狀。這些位於眼瞼邊緣的腺體負責分泌瞼脂，這種油性物質可以保護淚膜，防止淚膜過快蒸發，並保持眼部濕潤健康。

瞼板腺功能障礙 (MGD) 可發生在所有年齡層的人群中，尤其是 60 歲以上的人。導致 MGD 的因素有很多，包括老化、荷爾蒙變化、低濕度以及低 Omega-3 脂肪酸或高 Omega-6 脂肪酸的飲食。

其他促成因素包括配戴隱形眼鏡以及某些局部或全身用藥。長時間使用電子設備會導致眨眼頻率降低和眼瞼閉合不全，進而導致淚膜蒸發增加、不穩定，以及淚液滲透壓升高。長時間使用螢幕也可能是兒童和青少年乾眼症 (DED) 發病率上升的一個因素。

在瞼板腺功能障礙 (MGD) 病例中，由眼瞼中的瞼板腺分泌的油性分泌物（稱為瞼脂）分泌份量不足且成分改變。這會導致分泌物增厚、混濁且停滯，更難以擠出。如果沒有足夠的油脂分泌，由黏蛋白、水和油脂組成的健康淚膜層就無法正常形成。

促成因素包括淚膜不穩定、水份蒸發率增加、乾燥、淚液高滲透壓、發炎。眼球表面潤滑不足，導致眼瞼和眼球之間產生摩擦，令眼表細胞受損。這些問題會導致淚液代償性分泌過剩，從而形成乾眼症 (DED) 的持續循環。

乾眼症 (DED) 的眼睛症狀包括乾澀、眼部異物感、眼部疲勞、眼紅、灼熱或疼痛、視力模糊、畏光以及作為代償反應的過度流淚。 DED 也與眼瞼發炎和感染（例如瞼緣炎）以及蠕形蟎蟲感染有關。

總結: 瞼板腺功能障礙 (MGD) 是一種慢性進行性疾病，會危害眼表健康。如果不及時治療，MGD 可能會惡化，導致嚴重症狀、持續不適、角膜損傷、眼部感染以及潛在的嚴重視力障礙。優先考慮有效的醫學治療對於確保您的眼部健康和維持生活品質至關重要。

Dry eye disease (DED) is a highly prevalent ocular condition that is characterised by alterations in the homeostasis of the tear film and the ocular surface. According to a 2022 survey conducted by the Chinese University of Hong Kong, approximately 30% of the population suffers from DED. Notably, 80% of DED cases are lipid-deficient or evaporative dry eye, which is caused by Meibomian gland dysfunction (MGD). As a result, meibomian gland dysfunction affects millions of people, especially in Asian countries.

In patients with Meibomian gland dysfunction (MGD), the oil-secreting glands in the eyelids fail to produce enough oil or produce the wrong type of oil, resulting in dry eye symptoms. These glands, located at the edges of the eyelids, are responsible for creating meibum, an oily substance that protects the tear film. This helps prevent the tear film from evaporating too quickly, keeping the eyes moist and healthy.

Meibomian Gland Dysfunction (MGD) can occur in individuals of all age groups, especially in those over 60. Several factors contribute to MGD, including aging, hormonal changes, low humidity, and diets that are low in omega-3 fatty acids or high in omega-6 fatty acids.

Other contributing factors include the use of contact lenses and certain topical or systemic medications. Extended use of electronic devices can lead to decreased blink rates and incomplete eyelid closure, which results in increased evaporation and instability of the tear film, as well as higher tear osmolarity. Prolonged screen time may also be a factor in the rising rates of dry eye disease (DED) among children and young adults.

In cases of Meibomian Gland Dysfunction (MGD), the oily secretion known as meibum, which is produced by the meibomian glands in the eyelids, is often insufficient in quantity and altered in composition. This leads to a thickened, cloudy, and stagnant secretion that is more difficult to express. Without adequate oil, the healthy layers of the tear film—comprising mucin, water, and oil—cannot form properly.

Contributing factors include tear film instability, increased evaporation rate, dryness, tear hyperosmolarity, and inflammation. Inadequate lubrication of the eye surface causes friction between the eyelid and eyeball, which damages the cells on the eye surface. These problems lead to compensatory overproduction of tears, which creates a perpetuating cycle of dry eye disease (DED).

Ocular symptoms of Dry Eye Disease (DED) can include dryness, a gritty sensation, eye fatigue, redness, burning or pain, blurred vision, sensitivity to light, and excessive tearing as a compensatory response. DED is also associated with eyelid inflammation and infections, such as blepharitis, as well as infestations by Demodex mites.

Summary: Meibomian gland dysfunction (MGD) is a chronic, progressive disease that compromises the health of the ocular surface. If left untreated, MGD can worsen, leading to severe symptoms, ongoing discomfort, corneal damage, eye infection, and potentially serious visual impairment. Prioritizing effective medical treatment is critical to ensuring your eye health and maintaining quality of life.