正常睑板腺口及睑板腺口阻塞的结构特征

The structural characteristics of normal Meibomian gland orifice and the obstructive Meibomian glands orifice

目的观察正常睑板腺口及睑板腺口阻塞的构结特征。方法以上海兰荷视光眼科门诊部2016年8月至2019年2月正常睑板腺口10例(20眼)和睑板腺功能障碍睑板腺口阻塞104例(208眼)作为观察对象。使用数码显微镜对正常及阻塞的睑板腺口进行拍照,再以眼前段OCT对正常睑板腺口、阻塞睑板腺口及终末导管扫描成像,并与显微镜照片进行对比。睑板腺口巨大的囊泡状阻塞,采用囊壁截除术;帽状阻塞或腺口标志不清及瘢痕化选择睑板腺针刺术或睑板腺口探通扩张术,以使其再通。结果通过显微镜和眼前段OCT扫描观察到睑板腺管开口并非直接敞开的分泌口,分泌管口前有透光的圆盘状盖膜,中央有凸出的排放嘴及排放孔,排放孔细小,容易因细胞角化等原因发生狭窄或黏连闭锁而形成泡状阻塞。疏通手术可以使其再通。结论睑板腺口具有特殊盖膜状结构、排放嘴及排放孔。排放孔细小,各种病理因素易引起膜闭形成大小颜色不同的睑板腺口囊泡状阻塞。

Objective To observe the structural characteristics of normal Meibomian gland orifice and obstructive Meibomian glands orifice.Methods A total of 20 eyes of 10 cases with orifices of normal Meibomian gland and 208 eyes of 104 cases with orifices of disfunctional meibomian gland were observed from Aug.2016 to Feb.2019 in Shanghai Lanhe Optometry Ophthalmology Clinic.All cases were examined with the digital microscope and anterior segment OCT.The orifice of normal Meibomian glands as well as Meibomian glands obstruction were recorded as digital photos and OCT scan images.The photos of microscope were compared with that of anterior segment OCT.The cyst wall excision was used for the huge vesicular obstruction of meibomian gland orifice.Meibomian gland probing or orifice expansion was used for the cap-shaped obstruction and unclear orifice with scarring.Dredge surgery made the orifice of obstruction open again.Results The Meibomian gland duct orifice was not a direct secretory open with microscope and anterior segment OCT.There was a transparent disc-shaped cover membrane in front of the secretory duct,protruding as discharge nozzle with discharge hole in the center.The discharge hole was small,therefore prone to form the stenosis due to the cell keratinization or the vesicular obstruction due to the adhesion.Conclusion The Meibomian gland orifice has a special membrane-like structure,a discharge nozzle and a discharge hole.The discharge holes are small.The various pathological factors are likely to cause membrane closure,which forms the characteristic appearance of vesicular obstruction with different sizes and colors.