The TFOS Dry Eye Workshop II

The TFOS Dry Eye Workshop II: Key UpdatesIn 2007, the Tear Film and Ocular Surface Society (TFOS) published the Report of TFOS international Dry Eye Workshop, later known as TFOS DEWS. The original report expanded the scope of dry eye disease (DED), and since that time, the number of publications on the topic has roughly doubled.2007年,泪膜和视角表面的医学协会(TFOS)发表有关TFOS国际干眼研讨报告,后来被称为TFOS预警系统。

干眼病的原始报告扩大了监测范围从那时起,相关出版品的数量几乎翻了一倍。

A decade later, the highly anticipated TFOS DEWS II was released online in The Ocular Surface journal.1-9. The full report, comprising more than 350 pages, tackles the published literature on DED since the original TFOS DEWS. This article briefly summarizes key points from each section of the report and aims to increase awareness of the findings and recommendations from this landmark publication.十年后备受期待的TFOS预警文章发布在《视角表面》杂志1 – 9期上，检索自《泪膜及视角表面》发表的原始文献，全部文献包括350多页,。

本文简要概况了每个检索报告的要点,旨在提高人们关注干眼病的重要意义，特别是由这个具有里程碑意义的刊物所推荐的发现文章。

Definition and Classification1定义和分类TFOS DEWS II defines dry eye disease as the following: “Dry eye is a multi-factorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”TFOS预警系统II对干眼病的定义是:“干眼病是一种多因素促发的眼表面的泪液膜特定体内平衡丧失的眼部疾病，伴有眼部症状泪膜不稳定和高渗血症既眼部表面炎症和损伤以及感觉神经的异常等病原性作用。

”Establishing an appropriate definition for DED is extremely important because it serves to guide diagnostic methodologies and treatment modalities.建立恰当的干眼症定义是极其重要的，因为它能指导诊断方法和治疗方法。

Changes to definition.Notable differences from the 2007 TFOS DEWS definition include the recognition of the loss of tear film homeostasis as a key characteristic of DED as well as the acknowledgment of neurosensory abnormalities as an etiologic factor.改变的定义，显著的差异从2007 TFOS预警定义包括泪液膜内稳态的损失的识别的关键特征干眼症以及感觉神经的异常的确认病原性作用。

Aqueous deficient or evaporative?Identifying the primary DED subtype （aqueous deficient or evaporative）remains important for classification. However, the consensus of TFOS DEWS II is that these subtypes are part of a spectrum of disease, rather than being distinct pathophysiological entities. Determining the predominant underlying etiology can be useful in directing primary treatment strategies.泪水不足或泪液蒸发了吗?目前依仍是识别主要干眼症分型(水不足或蒸发)的重要依据。

然而TFOS达成的共识，这类分型仍然无法改变他们同属于同一类疾病的事实，而不存在病理生理学意义上的不同。

如果能确定主要潜在病因分类我们才谈得上制定指导治疗策略。

Sex, Gender, and Hormones2性、性别和荷尔蒙Sex versus gender.Although interrelated, sex and gender are distinct concepts that should be considered separately in the medical literature. The former is based on biological characteristics, the latter on societal constructs and definitions (including self-definition).性与性别。

虽然相关但性和性别是不同的概念，这应该在医学文献中单独考虑。

前者是基于生物学特性，后者的是对社会结构的定义(包括自我认知)等。

Sex-specific factors.Female sex has been identified as a risk factor for the development of DED across many studies. Some of the contributors to the higher prevalence of DED in women may include synthesis and interaction of tear film components: balance of sex steroids, including androgen deficiency; and even anatomic differences in structures including the meibomian glands and lacrimal apparatus.性别因素。

许多跨部门的研究中女性的性腺因素已被确定为干眼症发病的一个风险因素之一。

其中一些高危女性干眼症的贡献者的数据展现包括泪液膜成分的合成与相互作用：性类固醇的平衡,雄激素缺乏;甚至解剖结构的差异包括睑板腺和泪腺等都会成为影响干眼症发病相关因素。

Women also reported higher rates of depression, greater impact of DED on quality of life, and more negative treatment side effects, with a longer time required for improvement.同样被报道存在较高的女性抑郁案例，源于干眼症影响了生活质量、更多的负面治疗效果以及改善症状所需长的时间等原因。

More study needed. The TFOS DEWS II authors noted that the terms sex and gender were used interchangeably in many studies, making it difficult to tease apart factors related to biology versus societal identity, such as gender differences in health care utilization and expression of pain. Moreover, the effects of sex-, gender-, and hormone-based factors on DED are multifaceted, meriting further investigation and mindfulness in the clinical setting.仍需要更多的研究。

TFOS文献出版的作者们都注意到，在许多研究中性和性别被交替使用，很难区分生物学和社会身份的相关因素，性别的差异也正是医疗实践中表述的难点。

此外，性与性别及荷尔蒙对干眼症的影响是复杂的，值得进一步临床调查与回顾。

Epidemiology 3流行病学Wide-ranging estimates.Assessment of large-scale DED prevalence and incidence has been hindered by inconsistencies in the definition and diagnostic criteria among prior studies. When the diagnosis is based on symptoms (with or without signs), meta-analysis yields prevalence values ranging from 5% to 50%; when signs alone are used, theprevalence is as high as 75% in certain cohorts.多数人估计。