干眼是以泪膜稳态丢失及伴随眼部不适症状为特征的最常见眼表疾病，泪膜不稳定、泪液高渗透性、眼表炎症及感觉神经异常为其主要病因。地夸磷索钠是一种P2Y2受体激动剂，能刺激黏蛋白及泪液分泌，其独特的作用机制为干眼的治疗开辟了新的方向，本文就地夸磷索钠近年的临床及基础研究进展作一综述。

Dry eye is one of the most common ocular surface diseases. It is characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and tear hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play major etiological roles. Diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that promotes mucin and aqueous tear secretion. The unique pharmacological mechanism of diquafosol tetrasodium opens up a new direction for the medical therapies of dry eye. This article reviews the clinical therapeutic effect and research progress of diquafosol tetrasodium for the past few years.

目的：观察强脉冲光(intense pulse light，IPL)治疗睑板腺功能障碍(meibomian gland dysfunction，MGD)性干眼的临床效果。方法：选取2019年10月至2019年12月在东莞市东南部中心医院眼科门诊就诊的MGD性干眼患者64例(64只右眼)，随机分为对照组与观察组，每组32例。对照组采用睑板腺按摩联合常规药物治疗，观察组采用IPL联合睑板腺按摩及常规药物治疗，两组疗程均为6周；观察两组患者治疗前后干眼症状、体征及睑板腺功能变化。结果：治疗后两组干眼症状、体征及睑板腺功能均较治疗前明显改善，差异有统计学意义(P>0.05)；观察组治疗后2、4周干眼症状、体征及睑板腺功能评分改善优于对照组，差异有统计学意义(P<0.05)；治疗后6周两组各项观察指标差异无统计学意义(P>0.05)。经过6周治疗，观察组有效率为87.5%(28/32)，对照组有效率75%(24/32)，差异有统计学意义(P=0.021)。治疗期间两组均未发生不良反应。结论：IPL联合睑板腺按摩对MGD性干眼能有效减轻眼部不适症状、改善睑板腺功能，较单纯睑板腺按摩起效更快、效果更佳。

Objective: To observe the clinical effect of intense pulse light (IPL) on MGD dry eyes. Methods: Sixty-four patients(64 right eyes) with MGD dry eye from October 2019 to December 2019 were collected and randomly divided into control group (n=32) and observation group (n=32). The control group was treated with meibomian gland massage combined with conventional medicine, while the observation group was treated with IPL combined with meibomian gland massage and conventional medicine. The course of treatment of both groups was 6 weeks. The dry eye symptoms, dry eye signs and meibomian gland function changes were observed before and after treatment in both groups. Results: The dry eye symptoms, physical signs and meibomian gland function of the two groups after treatment were significantly improved compared with those before treatment (P>0.05). The improvement of dry eye  symptoms, physical signs and meibomian gland function in observation group were better than those of the control group at two and four weeks after treatment (P<0.05), while there was no statistically significant difference between the two groups at 6 weeks after treatment (P>0.05). The effective rate in observation group was 87.5% (28/32) after 6 weeks treatment, while control group was 75% (24/32), the difference was statistically significant (P=0.021). No adverse reactions occurred in both groups during the treatment. Conclusion: IPL combined with meibomian gland massage can effectively reduce the ocular discomfort and improve the function of meibomian gland in MGD dry eyes,which is faster and more effective than meibomian gland massage alone.

目的：探讨泪液中前列腺素E2(prostaglandin E2，PGE2)水平与干眼严重程度的关系。方法：选取干眼患者60例，并接受眼表疾病指数(Ocular Surface Disease Index，OSDI)问卷调查及眼科检查，包括泪膜破裂时间(tear film breakup time，BUT)、角膜荧光素染色评分(corneal fuorescein staining score，CFLS)、泪液分泌试验(Schirmer I试验)。使用酶联免疫吸附测定(ELISA)测量泪液中PGE2的水平。分析泪液PGE2水平与干眼临床症状相关指标的关系。结果：干眼患者泪液中的PGE2水平为(446.39±139.34) pg/mL。干眼患者泪液中PGE2水平与OSDI评分呈正相关(r=0.458，P<0.001)。泪液PGE2水平与BUT(r=0.164，P=0.354)、CFLS评分(r=0.265，P=0.086)、Schirmer I试验(r=?0.076，P=0.460)均无明显相关性。应用线性回归分析表明，泪液PGE2水平与OSDI评分呈正相关(95%CI：7.04~20.18，t=4.01，P<0.001)。结论：泪液中PGE2的水平与OSDI评分呈正相关，与BUT、CFLS评分、Schirmer I试验均无明显相关性。

Objective: To investigate the relationship between the level of prostaglandin E2 (PGE2) in tears and the severity of dry eye. Methods: Sixty patients with dry eye were selected and investigated with the Ocular Surface Disease Index (OSDI) questionnaire and ophthalmic examination, including tear film break-up time (BUT), corneal fluorescein staining score (CFLS) and tear secretion test (Schirmer I test). The level of PGE2 in tears was measured by enzyme-linked immunosorbent assay (ELISA). The relationship between the level of PGE2 in tears and related indexes of dry eye clinical symptoms was analyzed. Results: The average level of PGE2 in tears of patients with dry  eye was (446.39±139.34) pg/mL. The level of PGE2 in tears of patients with dry eye was positively correlated with the OSDI score (r=0.458, P<0.001). PGE2 levels were not significantly correlated with BUT (r=0.164, P=0.354),Schirmer I score (r=?0.076, P=0.460), and CFLS score (r=0.265, P=0.086). Linear regression analysis showed that the level of PGE2 in tears was positively correlated with OSDI score (95% CI: 7.04–20.18, t=4.01, P<0.001).Conclusion: The level of PGE2 in tears is positively correlated with OSDI score, but has no significant correlation with BUT, the CFLS score and Schirmer I test.

目的：探讨大气污染物NO₂水平与干眼患病的相关性。方法：选取2014年1月至2018年1月共计75 279例干眼患者的临床资料，进行资料汇总。空气质量和天气数据来自西安市气象局2014—2018年的每日环境空气质量数据。分析中包括的环境空气污染物NO₂。所有数据均按小时收集。计算每个变量的每日平均值，并计算本研究中使用的每周平均值。本研究中患者均自愿参加，并经南昌大学第一附属医院医学研究伦理委员会批准。结果：干眼的门诊就诊次数与NO₂水平显著相关。本研究发现不同年龄段的人受到不同的参数变化影响，环境中NO₂的浓度对于全年龄段的人患干眼有显著相关性，对性别无选择性，男女均会因为NO2在环境中的不同水平而患干眼。较高水平的环境NO₂会增加门诊患者干眼的概率。我们通过对患者人数的累计与环境中NO₂浓度进行相关性分析，发现其有显著相关性，因此环境空气污染和天气变化可能导致干眼的恶化。结论：大气污染物NO2与干眼患病有显著相关性。

Objective: To investigate the correlation between NO₂ levels in air pollutants and dry eye. Methods: The clinical data of 75 279 patients with dry eye from January 2014 to January 2018 were selected and summarized. The air quality and weather data were from the daily ambient air quality data of Xi’an Meteorological Bureau from 2014 to 2018. Environmental air pollutants NO₂ was included in the analysis. All data were collected on an hourly basis. We calculated the daily average for each variable and then calculated the weekly average used in this study.All patients in this study volunteered to participate. , and this study was approved by the Medical Research Ethics Committee of the First Affiliated Hospital of Nanchang University. Results: We found that the number of outpatient visits for dry eye was significantly correlated with NO₂ levels. Our study found that people of different ages were affected by different parameter changes. The concentration of NO₂ in the environment was significantly correlated with dry eyes in all age groups, and is not selective for gender. Both men and women could develop dry eyes due to different levels of NO₂ in the environment. Our results showed that higher levels of environmental NO₂ increased the chances of dry eyes in outpatients. By analyzing the correlation between the cumulative number of patients and the NO₂ concentration in the environment, we found that the correlation was significant.Therefore, ambient air pollution and weather changes may lead to the deterioration of dry eye. Conclusion: There is a significant correlation between atmospheric pollutant NO₂ and dry eye disease.

局部点药是眼部用药最常见的方式，但一般药物通过角膜困难，药物生物利用度低。纳米载体药物于8 0年代开始用于眼部，脂质体和类脂质囊泡(niosomes)与眼表的黏蛋白相互作用，延长药物在眼表的停留时间。纳米乳剂(nanoemulsion)的表面活性剂可以松解角膜上皮细胞紧密连接，形成转运开口，抑制细胞表面糖蛋白酶P(glycoprotein P，Pgp)降解药物活性蛋白。纳米粒子(nanoparticles)通过角膜上皮和结膜上皮而不会引起毒性。纳米胶囊(nanocapsules)更深地内化到角膜上皮(50 μm处)。聚合物胶束(polymeric micelles)自组装成核-壳纳米载体增强药物渗透角膜的能力。阴离子高代聚酰氨基胺(poly-amidoamine，PAMAM)树枝状大分子增强药物通透性，中性和阳离子低代树枝状大分子通过网格蛋白途径介导药物更高的通透性。纳米晶体(nanocrystal)，除增强药物溶解度和溶解速率之外，它的高黏附能力帮助药物保留和渗透到眼组织中。纳米结构材料与干眼关联密切，为干眼的治疗、诊断提供手段。

Topical administration is the most common method of ocular medication, but it is generally difficult for the drug to pass through the cornea, and the bioavailability of the drug is low. Nanocarrier drugs were used in eyes in the 1980s, and liposomes and lipoids vesicles (Niosomes) interacted with ocular surface mucins to prolong  the residence time of the drug on the ocular surface. Nanoemulsion surfactants can release the tight junctions of corneal epithelial cells, form transport openings, and inhibit the degradation of pharmaceutically active proteins by cell surface glycoprotein P (Pgp). Nanoparticles pass through the corneal and conjunctival epithelium without causing toxicity. Nanocapsules internalize deeper into the corneal epithelium (at 50 μm). Polymeric micelles self-assemble into core-shell nanocarriers to enhance the ability of drugs to penetrate the cornea. Anionic high-generation poly-amidoamine (PAMAM) dendrimers enhance drug permeability. Neutral and cationic low-generation dendrimers mediate higher drug permeability through clathrin pathway. Nanocrystal, in addition to enhancing drug solubility and dissolution rate, its high adhesion ability helps drug retention and penetration into ocular tissues. Nanostructured materials are closely related to dry eye and provide a choice for the treatment and diagnosis of dry eye.

泪膜的不同组成成分通过相互作用共同维持眼球表面的湿润，从而维持眼部健康。当这些组成成分出现病理性改变，将会不同程度的影响泪膜稳态，从而导致干眼的发生。而瞬目运动一定程度上影响着泪膜组成成分的分布，随着对干眼相关机制研究的逐步深入，以泪膜为导向的诊断(tear-film-oriented diagnosis，TFOD)的新概念被提出，并被逐渐被接受。我们可以通过泪膜破裂方式来确定眼球表面所缺乏的组成成分，并在此基础上对干眼进行诊断，从而定向补充泪膜缺失成分，重新恢复泪膜稳态。本文将着重分析瞬目、泪膜形成及泪膜破裂机制之间的关系，从而进一步明确泪膜定向诊断的新概念及发展方向。

Different components of the tear film work together to maintain the wettability of the ocular surface, thus maintaining eye health. When the pathological changes of these components occur, the tear film homeostasis will be affected to varying degrees, leading to dry eye. Blinking movement affects the distribution of tear film components to some extent. With the continuous development of research and understanding of the concept and mechanism of dry eye, new concepts of tear-film-oriented diagnosis (TFOD) have been gradually proposed and widely accepted. We can determine the components lacking on the surface of the eye through the tear film  breakup patterns (BUPs). On this basis, dry eye is diagnosed, so as to replenish the lacking components of tear film directionally and restore the stability of tear film. This paper will focus on analyzing the relationship between blinking, tear film formation and tear film break-up mechanism, so as to further clarify the new concept and development direction of tear-film oriented diagnosis.

目的：了解近5年世界干眼研究的文献分布特征，并分析这一领域的研究趋势及研究热点。方法：以Web of Science核心数据库(WoSCC)为基础，采用文献计量学方法对干眼相关的全球研究趋势进行评估。通过VOSviewer v.1.6.16构建知识图谱，可视化了该领域的出版物、国家/地区分布、国际合作、作者、来源期刊和研究热点。另外，用CiteSpace IV来捕获爆发的关键词，探索热点的兴起和没落时间，以发现研究前沿。结果：在2016—2020年间共检索到2 567篇同行评议文章，其中美国是发表文献数量最多的国家，文献产量最高的机构是日本的庆应义塾大学。Kazuo Tsubota是该领域发表论文最多的作者，MA Lemp是被引次数最多的作者。Ocular Surface是干眼研究中发表文章最多的杂志。被引用最多的文献主要是TFOS Dr y Eye Workshop II发表的干眼系列报道。关键词聚类分析得出6大类：1)致病机制和病理生理；2)定义和分类；3)流行病学研究；4)治疗；5)继发性干眼；6)诊断。目前的研究前沿是眼痛、瑞巴派特、小切口角膜基质透镜取出术(small incision lenticule extraction，SMILE)手术和泪膜动力学。结论：本研究通过对国际干眼领域近5年的文献进行文献计量学分析，可视化呈现了最近这一领域的研究现状、热点及前沿。干眼研究的前沿主题是眼痛、瑞巴派特、SMILE手术和泪液动力学。

Objective: To understand the literature distribution characteristics of dry eye research in the world in the last 5 years, and to analyze the research trend and hotspots in this field. Methods: Based on the Web of Science Core Collection (WoSCC) database, a bibliometric analysis was conducted to evaluate the global research trends related to dry eye. Knowledge mappings were constructed by VOSviewer v.1.6.16 to visualize the publications, the distribution of countries, international collaborations, author productivity, source journals, and research hotspots in this fifield. In addition, CiteSpace IV was used to capture the keywords of outbreaks and to explore the rise and fall of hotspots. Research frontiers could be discovered by this analysis. Results: In total, 2 567 peer-reviewed articles were retrieved on dry eye research from 2016 to 2020. The United States ranked the highest among countries withthe most publications. The most productive institution was the Keio University. Kazuo Tsubota contributed the largest number of publications in this field, and MA Lemp was the most cited author. Ocular Surface was the most prolific journal in dry eye research. The top-cited references were mainly about the reports of the International Workshop on Meibomian Gland Dysfunction (MGD). The most cited literature was mainly dry eye series reports by TFOS Dry Eye Workshop II. Six categories were obtained by cluster analysis: 1) pathogenic mechanism and pathophysiology; 2) definition and classification; 3) epidemiological study; 4) treatment; 5) secondary dry eye; 6) diagnosis. Current research foreword is ocular pain, rebamipide, small incision lenticule extraction (SMILE) surgery, and tear film dynamics. Conclusion: Through the bibliometrics analysis of the international literature in the field of dry eye in the past five years, this study visualized the current research status, hotspots, and frontier in this field. Leading topics in dry eye research are eye pain, rebamipide, SMILE surgery, and tear dynamics.

近年来，由于经济社会不断发展，社会压力增大，人们精神障碍和干眼的发病率不断增加，这既影响人们身心健康，也给社会经济造成一定负担。大量研究表明精神障碍与干眼显著相关，精神障碍是干眼的独立危险因素之一。然而在临床工作中，精神障碍与干眼间的关系在过去一直未受到重视，本文将从精神障碍与干眼关联性入手，探讨其中介作用，总结了精神障碍因素影响干眼症状和体征分离，并进一步倡导跨学科综合管理来治疗干眼，形成对干眼的正确感知并降低疼痛及健康焦虑水平，以期为干眼临床诊疗提供新的视角。

In recent years, due to the continuous development of economy and society and the increasing social pressure, the incidence rate of mental disorders and dry eyes is increasing, which not only affects people’s physical and mental health, but also creates a certain burden on the social economy. A large number of studies have shown that mental disorder is significantly related to dry eye, and mental disorder is one of the independent risk factors of dry eye. However, in clinical work, the relationship between mental disorder and dry eye has not been paid attention in the past. This paper will start with the correlation between mental disorder and dry eye, explore the mediating effects, summarize the mental disorder factors that affect the separation of symptoms and signs of dry eye, and further advocate interdisciplinary comprehensive management to treat dry eye, form a correct perception of dry eye and reduce the level of pain and health anxiety, In order to provide a new perspective for clinical diagnosis and treatment of dry eye.

干眼是一种临床常见慢性眼表疾病。它不仅能引发患者眼部不适及损害，还易导致患者出现心理障碍。目前最常见的干眼相关心理障碍主要为焦虑、抑郁和睡眠障碍。干眼病情的缓解，不仅需要针对干眼本身的积极治疗，还需要患者保持健康的心理状态。因此，应该关注干眼相关焦虑、抑郁等心理障碍的发病机制及预防、治疗措施。

Dry eye disease (DED) is a common chronic ocular surface disease. It can not only cause discomfort and damage to the eyes but also easily lead to psychological disorders in patients. The most common psychological disorders related to DED are anxiety, depression and sleep disorder. To alleviate the condition of DED, in addition to active treatment for DED itself, it is also necessary for the patients to maintain a healthy psychological state. Therefore, attention should be paid to the pathogenesis, prevention and treatment measures of DED-related anxiety, depression and other psychological disorders.

目的：调查干眼在郑州市机关工作者中的患病情况，分析相关危险因素，为有效防治干眼提供科学依据。方法：选取2019年9月到2020年9月在郑州大学第一附属医院体检的郑州市机关工作者873例。采用自行设计的一般资料问卷和OCULUS Jenvis-OSDI干眼问卷进行调查，记录评分结果，同时检查记录裂隙灯、角膜荧光素染色评分(corneal fluorescein staining score，FL)、基础泪液分泌实验(Schimier I test，SIT)、泪膜破裂时间(tear break-up time，BUT)测定结果。统计分析机关工作者干眼患病率与危险因素。结果：体检的873例郑州市机关工作者中360例诊断为干眼，干眼总患病率为41.24%，女性患病率(44.62%)明显高于男性(36.26%)，差异有统计学意义(P=0.014)。干眼问卷OSDI评分与FL评分呈正相关，BUT与SIT呈正相关，OSDI(和FL评分)与BUT(和SIT)呈负相关。Logistics多因素分析表明：干眼家族史、绝经、曾行眼部手术、滴眼液使用情况、长时间佩戴角膜接触镜、长时间操作视频终端、睡眠不足、糖尿病史是机关工作者干眼患病的危险因素(均P<0.05)，而饮酒是保护因素(P=0.001)。结论：机关工作者干眼患病率较高，危险因素囊括家族患干眼史、绝经、曾行眼部手术、滴眼液使用情况、长时间佩戴角膜接触镜、长时间操作视频终端、睡眠不足、糖尿病病史。加强干眼防治的宣传教育，针对不同危险因素提供眼健康指导并进行防控治疗，保护机关工作者的眼健康。

Objective: To investigate and analyze the prevalence of dry eyes in Zhengzhou office workers, and identify the related risk factors in order to provide evidence for effective prevention and treatment. Methods: We selected 873 cases of Zhengzhou office workers who had checkup in our hospital from September 2019 to September 2020 as the research subjects. They were investigated with self-designed general information questionnaire and OCULUS Jenvis-OSDI dry eye questionnaire and scores of the questionnaires will be assessed. At the same time,they underwent dry-eye-related inspections such as slit lamp examination, corneal fluorescein staining score (FL), Schimier I test (SIT) and tear break-up time (BUT) assessment. The prevalence and risk factors of dry eyes in these office workers were statistically analyzed. Results: Among 873 Zhengzhou office workers, 360 cases were diagnosed as dry eyes, and the total prevalence of dry eye was 41.24%. The female prevalence rate was 44.62%, which was significantly higher than that of male (36.26%, P=0.014). OSDI scores and FL scores were positively correlation as well as BUT and SIT, while OSDI (and FL) and BUT (and SIT) were negatively correlation. Logistic multivariate analysis showed that dry eyes family history, menopause, ocular surgery history, eye drops using, long time corneal contact lenses wearing, long time video terminal operating, lack of sleep and diabetes history were independent risk factors in office workers’ dry eye disease (all P<0.05), while drinking was protective factor (P=0.001). Conclusion: The dry eyes prevalence is high among office workers. The risk factors include dry eye family history, menopause, ocular surgery history, eye drops using, long time corneal contact lenses wearing, long time video terminal operating, lack of sleep and diabetes history. We should strengthen the publicity and education of the dry eye prevention and treatment, provide eye health guidance, prevention and treatment according to different risk factors, and protect the office workers’ eye health.