新型滚轮式睑板腺按摩镊对睑板腺功能障碍患者眼表症状与腺体功能的影响:一项随机对照试验

Efficacy of a novel roller-type meibomian gland massage forceps on ocular surface symptoms and gland function in patients with meibomian gland dysfunction: a randomized controlled trial

摘要

目的 探讨新型滚轮式睑板腺按摩镊与传统工具(圆头镊、棉签)在改善睑板腺功能障碍(meibomain gland dysfunction, MGD)患者眼表状况和睑板腺功能方面的效果。方法 选取确诊为MGD的患者共84例(168眼)作为研究对象,按照随机数字表法分为新型睑板腺按摩镊组、圆头镊组、传统棉签组,每组28例。分别采用相应工具进行睑板腺按摩,每周1次,共干预4周。并在干预前及干预后1、2、4周评估研究对象的眼表疾病指数(ocular surface disease index, OSDI)评分、角膜荧光素染色(fluorescein staining, FL)评分、睑板腺排出能力评分及睑板腺分泌物性状评分,从而评估三种睑板腺按摩工具对MGD患者的护理治疗效果。结果 三组患者干预前的一般资料及各观察指标(OSDI、FL、睑板腺排出能力及分泌物性状)基线水平一致,具有可比性(P均>0.05)。干预后第2周起,三组患者OSDI、FL、睑板腺排出能力及分泌物性状评分均较治疗前明显改善,且改善程度随干预时间延长而增加(P均<0.05)。组间比较中,新型滚轮式睑板腺按摩镊在改善患者主观症状(OSDI)、促进睑脂排出及改善分泌物性状方面均优于传统棉签(P均<0.05),且在多个指标上优于或等效于圆头镊;在改善FL评分方面,新型镊与圆头镊效果相当(干预后2周P=0.206,4周P=0.397),但二者均优于棉签组(P均<0.05)。结论 新型滚轮式睑板腺按摩镊在改善患者主观症状、泪膜稳定性、促进睑脂排出及改善分泌物性状方面均显著优于传统棉签,且在多个指标上优于或等效于圆头镊,为MGD治疗提供了一种更高效、安全的物理干预选择。

Abstract

Objective The objective of this study is to compare the efficacy of a novel roller-type meibomian gland massage forceps with traditional instruments (round-tip forceps and cotton-tipped applicator) in managing meibomian gland dysfunction (MGD). The study will evaluate improvements in ocular surface parameters and meibomian gland function. Methods In this randomised controlled trial, 84 patients (168 eyes) diagnosed with MGD were enrolled between April 2023 and April 2024. Participants were randomly allocated to one of three intervention groups: cotton-tipped applicator (n=28), round-tip forceps (n=28), or novel massage forceps (n=28). The study protocol stipulated that all groups receive a standardized meibomian gland massage protocol once per week for a period of four weeks. The primary outcomes encompassed the Ocular Surface Disease Index (OSDI) score, the corneal fluorescein staining (FL) score, the meibomian gland expressibility score, and the meibomian secretion quality score. These were assessed at baseline and at weeks 1, 2, and 4 post-intervention. Results A subsequent analysis of baseline demographic data and all outcome measures (OSDI, FL, meibomian gland expressibility, and secretion quality scores) revealed no statistically significant differences among the three groups, indicating consistent baseline characteristics and comparability (P>0.05). Subsequent to the second week following the intervention, all three groups exhibited significant enhancements in all outcome measures in comparison with baseline, with the extent of the enhancements increasing over time (P<0.05). Inter-group comparisons revealed that the novel roller-type meibomian gland massage forceps was significantly superior to the traditional cotton-tipped applicator in alleviating subjective symptoms (OSDI), promoting meibum expression, and improving secretion quality (P<0.05), and was either superior or equivalent to round-tip forceps across multiple indicators. With regard to the enhancement of FL scores, the novel forceps and round-tip forceps exhibited comparable efficacy (week 2: P=0.206; week 4: P=0.397), yet both were found to be significantly superior to the cotton-tipped applicator group (P<0.05). Conclusion The novel roller-type meibomian gland massage forceps have been demonstrated to be a more efficacious intervention than the traditional cotton-tipped applicator method for alleviating symptoms, restoring tear film stability, and improving meibomian gland function in patients diagnosed with MGD. Its efficacy is comparable to or superior to that of conventional round-tip forceps, suggesting that it is a promising and potentially more efficient tool for clinical practice.

关键词

睑板腺功能障碍 / 干眼症 / 睑板腺按摩

Key words

Meibomian gland dysfunction / Dry eye / Meibomian gland massage

参考文献

[1] Luo SB, Djotyan GP, Joshi R, et al. Modeling meibum secretion: Alternatives for obstructive Meibomian Gland Dysfunction (MGD)[J]. Ocul Surf, 2024, 31: 56-62. DOI: 10.1016/j.jtos.2023.11.005

[2] Kojima T, Dogru M, Kawashima M, et al. Advances in the diagnosis and treatment of dry eye[J]. Prog Retin Eye Res, 2020: 100842. DOI: 10.1016/j.preteyeres.2020.100842

[3] Hakim FE, Farooq AV. Dry eye disease: an update in 2022[J]. Jama, 2022, 327(5): 478. DOI: 10.1001/jama.2021.19963

[4] Narang P, Donthineni PR, D’Souza S, et al. Evaporative dry eye disease due to meibomian gland dysfunction: Preferred practice pattern guidelines for diagnosis and treatment[J]. Indian J Ophthalmol, 2023, 71(4): 1348-1356. DOI: 10.4103/IJO.IJO_2841_22

[5] 马小云, 辛瑞. 睑板腺功能障碍治疗的研究进展[J]. 国际眼科杂志, 2025, 25(4): 600-605. DOI: 10.3980/j.issn.1672-5123.2025.4.14

[6] Luo S, Guo YL, Liu ZG. Current pharmaceutical therapies for meibomian gland dysfunction: from basic research to clinical practice[J]. Clin Exp Ophthalmol, 2025, 53(8): 1039-1055. DOI: 10.1111/ceo.14577

[7] Yim TW, Pucker AD, Rueff E, et al. LipiFlow for the treatment of dry eye disease: a Cochrane systematic review summary[J]. Cont Lens Anterior Eye, 2025, 48(2): 102335. DOI: 10.1016/j.clae.2024.102335

[8] Qin GH, Chen JY, Li LZ, et al. Efficacy of intense pulsed light therapy on signs and symptoms of dry eye disease: a meta-analysis and systematic review[J]. Indian J Ophthalmol, 2023, 71(4): 1316-1325. DOI: 10.4103/IJO.IJO_2987_22

[9] Wang RW, Guo KJ, Li JC. Combined meibomian gland massage and acupuncture enhances tear film and ocular surface health in meibomian gland dysfunction[J]. Am J Transl Res, 2025, 17(9): 7240-7248. DOI: 10.62347/PYZZ2517

[10] Chen JY, Yu SL, Qin GH, et al. Immediate sequential changes in the tear film lipid layer following eyelid massage in dry eye syndrome: a comparative control study[J]. Heliyon, 2024, 10(17): e36590. DOI: 10.1016/j.heliyon.2024.e36590

[11] Chen JY, Qin GH, Yu SL, et al. Comparison of non-pharmaceutical treatments for evaporative dry eye: a randomised controlled study protocol[J]. BMJ Open, 2024, 14(2): e078727. DOI: 10.1136/bmjopen-2023-078727

[12] 石兢, 马晓玲. 不同睑板腺按摩法对睑板腺功能障碍的临床随机对照研究[J]. 新疆中医药, 2023, 41(4): 27-31

[13] 亚洲干眼协会中国分会, 海峡两岸医药卫生交流协会眼科学专业委员会眼表与泪液病学组, 中国医师协会眼科医师分会眼表与干眼学组, 等. 中国睑板腺功能障碍专家共识: 诊断和治疗(2023年)[J]. 中华眼科杂志, 2023, 59(11): 880-887. DOI: 10.3760/cma.j.cn112142-20230822-00054

[14] 李辉, 谢雪微, S H, 等. CONSORT 2025声明:随机试验报告指南更新版[J]. 中国卒中杂志, 2025, 20(05): 620-9. DOI: 10.3969/j.issn.1673-5765.2025.05.011

[15] 田碧珊, 李姝萍, 傅绮, 等. 《睑板腺按摩操作流程》团体标准解读[J]. 眼科学报, 2025, 40(3): 236-240. DOI: 10.12419/24102202

[16] 林晨, 杨敏敏, 郑虔. 眼表疾病指数量表中文版的研制和性能评价[J]. 眼科新进展, 2013, 33(1): 38-40. DOI: 10.13389/j.cnki.rao.2013.01.011

[17] 李威, 张斌. 优化脉冲光联合睑板腺按摩治疗睑板腺功能障碍的临床效果观察[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 105-109. DOI: 10.6040/j.issn.1673-3770.0.2020.341

[18] Li HZ, Tong WT, Hu M, et al. Effect of meibomian gland expression on optical quality in patients with meibomian gland dysfunction[J]. Curr Eye Res, 2025, 50(8): 785-790. DOI: 10.1080/02713683.2025.2497324

[19] 大连市第三人民医院. 一种滚轮式睑板腺按摩器: CN202410858199.5[P]. 2024-08-27

[20] Han D, Kim H, Kim S, et al. Comparative study on the effect of hyperthermic massage and mechanical squeezing in the patients with mild and severe meibomian gland dysfunction: an interventional case series[J]. PLoS One, 2021, 16(3): e0247365. DOI: 10.1371/journal.pone.0247365

[21] Wang DH, Liu XQ, Hao XJ, et al. Effect of the meibomian gland squeezer for treatment of meibomian gland dysfunction[J]. Cornea, 2018, 37(10): 1270-1278. DOI: 10.1097/ICO.0000000000001682

[22] Park HM, Lee WJ, Lim HW, et al. Immediate and quantitative changes in tear film parameters and meibomian gland structures after warm compression and meibomian gland squeezing in meibomian gland dysfunction patients and normal subjects[J]. J Clin Med, 2022, 11(15): 4577. DOI: 10.3390/jcm11154577

[23] 朱佳, 赵春丽. 两种睑板腺按摩方法在睑板腺功能障碍性干眼症患者中的应用效果比较[J]. 临床护理研究, 2024, 33(22): 31-33. DOI: 10.3969/j.issn.2097-1958.2024.22.011

[24] 张琪晨, 康随芳, 殷钏杰, 等. 强脉冲光治疗对脂质异常型干眼睑板腺及泪膜脂质层的影响[J]. 山东大学学报(医学版), 2024, 62(4): 54-60. DOI: 10.6040/j.issn.1671-7554.0.2024.0148

[25] 赖碧秀. 药物联合睑板腺按摩治疗睑板腺功能障碍型干眼症患者的临床效果[J]. 中外医学研究, 2023, 21(18): 147-150. DOI: 10.14033/j.cnki.cfmr.2023.18.038

[26] Li J, Liao YL, Zhang SY, et al. Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial[J]. BMJ, 2024, 386: e080474. DOI: 10.1136/bmj-2024-080474

[27] Bothwell LE, Greene JA, Podolsky SH, et al. Assessing the gold standard: lessons from the history of RCTs[J]. N Engl J Med, 2016, 374(22): 2175-2181. DOI: 10.1056/NEJMms1604593

[28] Santa Lucia G, Snyder A, Lateef A, et al. Safety and efficacy of topical lovastatin plus cholesterol cream vs topical lovastatin cream alone for the treatment of disseminated superficial actinic porokeratosis: a randomized clinical trial[J]. JAMA Dermatol, 2023, 159(5): 488-495. DOI: 10.1001/jamadermatol.2023.0205

[29] 李海焕, 李芳, 王小娜, 等. 睑板腺按摩护理在睑板腺功能障碍病人中的应用[J]. 护理研究, 2023, 37(14): 2656-2658. DOI: 10.12102/j.issn.1009-6493.2023.14.034

[30] Magno M, Moschowits E, Arita R, et al. Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction[J]. Surv Ophthalmol, 2021, 66(4): 612-622. DOI: 10.1016/j.survophthal.2020.11.005

基金资助

重庆医科大学附属第二医院2023年度护理骨干科研资助计划项目(HL2023-04)