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Blepharitis in dogs: a clinical evaluation in 102 dogs 犬睑炎：102只患犬的临床评估 作者：Christiane Weingart, Barbara Kohn, Martina Siekierski, Roswitha Merle and Monika Linek 翻译：杨硕 校对：王帆 Background – Blepharitis is a common finding in many dogs with various skin diseases 背景—许多犬患的各种皮肤病中常出现睑炎。 Objectives – To establish a definition for canine blepharitis versus periocular dermatitis (POD), to evaluate the clinical findings and underlying skin diseases of blepharitis, and to document the effects of blepharitis on tear production in dogs. 目标—建立犬睑炎和眼周皮炎（POD）定义，评估睑炎临床表现和潜在的皮肤病，并记录其对犬泪液量的影响。 Animals – One hundred and two privately owned dogs with clinical signs of blepharitis and a definitive diagnosis of skin disease. 动物—102只具有睑炎临床症状且确诊为某种皮肤病的家养犬。 Methods and materials – Prospective evaluation of clinical signs and underlying diseases in dogs with blepharitis alone compared to dogs with blepharitis and POD. 材料和方法—仅有睑炎的犬与同时患有睑炎和POD的犬的临床症状及潜在疾病的前瞻性评估。 Results – Brachycephalic dogs were significantly more likely to present with blepharitis than other breeds. Twenty five dogs had blepharitis alone [three dogs (2.9%) without and 22 dogs (21.5%) with cutaneous lesion beyond the periocular skin]. Seventy one of 102 (69%) presented with POD in addition to blepharitis. In six cases a differentiation between blepharitis and POD was not possible. Typical lesions included alopecia/hypotrichosis (97%), erythema (93%), eyelid oedema (50%) and crusts (39.2%). Allergic skin disease (52%) was the most common underlying cause of blepharitis, followed by infectious/parasitic diseases (21.5%), autoimmune disorders (17.7%) and neoplasia (4.9%). Four dogs could not be allocated to any of these disease groups. A diagnosis of parasitism was always accompanied by POD. Reduced tear production was detected in ten of the 53 dogs tested (18.8%). 结果—短头犬相对其他品种更易患睑炎。25只犬只有睑炎[其中3只犬（2.9%）没有超过眼周皮肤皮肤病变，22只犬（21.5%）皮肤病变超过眼周皮肤]。102只犬中，有71只犬（69%）患有POD另外伴有睑炎，有6只犬无法区分睑炎和POD。典型皮肤病变包括脱毛/少毛(97%)、红斑（93%）、眼睑水肿（50%）和结痂（39.2%）。过敏性皮肤病（52%）是睑炎最常见的潜在病因，其次有感染性/寄生虫性疾病（21.5%）、自体免疫性疾病（17.7%）和肿瘤病（4.9%）。但是有4只患犬无法归入上述疾病分组。寄生虫病总是会出现POD。测试的53只患犬中有10只（18.8%）检测到泪液量减少。 Conclusion – Blepharitis occurring in the absence of other skin lesions is rare. The most common underlying cause of blepharitis is allergic dermatitis. Measurement of tear production should be recommended in all cases of blepharitis. 结论—仅患睑炎无其他皮肤病变是罕见的。睑炎的最常见的潜在原因是过敏性皮肤病。所有睑炎病例都建议测泪液量。 Introduction 引言 Blepharitis is defined as inflammation of the eyelid and lid margin; it usually represents a clinical sign of primary ocular and/or cutaneous disease. However, allocation of cause to either an ophthalmological or a dermatological disease can be difficult. Typical signs of blepharitis are erythema, swelling and periocular alopecia, often accompanied by blepharospasm. Depending on the underlying cause, blepharitis may also be pruritic. The difference between periocular dermatitis (POD) and blepharitis alone has not, to the best of the authors’ knowledge, been defined in dogs and is more difficult to determine than in humans due to the anatomy of the canine eyelid. Additionally, a primary POD can lead to blepharitis and vice versa. Publications include review articles and book chapters on periocular diseases; there are no systematic evaluations of the underlying diseases of canine blepharitis. The objective of the study was to evaluate and document the clinical findings and underlying dermatological diseases associated with blepharitis and/or POD in dogs, and their impact on tear production. 睑炎被定义为眼睑和眼睑边缘的炎症。它通常是原发性眼病和/或皮肤病的临床症状，然而，很难将病因单纯归为眼科或皮肤科。睑炎的典型症状包括皮肤红斑、肿胀和眼周脱毛，常伴有眼睑痉挛。根据潜在病因，睑炎常伴有瘙痒。据作者所知，目前无法明确鉴别是眼周皮炎（POD）还是单纯的睑炎，而且由于犬眼睑的解剖结构，比人更难以确定。 此外，原发性POD可导致睑炎，反之亦然。已有关于眼周疾病的综述性文章和书籍章节都没有对犬睑炎的潜在疾病进行系统性评估。本研究的目的是评估和记录伴有睑炎和/或POD的临床表现和潜在的皮肤病，以及两者对患犬泪液量的影响。 Methods and materials 方法与材料 In this study, canine blepharitis was defined as the presence of inflammatory skin lesions which extended outward from the eyelid margins, a maximum distance equal to half of the globe’s diameter (Figure 1). Periocular dermatitis was defined as skin lesions extending beyond this region. Photographs were obtained from all dogs, and the differentiation between blepharitis alone and blepharitis with POD was performed retrospectively using a measuring tape. 在本研究中将犬睑炎定义为病变范围从眼睑边缘向外延伸的炎性皮肤病，最大距离等于眼球直径的一半（图1）。将眼周皮炎定义为皮肤病变范围超出该区域。从患犬照片中，单纯性睑炎与POD合并睑炎的鉴别采用量尺进行回顾性分析。 Animals 研究动物 Dogs presented to the dermatology department of the author’s clinic with either blepharitis alone or blepharitis with POD over a period of 32 months were included. They were allocated to one of the two groups according to the measurement described above. Dogs with primary abnormalities of the position of the eyelid, such as entropion and ectropion, as well as cases in which assignment was questionable, were excluded. All dogs underwent a physical and dermatological examination. 研究的患犬主要包括32个月内来作者的皮肤诊所就诊的动物，它们患有单纯性睑炎或POD伴有睑炎。通过采用上述测量方法，将这些动物分成两组。有原发性眼睑位置异常（如眼睑内翻和外翻）的患犬，以及难以进行分组的病例不作为本研究的研究对象。所有犬都已做体检和皮肤检查。 For cytological evaluation of the skin lesions, a cotton swab (Meditrade GmbH; Kiefersfelden, Germany) was rubbed over the sample site, rolled over a glass slide for staining with methylene blue or Diff Quik (LT-SYS Haema Schnellf€arbung, Labor+Technik; Berlin,Germany) and examined microscopically. Pyoderma was diagnosed when neutrophils and intra- and/or extracellular bacteria were found in cytological samples on *1,000 magnification. Surface pyoderma was diagnosed when erythema and exudation were present, whilst papules, pustules, epidermal collarettes and crusts were attributed to superficial pyoderma. The presence of nodules, fistulas and ulceration was defined as deep pyoderma. Screening for Demodex canis was performed via trichogram in all cases, and via superficial and deep skin scrapings in dogs with POD. Sarcoptes was ruled out in dogs with pruritus with a therapeutic trial of either selamectin(Stronghold®, Pfizer/Zoetis; Leverkusen, Germany) or moxidectin (Advocate®, Bayer; Louvain-la-Neuve, Belgium) applied three times at 14 day intervals; (the label use for these products is application every four weeks in dogs) 对皮肤病变进行细胞学检查，用棉拭子擦拭采样部位，然后旋转涂抹于玻片上，用亚甲蓝或Diff Quik染色并用显微镜检查。在1000倍放大，细胞学样本中发现中性粒细胞和细胞内和/或细胞外细菌，即可诊断为脓皮病。而当皮肤出现红斑或分泌物时即可诊断为表面脓皮病，同时出现丘疹、脓疱、表皮环和结痂时即为浅表脓皮病。深层脓皮病会出现结节、瘘道和溃疡。所有病例都进行毛发镜检、POD患犬通过皮肤浅刮和深刮排查犬蠕形螨。对于患有瘙痒症的犬，间隔14天连用3次塞拉菌素或莫昔克丁排除疥螨病（说明书建议这些产品犬一个月一次使用）。 In order to exclude fungal infection, trichoscopy with microscopic examination of the hair shaft and a dermatophyte culture (Laboklin; Bad Kissingen, Germany) were performed. Samples for dermatophyte cultures were taken from the eyelid and the periocular region. An aerobic bacterial culture was performed in all cases which previously had been treated locally or systemically with antimicrobial agents and still showed cytological evidence of pyoderma as defined above, and in cases where cytology presented neutrophils and macrophages without evidence of bacteria and a sterile pyogranulomatous dermatitis was suspected. Samples for bacterial culture were obtained with a sterile swab (TS Swab, Heinz Herenz Medizinalbedarf GmbH; Hamburg, Germany). Any prior treatments were recorded. 为了排除真菌感染，需要对毛干进行毛发检查并进行皮肤癣菌培养，皮肤癣菌培养样本取自眼睑和眼周区域。在进行外部治疗或全身抗生素治疗之前，所有病例都要进行需氧细菌培养（用无菌拭子获得细菌培养样本），细胞学仍符合上述脓皮病描述,在某些病例中细胞学显示有中性粒细胞和巨噬细胞，而没有细菌，疑似无菌性脓性肉芽肿性皮炎。使用无菌棉签采集细菌培养样本。所有病例先前的治疗都有记录。 The diagnosis of canine atopic dermatitis (cAD) was based on history, clinical signs and published criteria, a lack of improvement after ectoparasitic therapy and the exclusion of cutaneous adverse food reaction (CAFR). The latter was diagnosed when clinical improvement occurred after feeding a novel elimination diet for eight to 10 weeks and recurrence of clinical signs after provocation with the original diet. Cases without differentiation between cAD and CAFR were designated as undifferentiated allergic skin disease. 犬特应性皮炎（cAD）的诊断基于病史、临床症状和公认标准、经体外驱虫无效以及排除皮肤食物副反应（CAFR）。当饲喂新奇低敏日粮8-10周后，临床症状有所改善，而使用原有日粮进行激发时临床症状复发即可确诊CAFR。未进行CAD和CAFR鉴别的病例，被默认为去做区分的过敏症。 Histological examination of a skin biopsy was performed when immunemediated skin disease, sterile pyogranulomatous dermatitis or neoplasia was suspected, as well as in any ambiguous case (Institute for Pathology, FU Berlin, Germany). A skin biopsy was collected from the eyelid and/or the periocular region under general anaesthesia or, if contraindicated, under local anaesthesia. Additional biopsies were taken from the affected areas in dogs with lesions not restricted to the eyelids. Sterile pyogranulomatous dermatitis was diagnosed if pyogranulomatous inflammation was seen upon both cytological and histopathological examination, no causative infectious agent could be detected via microbiological/mycological or histological examinations, no underlying skin or systemic disease could be found, and clinical signs improved with immunosuppressive therapy. For this reason complete blood count (CBC) with a manually differentiated blood count and a clinical chemistry were performed. Leishmaniosis was excluded via serological examination (IFAT) and PCR from blood samples (Comparative Tropical Medicine and Parasitology, Ludwig-Maximilians-Universit€at Mu€nchen, Munich, Germany). 当怀疑免疫介导性皮肤病、无菌性脓性肉芽肿性皮炎或肿瘤，以及不明原因的皮肤病时，需进行皮肤活检及组织病理学检查（德国柏林大学病理学研究所）。在全身麻醉下，如果不允许就局部麻醉，在眼睑和/或眼周部位进行皮肤活检采样。其他有皮肤病变的部位也要进行活检采样，不局限于眼睑。如果在细胞学和组织病理学检查中均见到脓性肉芽肿性炎症，通过微生物学/真菌学培养或组织学检查未见感染性病原微生物，同时未发现潜在皮肤或全身性疾病，并且通过免疫抑制剂治疗症状有所改善，则可诊断为无菌性脓性肉芽肿性皮炎。因此，本研究的患犬都进行了人工计数的全血细胞计数（CBC）和临床生化检查。通过血清学检查（IFAT）和血液PCR排除了利什曼病。 Tear production was measured with the Schirmer’s tear test (STT). For this purpose, the test strip (Intervet Deutschland GmbH; Unterschleißheim, Germany) was folded along the indentation and then placed in the lower conjunctival sac. After 60 s tear production was recorded by measuring from the graduations printed on the strip. The normal values in dogs range between 18.64 ± 4.47 mm/min and 23.9 ± 5.12 mm/min. Tear production was graded as slightly decreased (10–14 mm/min), moderately decreased (5–9 mm/min) or severely decreased (<5 mm/min). A complete ophthalmological examination was conducted in those cases were STT revealed abnormal tear production. STT试验可以检测泪液生成量。检测方法，将试纸条沿压痕折叠放入下结膜囊内。60秒后，读取试纸上的刻度值，记录泪液生成量。正常犬的泪液量是18.64±4.47 mm/min和23.9±5.12 mm/min。泪液生成量分级：轻度降低（10-14mm/min）、中度降低（5-9mm/min）或严重降低（<5mm/min）。在研究中对STT显示泪液量产生异常的患犬进行了完整的眼科检查。 Statistical analyses 统计分析 Statistical analyses were descriptive, and the numerical data were reported as median, minimum and maximum. The data analysis was made by use of statistical software [Microsoft® Excel (Munich, Ger- many) and IBM SPSS® v24 (Ehningen, Germany)]. In order to compare the age of the dogs with blepharitis alone and blepharitis with POD, a Wilcoxon–Mann–Whitney U-test was conducted. The number of brachycephalic breeds was compared to the clinic population and differences in the proportion of dogs with blepharitis were examined via chi-square test. In addition, a Wilcoxon–Mann–Whitney U-test or Kruskal–Wallis test was performed to evaluate the association between the dog’s age or the duration of illness and dogs with blepharitis alone and blepharitis with POD, respective.Associations between the occurrence of skin lesions in dogs with blepharitis alone compared to those with blepharitis and POD and the occurrence of skin lesions in association with reduced tear production was evaluated using chi-square tests. A significance level of P < 0.05 was defined for all tests. 统计分析是描述性的，数值数据被报告记录为中位数、最小数和最大值。数据利用统计软件进行分析。为了比较犬的年龄与单纯睑炎和睑炎与POD的关系，进行了Wilcoxon-Mann-Whitney U-试验。通过卡方试验，比较短头患有睑炎占其他品种患睑炎的比例，此外，还进行了Wilcoxon-Mann-Whitney U-test或Kruskal-Wallis测试，以评估犬年龄或患病时间与单纯患有睑炎和睑炎伴有葡萄膜炎之间的关系 。通过卡方试验，比较在犬中单纯患有睑炎和伴有POD患有睑炎的概率，同时也评估皮肤病变对犬泪液量的影响。所有测试结果都是P<0.05，即存在显着相关性。 Results 结果 One hundred and two dogs fulfilled the inclusion criteria. Of these, 25 dogs (24.5%) had blepharitis alone and 71 (70%) had blepharitis with POD; six dogs (5.5%) could not be classified. Fifty dogs were female (19 spayed) and 52 were male (17 castrated) with a median age of 67.5 months (range two to 200 months; Table 1). There was no significant difference in the age between the two groups (P = 0.3) and no difference in duration of illness (P = 0.089). The prevalence of nodules was greater in dogs with blepharitis alone (P = 0.016), whereas the prevalence of lichenification was greater in dogs with blepharitis and POD (P = 0.022). 最终102只犬进入此次研究。其中，有25只犬（24.5%）仅有睑炎，有71只（70%）伴有POD；有6只犬（5.5%）无法分类。50只犬为雌性（其中19只绝育），52只为雄性（其中17只去势），中位年龄为67.5个月（范围2至200个月，如表1）。两组患者年龄差异无显着性（P=0.3），病程无差异显著性（P=0.089）。仅有睑炎的犬皮肤出现结节的患病率较高（P=0.016），睑炎同时伴有POD的犬皮肤苔藓化的患病率较高（P=0.022）。 Forty one different breeds were represented with the most common breeds (three or more dogs) being the French bulldog (n = 9), pug (n = 5), four each of the cocker spaniel, Labrador retriever and wire-haired dachshund, and three each of the boxer, beagle and West Highland white terrier. Twenty four dogs (23.5%) were brachycephalic breeds. In addition to the French bulldogs, pugs and boxers listed previously, there were two English bulldogs and one each of the following: Cavalier King Charles spaniel, Havanese, shi tzu, Pekingese and Bordeaux mastiff. In comparison to the clinic population, a significantly higher number of brachycephalic breeds was found in the study population (OR: 1.92, 95% CI: 1.22– 3.01; P = 0.004). In 81 cases (79.4%) blepharitis was bilateral. 102只犬中有41个不同的品种，其中最常见的品种（≥3只犬）是法国斗牛犬（n=9）、巴哥犬（n=5）、4只可卡犬、4只拉布拉多犬、4只刚毛腊肠犬、3只拳师犬、3只比格犬和3只西高地白㹴。短头品种共24只（23.5%）。除了之前列出的法国斗牛犬、巴哥犬和拳师犬，还有2只英国斗牛犬和查理王猎犬、哈威那犬、西施犬、京巴犬、波尔多獒犬各1只。与临床发病率相比，研究指出短头品种的发病率相对较高（OR：1.92，95% CI：1.22-3.01；P=0.004）。有81只犬（79.4%）患有双侧睑炎。 Ninety one dogs (89.2%) had cutaneous lesions beyond the periocular skin. The most common underlying disease was an allergic skin disease (n = 53, 52%) followed by infectious diseases (n = 22, 21.5%), autoimmune or immune-mediated disorders (n = 18, 17.7%%) and neoplasia (n = 5, 4.9%) (Table 2). Four dogs (3.9%) could not be allocated to any of these groups. Forty one dogs (40.2%) showed signs of secondary pyoderma of which 12 were surface, 20 were superficial and nine were deep. Sixty four (63%) dogs previously had received treatment for their blepharitis, which consisted of topical ophthalmic therapy in 18 cases and systemic drugs in 60 cases. 有91例（89.2%）除眼周外有其他部位皮肤病变。最常见的潜在病因是过敏性皮肤病（n=53，52%），其次是感染性疾病（n=22，21.5%）、自体免疫或免疫介导性疾病（n=18，17.7%）和肿瘤（ n=5，4.9%（表2））。有4例（3.9%）无法分类。41只犬（40.2%）出现继发性脓皮病症状，其中12只表面脓皮病，20只浅表脓皮病，9只深层脓皮病。有64只（63%）犬研究前接受过其睑炎的治疗，其中18例经过局部眼科治疗和60例经过全身药物治疗。 Dogs with blepharitis alone 单纯性睑炎患犬组 The median age of the 25 cases with blepharitis alone was 54 months (range seven to 152 months; Table 1). In five cases the blepharitis was unilateral. Clinical signs had been present for one to 1,825 days (median 28). Three of these dogs had blepharitis alone without skin lesions beyond the periocular skin, caused by either cAD, undifferentiated allergic skin disease or a drug reaction. 25例仅睑炎的患犬中位年龄为54个月（范围为7至152个月；表1），其中5例单侧，临床症状出现1至1825天（位数28天）。其中3例犬中仅患有睑炎，无眼周以外的皮肤病变，这是由cAD、未明确的过敏性皮肤病或药物反应引起的。 The types of skin lesions present at examination are listed in Table 3. The most common were erythema (100% of cases), followed by alopecia/hypotrichosis in 23 cases (92%) and crusts in 13 cases (52%). Twenty four of these dogs presented with three or more skin lesions, whereas one dog had only two lesional areas beyond the eyelids. Pyoderma was diagnosed in seven of the 25 cases (four surface and three superficial). All cases of pyoderma involving the eyelids also had pyoderma in other locations. 表3列出了检查时出现的皮肤病变情况。最常见的是红斑（100%的病例），其次是脱毛/少毛有23例（92%）、结痂有13例（52%）。其中24例犬出现了≥3种皮肤病变，而1例只有2种病变并不局限于眼睑。在25例中，有7例（4例表面和3例浅表）被诊断为脓皮病。所有患有眼睑的脓皮病病例在其他皮肤部位也有脓皮病。 Dogs with blepharitis and periocular dermatitis 睑炎伴有POD的患犬组 Seventy one dogs with blepharitis also showed POD (Table 1) of which 63 (88.7%) had skin lesions beyond the periocular areas. Fifteen dogs had unilateral blepharitis and POD. The median age of this group was 72 months (range two to 200). Clinical signs had been present for one to 1,642 days (median 43.5) and in five cases no information on the duration was available. 71只睑炎的犬也显示患有POD（表1），其中63只（88.7%）皮肤病变超过眼周区域。15只犬有单侧睑炎和POD。这组的中位年龄为72个月（2至200月）。临床症状出现1至1642天（中位数43.5天），有5例没有关于症状持续时间的资料。 The most common skin lesions in this group were alopecia/hypotrichosis in 69 cases (97.2%), erythema in 64 cases (90.1%) and eyelid oedema in 38 cases (53.5%). Other lesions included crusts in 26 cases (33%), scales in 23 cases, erosion/ulcer in 17 cases (25%) and lichenification in 12 cases (15.7%). Pustules and comedones were present in three cases each (7.9%). Dogs had one or two (nine dogs, 12.6%) or more than two (62 dogs, 83.4%) skin lesions. Of the eight dogs with no skin lesions beyond the periocular areas, four were diagnoses with undifferentiated allergic skin disease, two with localized demodicosis, one with medial canthal ulcerative blepharitis and one with surface pyoderma associated with hypothyroidism. Pyoderma was diagnosed in 33 of these 71 cases (seven surface, 17 superficial and nine deep). All cases of periocular pyoderma also had pyoderma in other locations. In fifteen dogs, Malassezia spp. yeast were detected (two to 15 Malassezia per *1,000 field). 该组最常见的皮肤病变为69例（97.2%）脱毛/少毛、64例（90.1%）红斑、38例（53.5%）眼睑水肿。其他病变包括26例（33%）结痂、23例皮屑、17例（25%）糜烂/溃疡和12例（15.7%）苔藓化。脓疱和粉刺病变各有3例（7.9%）。患犬有一两个（9只，12.6%）或两个以上（62只，83.4%）的皮肤病变。在8只眼周外无皮肤病变的犬中，有4只被诊断为无明确病因的过敏性皮肤病，2只被诊断为局部蠕形螨病，1只被诊断为内眦溃疡性睑炎，1只诊断为与甲状腺功能减退有关的表面脓皮病。在这71例中，有33例（7例表面，17例浅表，9例深层）被诊断为脓皮病。所有眼周脓皮病病例在其他皮肤也有脓皮病。15例患犬检测出有马拉色酵母菌（2-15个马拉色/油镜）。 Unclassified dogs 无法分组的患犬组 In six cases a differentiation between a blepharitis alone or blepharitis with POD was not possible, due to missing photographs or difficultly evaluating the photographs. These dogs were not considered in the statistical analysis. 在6个病例中，无法区分单纯性睑炎或睑炎伴有POD，因为缺少照片或照片难以评估。所以统计分析中不包括这些犬。 A STT was performed in 53 dogs, as shown in Table S1. Of these dogs, ten (18.8%) showed moderately to slightly reduced tear fluid, which was present in six dogs with blepharitis and POD, three with blepharitis alone, and one in the unclassified group. Underlying dis- ease included leishmaniosis in four cases, cAD in two cases, demodicosis in two cases, and juvenile cellulitis and undifferentiated allergic skin disease in one case each. Breeds are shown in Table S1; there was no association between reduced tear fluid and brachycephalic breeds (P = 0.42). Ophthalmological examination of the cases with reduced tear production revealed keratocon- junctivitis sicca (n = 4), keratocon-junctivitis sicca and uveitis (n = 1), and conjunctivitis alone (n = 1). In four cases no abnormalities other than a reduced STT were detected. Dogs with decreased STT had dermatitis with crusts more often than those with normal STT(P = 0.037). No other type of skin lesion was statistically associated with abnormal STT. 如表S1所示，53只实验犬进行了STT试验。10只（18.8%）犬泪液量轻度到中度的降低，其中6只同时患有POD，3只仅有睑炎，1例无法分类。潜在病因包括4只患利什曼病，2只患cAD，2只患有蠕形螨病，1患例幼年蜂窝织炎，1例为无法鉴别的过敏性皮肤病。研究显示品种与泪液量降低无相关性（P=0.42），详见表1。对泪液量降低的病例进行眼科检查，结果显示泪液量减少与角膜结膜炎（n=4）、角膜结膜炎伴有葡萄膜炎（n=1）、单纯性结膜炎（n=1）有关。在4个病例中，除了泪液量减少外，眼科检查无其它异常。与STT正常的犬相比，STT降低的犬患结痂性皮炎概率更高（P=0.037）。其他皮肤病变类型与STT异常无统计学相关性。 Discussion 讨论 In this study, the difference between blepharitis cases with or without POD was defined and the occurrence of each in dogs was systematically analysed, to the best of the authors’ knowledge for the first time. Blepharitis in combination with POD was more common than blepharitis alone. It is possible that blepharitis develops into POD. Indeed, the median age in dogs with blepharitis alone was lower and the median time of illness was shorter in comparison to dogs with an additional POD, although statistical significance could not be shown. 据作者所知，本研究是首篇将没有POD的睑炎和有POD同时有睑炎分别进行了定义，并系统性的分析了每个病在犬上的发病情况。伴有POD的睑炎比单纯性睑炎更常见。可能是睑炎发展为POD。的确，与单纯性睑炎的中位年龄更小，与伴有POD的患犬相比，其平均发病时间更短，但没有统计学意义。 Interestingly, 23.5% of dogs in this study belonged to a brachycephalic breed, which when compared to the general clinic population of brachycephalic breeds, showed them to be at increased risk. The predisposition of brachycephalic dogs to develop blepharitis has been described previously, in association with pyoderma of the nose folds. In our study blepharitis occurred in combination with POD in all brachycephalic dogs, which supports the theory that in these breeds POD develops into blepharitis. 有趣的是，在这项研究中，23.5%的患犬属于短头品种，与全科门诊的短头品种相比，显示该品种患病率较高。以前认为短头犬易患睑炎，与鼻部褶皱脓皮病有关。在本研究中，所有短头犬都患有睑炎伴有POD，这支持了是由POD发展为睑炎的依据。 The significantly higher occurrence of nodules in dogs with blepharitis alone could be explained by the underlying diseases (e.g. leishmaniosis, sterile pyogranulomatous dermatitis) afflicting these dogs, which are typically associated with nodule development. Lichenification, a skin lesion often seen in with chronic dermatitis, occurred only in dogs with additional POD. Unilateral blepharitis occurred in the minority of cases (21%) and was not associated with breed, age, other clinical signs or underlying. 单纯性睑炎患犬明显高发结节病变，原因与潜在疾病（例如利什曼病、无菌性脓性肉芽肿性皮炎）有关，这些病典型病变为结节。苔藓化是一种常见的慢性皮肤病病变，只发生在伴有POD的患犬。少数病例（21%）发生单侧睑炎，与品种、年龄、其他临床症状或潜在疾病无关。 The most common primary skin disease associated with blepharitis in this study was allergic dermatitis, including 22 dogs with cAD, six with CAFR and three dogs with cAD + CAFR. In 22 cases the allergic dermatitis was not differentiated. In a study which analysed dogs with allergic dermatitis, 240 of 743 cases had allergic dermatitis involving the eyelids. In that study, dogs with cAD (34.3%) were affected more often than dogs with CAFR (25.8%). Allergic blepharitis can be associated with conjunctivitis or, in chronic cases, even with keratocon-junctivitis. In humans with allergic dermatitis there is a predisposition to the development of blepharo-conjunctivitis due to the high number of mast cells in the eyelid and conjunctiva. However, no specific data on the histology of the canine eyelids have been published to the best of the authors’ knowledge. 本研究中最常见的与睑炎相关的原发性皮肤病是过敏性皮炎，包括22例cAD患犬、6例CAFR患犬和3例同时有cAD和CAFR患犬。但是有22例过敏性皮炎原因无法鉴别。在一项研究中，对743例患有过敏性皮炎的犬进行分析，其中有240例病变涉及眼睑。在这项研究中，患有cAD的犬（34.3%）涉及眼睑患病率比患有CAFR的犬（25.8%）更高。过敏性睑炎可伴有结膜炎，在慢性病例中，甚至伴有角膜结膜炎。 在人过敏性皮炎中，由于眼睑和结膜中肥大细胞数量较多，更易发生眼睑结膜炎。然而，据作者所知，尚未有犬眼睑组织学的具体资料。 Parasitic disease (15 dogs with demodicosis and six dogs with leishmaniosis) was the second most common primary underlying skin disease of blepharitis in this study. No dog with demodicosis showed blepharitis alone; it was always in combination with POD and most often with other skin lesions. This is compatible with the described initial presentation with lesions on the head, cranial thorax and forelimbs. In a study where blepharitis was included in the scoring system for the diagnosis of leishmaniosis, 21.4% of 265 dogs showed blepharitis and this was rated as a common clinical sign. One possible explanation could be that Phlebotomus spp. prefer to bite the head area. 寄生虫病（15例患有蠕形螨的犬和6只患有利什曼病的犬）是本研究中睑炎第二常见的原发性皮肤病。无蠕形螨病患犬出现单纯性眼睑炎，睑炎总是伴随POD发病，且常伴随其他部位有皮肤病变。最初发病部位通常是头部、胸廓头侧和前肢。在一项研究中，把睑炎列入利什曼病的评分系统，在265只患犬中，21.4%的犬都有睑炎，这被认为是一种常见的临床症状。可能跟白蛉更喜欢咬头部有关。 In four dogs, juvenile cellulitis was the underlying cause of blepharitis, which is a typical presentation for this disease. In a retrospective study, six of 10 dogs with juvenile cellulitis had blepharitis. 在4只犬中，幼犬蜂窝织炎是睑炎的根本病因，睑炎是该疾病的典型表现。在一项回顾性研究中，在10只患有幼犬蜂窝织炎中，有6只有患有睑炎。 In human medicine the correlation of reduced tear production and blepharitis is well-known and called “dry eye blepharitis syndrome”. The meibomian gland is located in the eyelid and produces the lipids that are a part of the tear film. Inflammation of the meibomian gland due to blepharitis can lead to accelerated evaporation of the tear fluid due to its altered composition. Reduced tear fluid may then lead to keratoconjunctivitis sicca (KCS). Ten of 53 dogs (18.8%) in which STT was measured showed reduced tear production; seven of these cases showed severe blepharitis with ulceration, erosion, nodules and purulent exudate. One of these dogs was a West Highland white terrier with undifferentiated allergic skin disease. This breed is predisposed to dry eye syndrome, and therefore a direct correlation to underlying allergy cannot be confirmed. It is known that severe systemic diseases also can lead to decreases in tear production. One dog with moderately reduced tear production in the current study had a systemic allergic reaction with generalized erythema and reduced general condition (with lethargy and inappetence). The case was not available for follow-up STT testing. No other cases with reduced tear production showed signs of severe systemic disease. 在人类医学中，泪液量减少和睑炎的相关性是众所周知的，被称为“干眼睑炎综合征”。睑板腺位于眼睑，并产生脂质，脂质是泪膜的一部分。因为睑炎会引起的睑板腺的炎症，由于泪液成分的改变可导致泪液加速蒸发。泪液减少可能导致干眼症（KCS）。在对53只犬进行STT测量，其中有10只（18.8%）显示泪液量减少；7只表现为严重睑炎并伴有溃疡、糜烂、结节和脓性分泌物。其中一只患有不明原因的过敏性皮炎的西高地白㹴，这个品种易患干眼症，但是与过敏症直接相关的潜在病因尚不明确。已知，严重的全身性疾病也会导致泪液量减少。在本研究中，一只泪液产生轻度减少的犬患有全身过敏反应，症状包括全身红斑、体况下降（伴有嗜睡和食欲不振）。此病例后续未能继续测量STT。其他泪液量减少的病例并无严重全身性疾病。 There were several limitations to this study. Photographs were used retrospectively to measure the extent of periocular dermatitis and classify cases, which in some cases proved to be difficult, especially when the palpebral fissure was not entirely open. Therefore, we cannot exclude the possibility that some “borderline cases” could have been classified incorrectly. In addition, a complete ophthalmological examination was only performed in dogs with reduced tear production, STT was not performed in all dogs and those with an abnormal STT value were not tested again. Therefore, it is not known if tear production improved after the blepharitis was resolved. 本项研究存在几个局限性。回顾性使用照片来测量眼周皮炎的程度并对病例进行分类，在某些病例中比较困难，尤其当眼裂未能充分暴露。因此，我们不能排除一些“临界病例”被错误分类。此外，只对泪液量减少的犬进行了完整的眼科检查，未对所有犬进行STT检查，也没有对STT异常的犬进行复查。所以，目前尚不清楚在睑炎治愈后泪液量是否改善。 In conclusion, blepharitis is a common clinical sign of dogs with skin disease and most common in brachycephalic breeds. Blepharitis alone without any other skin lesions is rare, as is unilateral blepharitis. Allergic dermatitis and parasitic diseases are the most common underlying causes for blepharitis and periocular dermatitis, but as the variety of different underlying skin diseases noted in this study shows, a thorough dermatological investigation must be performed in each case. The measurement of tear production via STT should be recommended for all dogs with blepharitis. 总之，睑炎是犬皮肤病的一种常见临床症状，短头犬高发。无其他皮肤病变的单纯性睑炎罕见，单侧睑炎也罕见。过敏性皮炎和寄生虫病是引起睑炎和眼周皮炎的最常见的潜在病因，但本研究指出其潜在病因多样化，所以每个病例都必须进行完整的皮肤病学检查。除此之外建议所有患有睑炎的犬都使用STT检测泪液量。 Figure 1. Schematic diagram used to differentiate blepharitis alone from blepharitis with periocular dermatitis. a）Blepharitis alone (dog with sterile pyogranulomatous dermatitis; b) blepharitis with pericoular dermatitis (dog with juvenile-onset demodicosis). 图1.用于鉴别单纯性睑炎和睑炎伴有眼周皮炎的指导图。a)单纯睑炎(无菌性脓性肉芽肿性皮炎)；b)睑炎伴有眼周皮炎（幼年发病的蠕形螨病患犬） 表1. 96只同时患有睑炎和眼周皮炎（POD）、单纯眼睑炎和6只未分组患犬的数量、性别、年龄和其他部位皮肤病变的发生率 | | | | | | | | | F 35 (12只已绝育), M 36 (12只已去势) | F 12 (5只已绝育), M 13 (3只已去势) | F 3 (2只 已绝育), M 3 (2只已去势) | | | | | | | | | | | | | | | | |
表2. 96只犬单纯性睑炎和睑炎伴有眼周皮炎（POD）和6只未分组患犬的皮肤病诊断 表3. 96只单纯性睑炎和睑炎伴有眼周皮炎（POD）患犬的眼睑和眼周区皮肤症状
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发表于 2022-5-7 20:24:24
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